Effect of early enteral nutrition combined with probiotics in patients with stroke: a meta-analysis of randomized controlled trials.
Journal
European journal of clinical nutrition
ISSN: 1476-5640
Titre abrégé: Eur J Clin Nutr
Pays: England
ID NLM: 8804070
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
06
03
2021
accepted:
08
07
2021
revised:
05
07
2021
pubmed:
25
7
2021
medline:
13
4
2022
entrez:
24
7
2021
Statut:
ppublish
Résumé
Whether to conduct early enteral nutrition combined with probiotics (EEN/probiotics) in stroke patients remains controversial. This study was aimed to systematically explore the efficacy and safety of EEN/probiotics in stroke patients. We performed searches in EMBASE, PubMed, Medline, Cochrane Library, Chinese Biomedicine Literature Database (SinoMed), Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI) and Wanfang database. A total of 26 randomized controlled trials (2216 patients) were included. Meta-analysis showed a significantly lower incidence of gastrointestinal complications (%) (OR, 0.29; 95% CI,0.24-0.36; P < 0.00001), a lower incidence of infection (%) (OR, 0.27; 95% CI, 0.21-0.36; P < 0.00001), a shorter length of hospital stay (d) (MD, -8.70; 95% CI, -13.24 to -4.16; P = 0.003), and a lower dysbacteriosis rate (%) (OR, 0.17; 95% CI, 0.07-0.41; P < 0.0001) in the EEN/probiotics group than EEN group. Compared with EEN group, EEN/probiotics group had lower levels of diamine oxidase (U/L) (MD, -0.78; 95% CI, -0.93 to -0.63; P < 0.00001), D-lactic acid (mmol/L) (MD, -0.06; 95% CI, -0.07 to -0.05; P < 0.00001) and higher levels of albumin (g/L) (MD, 3.38; 95% CI, 2.74-4.02; P < 0.00001), prealbumin (mg/L) (MD, 32.20; 95% CI, 24.42-39.98; P < 0.00001), total protein (g/L) (MD, 4.91; 95% CI, 3.20-6.62; P < 0.00001), hemoglobin (g/L) (MD, 9.62; 95% CI, 7.92-11.32; P < 0.00001), immunoglobulin A (g/L) (MD, 0.23; 95% CI, 0.12-0.34; P < 0.0001) and immunoglobulin G (g/L) (MD, 0.33; 95% CI, 0.21-0.45; P < 0.00001). Early enteral nutrition combined with probiotics may effectively improve the nutritional status of stroke patients, regulate the intestinal flora and intestinal mucosal barrier function, improve the immune function, reduce the incidence of infectious complications and gastrointestinal motility disorders.
Sections du résumé
BACKGROUND/OBJECTIVES
Whether to conduct early enteral nutrition combined with probiotics (EEN/probiotics) in stroke patients remains controversial. This study was aimed to systematically explore the efficacy and safety of EEN/probiotics in stroke patients.
SUBJECT/METHODS
We performed searches in EMBASE, PubMed, Medline, Cochrane Library, Chinese Biomedicine Literature Database (SinoMed), Chinese Scientific Journal Database (VIP), Chinese National Knowledge Infrastructure (CNKI) and Wanfang database.
RESULTS
A total of 26 randomized controlled trials (2216 patients) were included. Meta-analysis showed a significantly lower incidence of gastrointestinal complications (%) (OR, 0.29; 95% CI,0.24-0.36; P < 0.00001), a lower incidence of infection (%) (OR, 0.27; 95% CI, 0.21-0.36; P < 0.00001), a shorter length of hospital stay (d) (MD, -8.70; 95% CI, -13.24 to -4.16; P = 0.003), and a lower dysbacteriosis rate (%) (OR, 0.17; 95% CI, 0.07-0.41; P < 0.0001) in the EEN/probiotics group than EEN group. Compared with EEN group, EEN/probiotics group had lower levels of diamine oxidase (U/L) (MD, -0.78; 95% CI, -0.93 to -0.63; P < 0.00001), D-lactic acid (mmol/L) (MD, -0.06; 95% CI, -0.07 to -0.05; P < 0.00001) and higher levels of albumin (g/L) (MD, 3.38; 95% CI, 2.74-4.02; P < 0.00001), prealbumin (mg/L) (MD, 32.20; 95% CI, 24.42-39.98; P < 0.00001), total protein (g/L) (MD, 4.91; 95% CI, 3.20-6.62; P < 0.00001), hemoglobin (g/L) (MD, 9.62; 95% CI, 7.92-11.32; P < 0.00001), immunoglobulin A (g/L) (MD, 0.23; 95% CI, 0.12-0.34; P < 0.0001) and immunoglobulin G (g/L) (MD, 0.33; 95% CI, 0.21-0.45; P < 0.00001).
