MIAMI (EGMN) – Some conditions show promise for treatment with probiotics, but most claims concerning the health benefits of probiotics should be viewed with caution, according to Dr. Robert Martindale.

Physicians should critically evaluate the data and use probiotics only when evidence supports their use. In addition, he said, “do not extrapolate from one strain [of probiotics] to another.”

There are good data in the literature to support a role for probiotics for patients with irritable bowel disease, diarrheal diseases, sepsis, and clearance of vancomycin-resistant enterococci (Med. J. Aust. 2007;186:454-7). And one double-blind, placebo-controlled study by other investigators has shown that probiotics may prevent gestational diabetes, Dr. Martindale reported at the International Probiotics Association World Congress.

In the study, in which researchers in Finland enrolled 256 women and tracked their pregnancy and infant outcomes, women randomized to a combination of intensive dietary counseling and probiotic supplementation during the first trimester of pregnancy had a significant reduction in the rate of gestational diabetes, compared with women who received counseling and placebo or no intervention (Br. J. Nutr. 2010 Feb. 4 [doi:10.1017/S0007114509993898]). The investigators found no significant differences in prenatal or postnatal growth between groups in 24 months of follow-up.

Gestational diabetes frequency was 13% among the women in the diet-probiotics group. This rate was significantly lower than the 36% in the group who got the diet and placebo and the 34% among controls who received no special intervention.

The pregnancies of the women who received probiotics were normal in duration. No treatment-related adverse events were reported for the mothers or children. In addition, the dietary counseling was associated with a lower risk of larger birth size (weight and length) for children born to women who did develop gestational diabetes, said Dr. Martindale, a gastrointestinal and laparoscopic general surgeon as well as medical director of the hospital nutrition service at Oregon Health and Science University in Portland.

Nutritionists provided the intensive dietary counseling. Women randomized to the probiotic arm received Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 supplements throughout the remainder of their pregnancy.

Future research is warranted to identify optimal strain(s) of probiotics, duration of treatment, and dosage for each indication that shows promise, he said.

Proponents “have made too many claims that probiotics will treat everything – that is the problem. People have to get through the 90% of claims that are quackery to get to the remainder,” Dr. Martindale said.

He said he had no relevant financial disclosures.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

迈阿密(EGMN)——使用益生菌治疗某些疾病的前景看好，但我们应该谨慎对待与益生菌健康效益相关的大部分宣传，据Robert Martindale博士说。

 

医师们应该审慎评估该数据，并仅在有证据支持其应用的情况下才使用益生菌。此外，他说：“不要从一种(益生菌)菌株外推至另外一种菌株。”

 

文献中存在的完备资料业已证明，益生菌对患有肠易激综合征、腹泻病、脓毒血症和需要清除耐万古霉素肠球菌的患者均有作用(Med. J. Aust. 2007;186:454-7)。一项由其他研究者进行的双盲、安慰剂对照研究显示，益生菌可用于预防妊娠期糖尿病，Martindale博士在国际益生菌协会世界大会上报告说。

 

在该研究中，研究者们在芬兰招募了256例女性受试者，并对她们的妊娠期及婴儿临床转归进行了追踪，与那些接受饮食指导和安慰剂治疗或是不接受任何治疗的女性相比，那些被随机分配接受特别饮食指导和益生菌补剂联合治疗的女性在妊娠前3个月妊娠期糖尿病的患病率显著下降(Br. J. Nutr. 2010 Feb. 4 [doi:10.1017/S0007114509993898])。研究者们发现在24个月的随访期内不同受试者组产前或产后生长情况并不存在显著差异。

 

对饮食-益生菌组的女性受试者而言，其妊娠期糖尿病的发病频率为13%。与饮食-安慰剂组受试者36%的发病率及未接受任何特殊治疗的对照组受试者34%的发病率相比，该发病率显著更低。

 

接受益生菌治疗的女性受试者的妊娠期长度正常。据报告，母亲和儿童均未出现任何治疗相关的不良事件。此外，对确实罹患妊娠期糖尿病的女性而言，接受饮食指导与其产下出生体形更大的婴儿 (体重和体长)的风险降低有关，Martindale博士说。他是一名胃肠道内镜外科医生，同时还是波特兰市俄勒冈健康与科学大学主管营养服务的医务主任。

 

营养学家可以提供特别饮食指导。被随机分配至益生菌组的女性受试者在其余下的妊娠期中均接受了鼠李糖乳杆菌和乳双歧杆菌Bb12补剂治疗。

 

有必要进行进一步研究，以确认益生菌治疗的最佳菌株、疗程长短及其对每一种具备益生菌应用前景的适应证的治疗剂量，他说。

 

支持者们“对益生菌可用于治疗任何疾病已经进行了过多的宣传——这正是问题所在。在这些宣传中有90%都属于庸医的骗术，人们必须对此加以鉴别才能发现余下的真实宣传，” Martindale博士说。

 

他说他无任何相关的经济利益披露。

 

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