治疗自闭症谱系障碍的益生菌：关于对症状影响的最新系统综述和荟萃分析

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research Pub Date : 2024-09-11 DOI:10.1016/j.jpsychires.2024.09.009

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引用次数: 0

摘要

背景最近的研究强调了肠-脑轴和肠道微生物群在自闭症谱系障碍（ASD）中的重要作用，自闭症谱系障碍是一种神经行为发育障碍，以各种神经精神症状和胃肠道症状为特征，这表明肠道微生物群的改变可能与自闭症谱系障碍症状的严重程度相关。因此，本研究旨在对益生菌干预对改善 ASD 患者行为症状的有效性进行全面的系统综述和荟萃分析。方法本研究遵循系统综述和荟萃分析首选报告项目（PRISMA）指南。我们在多个数据库中进行了全面的文献检索，包括 Cochrane Library、PubMed、Web of Science 和 Google Scholar（截至 2024 年 6 月）。纳入标准包括已发表的随机临床试验（RCT），重点关注益生菌干预措施，并评估与 ASD 行为症状相关的结果。研究采用 Cochrane 的 "偏倚风险 2"（Risk of Bias 2）进行偏倚评估，并应用随机效应模型和逆方差法进行统计分析，同时还解决了发表偏倚问题，并通过 Begg's 和 Egger's 检验进行了亚组分析，以探讨各种因素对结果的影响。结果我们的荟萃分析研究了 8 项研究，共 318 个样本，均来自 1.5-20 岁的 ASD 患者。汇总的标准化平均差异（SMD）为-0.38（95% CI：0.58至-0.18，p <0.01）。分组分析显示，各种因素都有显著的结果：在欧洲地区进行的研究显示，SMD 为 -0.44 (95%CI: 0.72 to -0.15)，有明显的改善；持续时间超过三个月的干预显示出显著的改善，SMD 为 -0.44 (95%CI: 0.72 to -0.15)；持续时间超过三个月的干预显示出显著的改善，SMD 为 -0.44 (95%CI: 0.72 to -0.15)。43 (95%CI: 0.65 to -0.21)；针对10岁以下和10岁以上参与者的研究发现，SMD分别为-0.37和-0.40（95%CI: 0.65 to -0.09，95%CI: 0.69 to -0.11），具有显著的益处。此外，多菌株益生菌和单菌株干预均显示出整体显著改善，SMD 分别为-0.53（95%CI：0.85 至 -0.22）和-0.28（95%CI：0.54 至 -0.02）。此外，分析还证实，这些研究结果的发表偏倚可能性较低，且具有稳健性。我们强调了个性化治疗方法的必要性，以及进一步研究证实益生菌在ASD治疗中的有效性和安全性的必要性。

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Probiotics for autism spectrum disorder: An updated systematic review and meta-analysis of effects on symptoms

Background

Recent researches highlighted the significant role of the gut-brain axis and gut microbiota in autism spectrum disorder (ASD), a neurobehavioral developmental disorder characterized by a variety of neuropsychiatric and gastrointestinal symptoms, suggesting that alterations in the gut microbiota may correlate with the severity of ASD symptoms. Therefore, this study was designed to conduct a comprehensive systematic review and meta-analysis of the effectiveness of probiotic interventions in ameliorating behavioral symptoms in individuals with ASD.

Methods

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive literature search was performed across multiple databases including the Cochrane Library, PubMed, Web of Science, and Google Scholar up until June 2024. Inclusion criteria encompassed published randomized clinical trials (RCTs), focusing on probiotic interventions and evaluating outcomes related to ASD behavior symptoms. The study utilized Cochrane's Risk of Bias 2 for bias assessment and applied random effect models with inverse variance method for statistical analysis, also addressing publication bias and conducting subgroup analyses through Begg's and Egger's tests to explore the effects of various factors on the outcomes.

Results

Our meta-analysis, which looked at eight studies with a total of 318 samples from ASD patients aged 1.5–20 years, showed that the probiotic intervention group had significantly better behavioral symptoms compared to the control group. This was shown by a pooled standardized mean difference (SMD) of −0.38 (95% CI: 0.58 to −0.18, p < 0.01). Subgroup analyses revealed significant findings across a variety of factors: studies conducted in the European region showed a notable improvement with an SMD of −0.44 (95%CI: 0.72 to −0.15); interventions lasting longer than three months exhibited a significant improvement with an SMD of −0.43 (95%CI: 0.65 to −0.21); and studies focusing on both participants under and greater than 10 years found significant benefits with an SMDs of −0.37 and −0.40, respectively (95%CI: 0.65 to −0.09, and 95%CI: 0.69 to −0.11, respectively). Moreover, both multi-strain probiotics and single-strain interventions showed an overall significant improvement with a SMD of −0.53 (95%CI: 0.85 to −0.22) and −0.28 (95%CI: 0.54 to −0.02), respectively. Also, the analysis confirmed the low likelihood of publication bias and the robustness of these findings.

Conclusion

Our study highlighted the significant improvement in ASD behavioral symptoms through probiotic supplementation. The need for personalized treatment approaches and further research to confirm efficacy and safety of probiotics in ASD management is emphasized.

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来源期刊

Journal of psychiatric research 医学-精神病学

CiteScore

7.30

自引率

2.10%

发文量

622

审稿时长

130 days

期刊介绍： Founded in 1961 to report on the latest work in psychiatry and cognate disciplines, the Journal of Psychiatric Research is dedicated to innovative and timely studies of four important areas of research: (1) clinical studies of all disciplines relating to psychiatric illness, as well as normal human behaviour, including biochemical, physiological, genetic, environmental, social, psychological and epidemiological factors; (2) basic studies pertaining to psychiatry in such fields as neuropsychopharmacology, neuroendocrinology, electrophysiology, genetics, experimental psychology and epidemiology; (3) the growing application of clinical laboratory techniques in psychiatry, including imagery and spectroscopy of the brain, molecular biology and computer sciences;