CONCLUSION
Early enteral nutrition combined with probiotics may effectively improve the nutritional status of stroke patients, regulate the intestinal flora and intestinal mucosal barrier function, improve the immune function, reduce the incidence of infectious complications and gastrointestinal motility disorders.
Identifiants
pubmed: 34302128
doi: 10.1038/s41430-021-00986-3
pii: 10.1038/s41430-021-00986-3
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
592-603Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Nature Limited.
Références
Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ. 1976;54:541–53.
pubmed: 1088404
pmcid: 2366492
Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6:182–7. https://doi.org/10.1016/S1474-4422(07)70031-5 .
doi: 10.1016/S1474-4422(07)70031-5
pubmed: 17239805
Kim BR, Lee J, Sohn MK, Kim DY, Lee SG, Shin YI, et al. Risk factors and functional impact of medical complications in stroke. Ann Rehabil Med. 2017;41:753–60. https://doi.org/10.5535/arm.2017.41.5.753 .
doi: 10.5535/arm.2017.41.5.753
pubmed: 29201813
pmcid: 5698661
Xu CY, Ye HW, Chen B, Wu YF, Cao Z, Ding Z, et al. Analysis of risk factors and prognosis of post-stroke pulmonary infection in integrated ICU. Eur Rev Med Pharm Sci. 2021;25:856–65. https://doi.org/10.26355/eurrev_202101_24654 .
doi: 10.26355/eurrev_202101_24654
Li X, Wang L, Zhao B, Mei D, Jiang J. Enteral nutrition bibliometry from 2010 to 2019. Asia Pac J Clin Nutr. 2020;29:681–9. https://doi.org/10.6133/apjcn.202012_29(4).0002 .
doi: 10.6133/apjcn.202012_29(4).0002
pubmed: 33377361
Sheng L, Yin L, Peng D, Zhao L. From best evidence to best practice: enteral nutrition from continuous nasal feeding in stroke patients. Int J Gen Med. 2020;13:927–36. https://doi.org/10.2147/IJGM.S269393 .
doi: 10.2147/IJGM.S269393
pubmed: 33132703
pmcid: 7592149
Yuan MZ, Li F, Fang Q, Wang W, Peng JJ, Qin DY, et al. Research on the cause of death for severe stroke patients. J Clin Nurs. 2018;27:450–60. https://doi.org/10.1111/jocn.13954 .
doi: 10.1111/jocn.13954
pubmed: 28677276
Mi H, Li S, Li H, Hu W. The effects of infection on severe stroke patients in the neurological intensive care unit in China. Int J Neurosci. 2018;128:715–20. https://doi.org/10.1080/00207454.2017.1412966 .
doi: 10.1080/00207454.2017.1412966
pubmed: 29202613
Lieber AC, Hong E, Putrino D, Nistal DA, Pan JS, Kellner CP. Nutrition, energy expenditure, dysphagia, and self-efficacy in stroke rehabilitation: a review of the literature. Brain Sci. 2018;8:218. https://doi.org/10.3390/brainsci8120218 .
doi: 10.3390/brainsci8120218
pmcid: 6316714
Zhao D, Qin HL, Li N. [Integrated strategy based on microecological therapy in the treatment of inflammatory bowel disease]. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23:38–44. https://doi.org/10.3760/cma.j.cn.441530-20200414-00205 .
doi: 10.3760/cma.j.cn.441530-20200414-00205
pubmed: 32594724
Cunningham M, Azcarate-Peril MA, Barnard A, Benoit V, Grimaldi R, Guyonnet D, et al. Shaping the future of probiotics and prebiotics. Trends Microbiol. 2021;S0966-842X:00005–6. https://doi.org/10.1016/j.tim.2021.01.003 .
