微生物调节疗法对代谢综合征患者葡萄糖稳态的影响:临床试验的系统回顾、荟萃分析和荟萃回归

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM Diabetes & Metabolic Syndrome-Clinical Research & Reviews Pub Date : 2024-08-01 DOI:10.1016/j.dsx.2024.103118
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引用次数: 0

摘要

背景代谢综合征(MetS)是一种以超重/肥胖、高血压、脂质和碳水化合物代谢障碍为特征的慢性疾病。微生物组调节益生菌、益生元、合成益生菌和粪便微生物组移植(FMT)是改善葡萄糖稳态和胰岛素血症参数的有前途的辅助疗法。方法我们对 2023 年 4 月之前发表的临床试验进行了全面的系统综述、荟萃分析和荟萃回归,以研究上述微生物组疗法对各种生物标志物的影响。我们使用随机效应荟萃分析对数据进行了汇总,以平均差(MD)和 95% 置信区间(CI)的形式报告数据,并进行了单变量线性模型荟萃回归。结果来自 19 项研究(n = 911)中 21 项试验比较的数据显示,与安慰剂/对照组相比,微生物组调节疗法与空腹血浆葡萄糖的统计学显著变化相关(MD:4.03 mg/dL [95%CI: 6.93; -1.13]; p effect = 0.006, I2 = 89.8 %)和空腹胰岛素(MD:2.56 μU/mL [95%CI: 4.28; -0.84];p effect = 0.004, I2 = 87.9 %)发生了统计学意义上的显著变化,但胰岛素抵抗或敏感性指数和 HbA1c 没有发生变化。年龄、基线体重指数(BMI)、基线生物标志物值、益生菌剂量、试验持续时间、营养保健品类型和世界卫生组织地区是影响这些干预措施在生物标志物变化方面疗效的因素,这表明个性化精准医学辅助疗法在治疗 MetS 患者血糖平衡失调方面具有潜在作用。结论 补充益生菌、益生元、合成益生菌和 FMT 可改善 MetS 患者的空腹血糖和胰岛素。在潜在的临床应用之前,还需要进一步开展大规模、高质量的试验。
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The effect of microbiome-modulating therapeutics on glucose homeostasis in metabolic syndrome: A systematic review, meta-analysis, and meta-regression of clinical trials

Background

Metabolic syndrome (MetS) is a chronic disorder featuring overweight/obesity, high blood pressure, and dysfunction of lipid and carbohydrate metabolism. Microbiome-modulating probiotics, prebiotics, synbiotics and fecal microbiota transplant (FMT) are promising adjunct therapies for improving parameters of glucose homeostasis and insulinemia.

Methods

We conducted a comprehensive systematic review, meta-analyses, and meta-regressions to investigate the effect of the abovementioned microbiome therapies on various biomarkers after screening clinical trials published through April 2023. We pooled data using random effects meta-analyses, reporting them as mean differences (MDs) with 95 % confidence intervals (CIs), and conducting univariate linear model meta-regressions.

Results

Data from 21 trial comparisons across 19 studies (n = 911) revealed that, compared to placebo/control, microbiome-modulating therapies were associated with statistically significant changes in fasting plasma glucose (MD: 4.03 mg/dL [95%CI: 6.93; −1.13]; p effect = 0.006, I2 = 89.8 %), and fasting insulin (MD: 2.56 μU/mL [95%CI: 4.28; −0.84]; p effect = 0.004, I2 = 87.9 %), but not insulin resistance or sensitivity indices and HbA1c. Age, baseline BMI, baseline biomarker value, pro/synbiotic dosage, trial duration, nutraceutical type, and WHO region were factors affecting the efficacy of these interventions at producing changes in biomarkers, signaling the potential role of personalized precision medicine adjunct therapy for deranged glucose homeostasis in patients with MetS. Nevertheless, presence of heterogeneity calls for further investigation before their clinical application.

Conclusions

Probiotics, prebiotics, synbiotics and FMT supplementation improved fasting glucose and insulin in patients with MetS. Further large-scale and high-quality trials are required before potential clinical applications.

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来源期刊
CiteScore
22.90
自引率
2.00%
发文量
248
审稿时长
51 days
期刊介绍: Diabetes and Metabolic Syndrome: Clinical Research and Reviews is the official journal of DiabetesIndia. It aims to provide a global platform for healthcare professionals, diabetes educators, and other stakeholders to submit their research on diabetes care. Types of Publications: Diabetes and Metabolic Syndrome: Clinical Research and Reviews publishes peer-reviewed original articles, reviews, short communications, case reports, letters to the Editor, and expert comments. Reviews and mini-reviews are particularly welcomed for areas within endocrinology undergoing rapid changes.
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