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摘要：
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摘要：目的 系统评价益生菌治疗轻微肝性脑病（minimal hepatic encephalopathy，
MHE）的有效性。方法 计算机检索PubMed、EMbase、Cochrane Central Register of
Controlled Trials、中国知网、万方、中国生物医学文献数据库和维普数据库，检索益
生菌制剂治疗MHE的随机对照试验（randomized controlled trial，RCT），检索时限
均为建库至2020年7月26日。检索美国临床试验注册平台（ClinicalTrials.gov）进行文
献补充。由2名研究人员独立筛选文献、提取数据、评价纳入研究的偏倚风险，采用
RevMan 5.3进行Meta分析。结果 共纳入13篇RCT，Meta分析表明益生菌治疗组在降低
血氨水平（SMD = -0.79，95%CI：-1.20～-0.37，P = 0.0002）、缩短数字连接试验-A型
（number connection test-type A，NCT-A）反应时间（MD = -16.31，95%CI：-22.09～
-10.53，P ＜ 0.001）、降低显性肝性脑病发生率（RR = -0.26，95%CI：0.12～0.56，
P = 0.0007）、提高MHE逆转率（RR = 1.48，95%CI：1.11～1.97，P = 0.008）和提高
数字符号试验（digit symbol test，DST）分数（SMD = 0.61，95%CI：0.35～0.86，P ＜
0.001）方面均显著优于对照组。益生菌治疗组与对照组的内毒素水平（SMD = -0.58，
95%CI：-2.29～1.13，P = 0.51）和丙氨酸氨基转移酶水平（MD = -36.18，95%CI：
-86.65～14.29，P = 0.16）差异均无统计学意义。结论 益生菌可改善MHE患者认知功
能，提高MHE逆转率，降低显性肝性脑病发生率，有望成为临床治疗MHE的新选择。
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Abstract: Objective To systematically evaluate the effects of probiotics in treatment of
minimal hepatic encephalopathy (MHE). Methods PubMed, EMbase, The Cochrane Central
Register of Controlled Trials, CNKI, Wanfang, CBM and Viper databases were electronically
searched to collect randomized controlled trial (RCT) of the treatment of MHE by probiotics
from inception to July 26th, 2020. US clinical trial registration platform (ClinicalTrials.gov)
was also searched for supplementary literature. Two reviewers screened literature, extracted
data and assessed the risk of bias of included studies independently. Meta-analysis was
performed by RevMan 5.3 software. Results A total of 13 RCT were included. The results of
Meta-analysis indicated that probiotics treatment group was superior to control group on blood
ammonia level (SMD = -0.79, 95%CI: -1.20～-0.37, P = 0.0002), time of number connection
test-type A (NCT-A) (MD = -16.31, 95%CI: -22.09～-10.53, P ＜ 0.001), incidence of overt
hepatic encephalopathy (RR = -0.26, 95%CI: 0.12～0.56, P = 0.0007), reversal rate of MHE
(RR = 1.48, 95%CI: 1.11～1.97, P = 0.008) and score of digital symbol test (DST) (SMD =
0.61, 95%CI: 0.35～0.86, P ＜ 0.001). There were no significant differences in endotoxin
level (SMD = -0.58, 95%CI: -2.29～1.13, P = 0.51) and the alanine transaminase (ALT) level
(MD = -36.18, 95%CI: -86.65～14.29, P = 0.16) of patients between two groups. Conclusions
Probiotics can improve cognitive function of patients with MHE, increase the reversal rate of
MHE and reduce the incidence of overt hepatic encephalopathy, which may become a new
measure of clinical treatment in future.
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