doi: 10.1016/j.tim.2021.01.003
Du T, Jing X, Song S, Lu S, Xu L, Tong X, et al. Therapeutic effect of enteral nutrition supplemented with probiotics in the treatment of severe craniocerebral. Injury: A Syst Rev Meta-Anal World Neurosurg. 2020;139:e553–71. https://doi.org/10.1016/j.wneu.2020.04.083 .
doi: 10.1016/j.wneu.2020.04.083
Yi LJ, Tian X, Shi B, Pi YP, Chen WQ. Early enteral nutrition supplemented with probiotics improved the clinical outcomes in severe head injury: some promising findings from Chinese patients. Medicine. 2019;98:e15426. https://doi.org/10.1097/MD.0000000000015426 .
doi: 10.1097/MD.0000000000015426
pubmed: 31027144
pmcid: 6831228
Gu WJ, Deng T, Gong YZ, Jing R, Liu JC. The effects of probiotics in early enteral nutrition on the outcomes of trauma: a meta-analysis of randomized controlled trials. JPEN J Parenter Enter Nutr. 2013;37:310–7. https://doi.org/10.1177/0148607112463245 .
doi: 10.1177/0148607112463245
Page MJ, Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement and extensions: a scoping review. Syst Rev. 2017;6:263. https://doi.org/10.1186/s13643-017-0663-8 .
doi: 10.1186/s13643-017-0663-8
pubmed: 29258593
pmcid: 5738221
Wang XD. Diagnosis points of various cerebrovascular diseases[J]. Chin J Neurol. 1996;029:379–80.
Higgins J. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration[J]. Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie, 2008;5:S38.
Veroniki AA, Jackson D, Viechtbauer W, Bender R, Bowden J, Knapp G, et al. Methods to estimate the between-study variance and its uncertainty in meta-analysis. Res Synth. Methods. 2016;7:55–79. https://doi.org/10.1002/jrsm.1164 .
doi: 10.1002/jrsm.1164
Wang J, Ru R, Sun J, Mi XC, Dong ZH, Liu YF, et al. Effects of Enteral Nutrition Combined with Probiotics on Nutritional Status in Patients with Acute Ischemic Stroke After Neural Intervention Therapy[J]. J Chengdu Med Coll. 2021;16:29–32. CNKI:SUN:CDYU.0.2021-01-007.
Dong GH. Clinical effect of probiotics combined with enteral nutrition in the treatment of patients with severe stroke[J]. Chin Remedies Clin. 2020;20:1687–8. CNKI:SUN:YWLC.0.2020-10-052.
He XH, Li L, Ma XW. Effect of bifidobacterium combined with enteral nutrition on nutrition, immunity and intestinal flora in patients with severe stroke[J]. China Health Care Nutr. 2020;30:75.
Xie YM. Effect of early enteral nutrition combined with probiotics on nutritional status and gastrointestinal function of stroke patients with nasal feeding[J]. J North Pharm. 2020;17:44–45+52. CNKI:SUN:BFYX.0.2020-09-015.
Zhang L. Effect of early enteral nutrition combined with microecological preparation on patients with dysphagia after stroke and its effect on nutrition indexes[J]. Chin Foreign Med Res. 2020;18:170–2. https://doi.org/10.14033/j.cnki.cfmr.2020.14.070
doi: 10.14033/j.cnki.cfmr.2020.14.070
Ban BX, Sun ZG, Jin J. Influence of Probiotics combined with Enteral Nutrition on Nutritional Status and Complications in Acute Stroke Pa-tients with Type 2 Diabetes[J]. J Med Theory Pract. 2019;32:3588–90. https://doi.org/10.19381/j.issn.1001-7585.2019.22.003 .
doi: 10.19381/j.issn.1001-7585.2019.22.003
Chen JQ. Effect of Bifidobacterium Tetravaccine tablets combined with enteral nutrition on gastrointestinal complications and intestinal mucosal barrier function in patients with severe stroke[J]. Med Forum. 2019;23:2397–8. https://doi.org/10.19435/j.1672-1721.2019.17.018 .
