目的:评价益生菌在头颈部肿瘤患者化疗或放疗所致口腔黏膜炎中的作用。
方法:PubMed,Embase,科克伦图书馆,临床试验的筛选时间为2010年1月至2024年4月。比较益生菌治疗HNC口腔粘膜炎的疗效的随机临床试验(RCT)是合格的。感兴趣的结果是口腔粘膜炎和严重口腔粘膜炎的发生率。PROSPERO注册号为42022384685。Cochrane偏倚风险工具(RoB2)用于评估研究的方法学质量,并应用GRADEPro标准(GRADEPro)对证据的确定性进行评级。采用RevMan5.4进行Meta分析。
结果:本荟萃分析共纳入8项RCT,包括691例HNC患者。服用益生菌可显著降低SOM的发生率(RR=0.60,95CI:0.46-0.78,P=0.0002)。然而,在降低口腔黏膜炎的总体发生率方面没有明显优势(RR=0.88,95CI:0.76-1.02,P=0.08).亚组分析发现,多细菌治疗组(RR=0.35,95CI:0.17-0.73,P=0.005)比单一细菌治疗组(RR=0.69,95CI:0.58-0.82,P<0.0001)更有利于降低SOM。此外,益生菌可降低鼻咽癌调强放疗后SOM的发生率(RR=0.43,95CI:0.26~0.70,P=0.0006)。
结论:益生菌可降低HNC化疗或放疗引起的SOM发生率。多细菌联合疗法比单细菌疗法更有效。此外,益生菌还降低了鼻咽癌中SOM的发生率。然而,尚未确定益生菌在OM总发病率中的优势.
OBJECTIVE: To assess the effect of probiotics in oral mucositis induced by chemotherapy or radiotherapy on patients with head and neck cancer (HNC).
METHODS: The PubMed, Embase, Cochrane Library, Clinical trials were screened from January 2010 to April 2024. Randomized clinical trials (RCTs) comparing the efficacy of probiotics in treatment of oral mucositis in HNC were eligible. Outcomes of interest were incidence of oral mucositis and severe oral mucositis. The PROSPERO registration number was 42 022 384 685. The Cochrane risk-of-bias tool (RoB2) was used to assess methodological quality of studies and GRADE criteria (GRADEpro) was applied for rating the certainty of evidence. Meta-analysis was performed by using RevMan 5.4.
RESULTS: A total of eight RCTs comprising 691 patients with HNC were included in this meta-analysis. Probiotics administration significantly reduced the incidence of SOM (RR = 0.60, 95%CI: 0.46-0.78, P = 0.0002). However, it showed no distinct advantage in reducing the overall incidence of oral mucositis (RR = 0.88, 95%CI: 0.76-1.02, P = 0.08). Subgroup analysis found more benefit for reducing SOM in multi-bacterial treated group (RR = 0.35, 95%CI: 0.17-0.73, P = 0.005) than mono-bacterial treated group (RR = 0.69, 95%CI: 0.58-0.82, P < 0.0001). In Addition, probiotics could reduce the incidence of SOM in nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (RR = 0.43, 95%CI: 0.26-0.70, P = 0.0006).
CONCLUSIONS: Probiotics reduced the incidence of SOM caused by chemotherapy or radiotherapy for HNC. The multi-bacterial combination therapy was more efficacious than the mono-bacterial therapy. Moreover, probiotics also reduced the incidence of SOM in nasopharyngeal carcinoma. However, the advantage of probiotics had not been established in the overall incidence of OM.