目的:微生物组靶向治疗(MTT)被认为是肝硬化的有希望的干预措施,但肠道微生物组调节对肝功能和疾病严重程度的影响尚未得到充分评估.我们综合评价MTT对肝硬化患者的疗效。
方法:通过MEDLINE收集来自随机对照试验的数据,EMBASE,Cochrane中央控制试验登记册,和ClinicalTrial.gov从成立到2023年2月20日。合并临床结果,并以风险比或平均差异(MD)表示。进行了其他亚组和敏感性分析,以验证研究结果的稳健性。应用试验序贯分析来计算所需的信息大小并评估荟萃分析结果的可信度。
结果:21项研究共1699例肝硬化患者纳入荟萃分析。MTT与天冬氨酸转氨酶的显着降低有关(MD,-3.62;95%CI,-6.59至-0.65),肝性脑病的风险(风险比=0.56,95%CI:0.46至0.68),终末期肝病评分模型(MD,-0.90;95%CI,-1.17至-0.11),氨(MD,-11.86;95%CI,-16.39至-7.33),和内毒素(MD,-0.14;95%CI,-0.23至-0.04)。试验序贯分析得出了这些结果的可靠结果。未观察到对其他肝功能指标变化的影响。
结论:MTT似乎与肝硬化进展缓慢有关,为临床医生根据肝硬化患者的病情进行治疗提供参考。
OBJECTIVE: Microbiome-targeted therapies (MTTs) are considered as promising interventions for cirrhosis, but the impact of gut microbiome modulation on liver function and disease severity has not been fully assessed. We comprehensively evaluated the efficacy of MTTs in patients with liver cirrhosis.
METHODS: Data from randomized controlled trials were collected through MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov from inception to February 20, 2023. Clinical outcomes were pooled and expressed in terms of risk ratios or mean differences (MD). Additional subgroup and sensitivity analyses were performed to validate the robustness of findings. A trial sequential analysis was applied to calculate the required information size and evaluate the credibility of the meta-analysis results.
RESULTS: Twenty-one studies with a total of 1699 cirrhotic patients were included for meta-analysis. MTTs were associated with a significant reduction in aspartate aminotransferase (MD, -3.62; 95% CI, -6.59 to -0.65), the risk of hepatic encephalopathy (risk ratio = 0.56, 95% CI: 0.46 to 0.68), model for end-stage liver disease score (MD, -0.90; 95% CI, -1.17 to -0.11), ammonia (MD, -11.86; 95% CI, -16.39 to -7.33), and endotoxin (MD, -0.14; 95% CI, -0.23 to -0.04). The trial sequential analysis yielded reliable results of these outcomes. No effects were observed on the changes of other hepatic function indicators.
CONCLUSIONS: MTTs appeared to be associated with a slowed deterioration in liver cirrhosis, which could provide reference for clinicians in treatment of cirrhotic patients based on their conditions.