doi: 10.19435/j.1672-1721.2019.17.018
Chen JY, Luo YY, Zhu ZP, Zhu BH, Fu P. Effects of early enteral nutrition combined with probiotics on intestinal flora and immune function in patients with severe ischemic stroke[J]. Chin J Integr Traditional West Med Intensive Crit Care. 2019;26:329–33. https://doi.org/10.3969/j.issn.1008-9691.2019.03.019 .
doi: 10.3969/j.issn.1008-9691.2019.03.019
Chen K. Application effect analysis of probiotics combined with early indwelling gastric tube nasogastric feeding enteral nutrition support in elderly patients with severe stroke[J]. Yiyao Qianyan. 2019;9:155–6. https://doi.org/10.3969/j.issn.2095-1752.2019.02.122 .
doi: 10.3969/j.issn.2095-1752.2019.02.122
Huang J, Jiang ZL. Early enteral nutrition reconstructs intestinal microecology to promote the rehabilitation of ischemic stroke[J]. Mod Digestion Intervent. 2019;24:398–401. CNKI:SUN:XDXH.0.2019-04-018.
Jin X, Shi Y, Yuan B, Wang HL, Liu HY, Chen YJ, et al. The effect of early enteral nutrition supplemented with probiotics on ventilator-associated pneumonia in patients with severe stroke[J]. Chin J Microecol. 2019;31:174–8. https://doi.org/10.13381/j.cnki.cjm.201902012 .
doi: 10.13381/j.cnki.cjm.201902012
Li JH, Li JY. Effect of Bifidobacterium Tetravaccine tablets combined with enteral nutrition on gastrointestinal complications and intestinal mucosal barrier function in patients with severe stroke[J]. J China Prescr Drug. 2019;17:125–6. CNKI:SUN:ZGCF.0.2019-09-075.
Zhang HB, Lu L, Tian YN, Li Y, Zheng Q. Effect of enteral nutrition support on acute cardiogenic stroke patients with swallowing dysfunction[J]. Chin J Microecol. 2019;31:90–93. https://doi.org/10.13381/j.cnki.cjm.201901020 .
doi: 10.13381/j.cnki.cjm.201901020
Gao SJ. Effect of early enteral nutrition combined with probiotics in patients with acute severe stroke[J]. China Med Eng. 2018;26:34–37. https://doi.org/10.19338/j.issn.1672-2019.2018.06.010 .
doi: 10.19338/j.issn.1672-2019.2018.06.010
Gao YX. The effect of early enteral nutrition combined with Clostridium caseinate Enterococcus triunion on improving intestinal flora and nutritional index in elderly stroke patients[J]. Chin J Geriatr Care. 2018;16:65–67. CNKI:SUN:LNBJ.0.2018-02-025.
Liao P. Effect of early enteral nutrition combined with probiotics on nutritional status and gastrointestinal function of stroke patients with nasal feeding[J]. Yiyao Qianyan. 2018;8:186–7. https://doi.org/10.3969/j.issn.2095-1752.2018.28.165 .
doi: 10.3969/j.issn.2095-1752.2018.28.165
Sun HC, Zhang XG, Liu Z, Wang X, Zheng YL, Jin Y, et al. Effect of Bifidobacterium Tetravaccine Tablets on intestinal function in patients with severe stroke[J]. Chin J Microecol. 2018;30:1292–6. https://doi.org/10.13381/j.cnki.cjm.201811013 .
doi: 10.13381/j.cnki.cjm.201811013
Zhou Q. Effect of Bifid Triple Viable capsules combined with early enteral nutrition on nutritional status and complications in patients with severe stroke[J]. Diet Health. 2018;5:66–67. https://doi.org/10.3969/j.issn.2095-8439.2018.01.078 .
doi: 10.3969/j.issn.2095-8439.2018.01.078
Dong GH. Clinical effect of probiotics combined with enteral nutrition in the treatment of patients with severe stroke[J]. Jiankang Qianyan. 2017;26:123. https://doi.org/10.3969/j.issn.9128-6509.2017.10.116 .
doi: 10.3969/j.issn.9128-6509.2017.10.116
Chen CC. Clinical effect of enteral nutrition with probiotics on stroke patients[J].Journal of BingTuan. Medicine. 2016;48:15–16. CNKI:SUN:BTYU.0.2016-02-006.
Chen DY, Chen J. Effect of Bifid Triple Viable capsules combined with early enteral nutrition on nutritional status and complications in patients with severe stroke[J]. J Brain Nerv Dis. 2016;24:79–81. CNKI:SUN:LYSJ.0.2016-02-004.
Hou JH. Influence of BifidobacteriumT etravaccine Tablets Combined with Enteral Nutrition on Complications of Digestive Canal and Intestinal Mucous Membrane Barrier Function of Patients with Severe Stroke[J]. Chin J Pharmacoepidemiol. 2016;25:11–13+42. CNKI:SUN:YWLX.0.2016-01-004.
Wang Y, Shi J, Gong LY. Effect of probiotics combined with early enteral nutrition on the incidence of pulmonary infection in patients with acute severe stroke[J]. China Health Industry Development Working Committee, China Medical Education Association. 2016:415–6. https://d.wanfangdata.com.cn/conference/ChZDb25mZXJlbmNlTmV3UzIwMjEwNTIxEgc4Nzk0OTE5GghncmppMXk0OQ%3D%3D .
Wu LJ, Li JP, Guo BW. Additional bifidobacteria in severe stroke patients receiving enteral nutrition[J]. Parenter Enter Nutr. 2016;23:220–2. https://doi.org/10.16151/j.1007-810x.2016.04.007 .
doi: 10.16151/j.1007-810x.2016.04.007
Hou JH, Zhuo JM, Zhong WG, Guan XB, Xia B. Effect of Bifidobacterium Tetravaccine tablets on nutritional status and immune indexes in patients with severe stroke[J]. Chin J Rural Med Pharm. 2016;23:6–7. https://doi.org/10.19542/j.cnki.1006-5180.2016.07.003 .
doi: 10.19542/j.cnki.1006-5180.2016.07.003
Bai GY. Clinical research of probiotics enteral nutrition for the treatment of critically ill patients with cerebral apoplexy[D]. Xinjiang:Xinjiang Medical University, 2014. https://doi.org/10.7666/d.D601665 .
Gomes F, Emery PW, Weekes CE. Risk of malnutrition is an independent predictor of mortality, length of hospital stay, and hospitalization costs in stroke patients. J Stroke Cerebrovasc Dis.2016;25:799–806. https://doi.org/10.1016/j.jstrokecerebrovasdis .
doi: 10.1016/j.jstrokecerebrovasdis
pubmed: 26796058
Setyopranoto I, Lestari LA, Wijayanti PM, Rochmah MA. The effects of local food-based enteral nutrition to improve nutritional status of post-stroke patients. J Neurosci Rural Pract.2021;12:204–9. https://doi.org/10.1055/s-0040-1721202 .
doi: 10.1055/s-0040-1721202
pubmed: 33531785
pmcid: 7846313
English C, MacDonald-Wicks L, Patterson A, Attia J, Hankey GJ. The role of diet in secondary stroke prevention. Lancet Neurol.2021;20:150–60. https://doi.org/10.1016/S1474-4422(20)30433-6 .
doi: 10.1016/S1474-4422(20)30433-6
pubmed: 33347806
Bonsack B, Jiang RH, Borlongan CV. A gut feeling about stroke reveals gut-brain axis’ active role in homeostasis and dysbiosis. J Cereb Blood Flow Metab. 2020;40:1132–4. https://doi.org/10.1177/0271678X19900037 .
doi: 10.1177/0271678X19900037
pubmed: 32063084
pmcid: 7181096
Sharifi-Rad J, Rodrigues CF, Stojanović-Radić Z, Dimitrijević M, Aleksić A, Neffe-Skocińska K, et al. Probiotics: Versatile Bioactive Components in Promoting Human Health. Med (Kaunas). 2020;56:433. https://doi.org/10.3390/medicina56090433 .
doi: 10.3390/medicina56090433
Jiang J, Chu C, Wu C, Wang C, Zhang C, Li T, et al. Efficacy of probiotics in multiple sclerosis: a systematic review of preclinical trials and meta-analysis of randomized controlled trials. Food Funct. 2021. https://doi.org/10.1039/d0fo03203d .
Zhang XF, Guan XX, Tang YJ, Sun JF, Wang XK, Wang WD, et al. Clinical effects and gut microbiota changes of using probiotics, prebiotics or synbiotics in inflammatory bowel disease: a systematic review and meta-analysis. Eur J Nutr. 2021. https://doi.org/10.1007/s00394-021-02503-5 .
Biswasroy P, Pradhan D, Sahu DK, Sahu A, Ghosh G, Rath G. Recent advances in clinical utility of probiotics in gastrointestinal tract disorders. Curr Pharm Biotechnol. 29 Oct 2020. https://doi.org/10.2174/1389201021666201029154239 . Epub ahead of print.
Patejdl R, Kästner M, Kolbaske S, Wittstock M. Clinical nutrition and gastrointestinal dysfunction in critically ill stroke patients. Neurol Res. 2017;39:959–64. https://doi.org/10.1080/01616412.2017.1367545 .
doi: 10.1080/01616412.2017.1367545
pubmed: 28828964
Prame Kumar K, Wong CH. Imbalance in the force: the dark side of the microbiota on stroke risk and progression. Curr Opin Neurobiol. 2020;62:10–16. https://doi.org/10.1016/j.conb .
doi: 10.1016/j.conb
pubmed: 31809996
Battaglini D, Pimentel-Coelho PM, Robba C, Dos Santos CC, Cruz FF, Pelosi P, et al. Gut microbiota in acute ischemic stroke: from pathophysiology to therapeutic implications. Front Neurol.2020;11:598. https://doi.org/10.3389/fneur.2020.00598 .
doi: 10.3389/fneur.2020.00598
pubmed: 32670191
pmcid: 7330114
Stanley D, Mason LJ, Mackin KE, Srikhanta YN, Lyras D, Prakash MD, et al. Translocation and dissemination of commensal bacteria in post-stroke infection. Nat Med.2016;22:1277–84. https://doi.org/10.1038/nm.4194 .
doi: 10.1038/nm.4194
pubmed: 27694934
Metin M, Altun A, Köylüoğlu G. The effect of probiotics on ıntestinal motility in an experimental short bowel model. Acta Cir Bras. 2020;35:e202000804. https://doi.org/10.1590/s0102-865020200080000004 .
doi: 10.1590/s0102-865020200080000004
pubmed: 32901681
pmcid: 7478466
Xu H, Ma C, Zhao F, Chen P, Liu Y, Sun Z, et al. Adjunctive treatment with probiotics partially alleviates symptoms and reduces inflammation in patients with irritable bowel syndrome. Eur J Nutr. 2021;60:2553–65. https://doi.org/10.1007/s00394-020-02437-4 . Epub 22 Nov 2020.
Kambale RM, Nancy FI, Ngaboyeka GA, Kasengi JB, Bindels LB, Van der Linden D. Effects of probiotics and synbiotics on diarrhea in undernourished children: Systematic review with meta-analysis. Clin Nutr. 2020;S0261-5614:30701–9. https://doi.org/10.1016/j.clnu.2020.12.026 .
doi: 10.1016/j.clnu.2020.12.026
Lehtoranta L, Latvala S, Lehtinen MJ. Role of probiotics in stimulating the immune system in viral respiratory tract infections: a narrative review. Nutrients. 2020;12:3163. https://doi.org/10.3390/nu12103163 .
doi: 10.3390/nu12103163
pmcid: 7602805
Tan AH, Lim SY, Chong KK, Manap A, Hor JW, Lim JL. Probiotics for constipation in Parkinson disease: a randomized placebo-controlled study. Neurology. 2021;96:e772–82. https://doi.org/10.1212/WNL.0000000000010998 .
doi: 10.1212/WNL.0000000000010998
pubmed: 33046607
Zhao Y, Zeng Y, Zeng D, Wang H, Zhou M, Sun N, et al. Probiotics and MicroRNA: their roles in the host-microbe interactions. Front Microbiol. 2021;11:604462. https://doi.org/10.3389/fmicb.2020.604462 .
doi: 10.3389/fmicb.2020.604462
pubmed: 33603718
pmcid: 7885260