不同粪菌移植途径治疗溃疡性结肠炎患者的临床疗效及安全性评价

刘晓琳; 陈晓翠; 孙杨; 李敏丽; 缪应雷

doi:10.12259/j.issn.2095-610X.S20220612

不同粪菌移植途径治疗溃疡性结肠炎患者的临床疗效及安全性评价

doi: 10.12259/j.issn.2095-610X.S20220612

云南省消化系统疾病临床医学研究中心/昆明医科大学第一附属医院消化内科，云南昆明　650032

基金项目: 国家自然科学基金资助项目（U1802282）

详细信息

作者简介:
刘晓琳（1989～），女，云南大理人，医学硕士，住院医师，主要从事炎症性肠病研究工作

通讯作者:
缪应雷，E-mail： myldu@sina.com

中图分类号: R574.62
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出版历程
- 收稿日期: 2022-03-24
- 刊出日期: 2022-06-25

Clinical Efficacy and Safety Evaluation of Fecal Bacteria Transplantation by Different Ways on Ulcerative Colitis

Yunnan Province Clinical Research Center for Digestive Disease/Dept. of Gastroenterology，The 1st Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032，China

摘要

摘要: 目的评估经上、下消化道2种移植途径行粪菌移植（fecal microbiota transplantation，FMT）治疗溃疡性结肠炎（Ulcerative colitis，UC）的疗效及安全性，以期指导临床实践。方法选取2019年10月至2021年09月昆明医科大学第一附属医院消化内科收治的轻-中度活动期UC患者74例，随机分2组，中途脱失2例，最终上消化道途径组35例，下消化道途径组37例完成研究。使用改良Mayo 评分系统评估患者的疗效。结果 2组UC患者经FMT治疗后Mayo评分均下降（P < 0. 05），肠镜也显示，充血、水肿、糜烂、溃疡等黏膜炎症情况较治疗前均有所改善；2组UC患者治疗前后的改良Mayo评分差值差异无统计学意义（ P > 0.05）。结论 FMT具有一定治疗UC的效果，安全性可靠，经上消化道途径与下消化道途径粪菌移植治疗UC疗效相当。
- 溃疡性结肠炎 /
- 粪菌移植 /
- 内镜肠道植管 /
- 临床疗效
Abstract: Objective To evaluate the efficacy and safety of upper and lower alimentary canal fecal bacteria transplantation in the treatment of ulcerative colitis, in order to guide clinical practice. Methods A total of 74 patients with mild to moderate active ulcerative colitis admitted to the Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University from October 2019 to September 2021 were selected, and they were randomly divided into two groups, including 2 cases of mid-course loss, 35 cases in the upper gastrointestinal tract pathway group and 37 cases in the lower gastrointestinal tract pathway group. Patients were evaluated with a modified Mayo Score. Results Mayo score of UC patients in both groups decreased after FMT treatment （P < 0.05）, and colonoscopy showed that mucosal inflammation, such as hyperemia, edema, erosion and ulcer, was improved compared with before treatment. There was no significant difference in Mayo Risk score between 2 groups before and after treatment （ P > 0.05）. Conclusion Fecal bacteria transplantation has a certain effect on the treatment of UC, and is safe and reliable. Fecal bacteria transplantation through upper gastrointestinal tract is as effective as that through lower gastrointestinal tract in the treatment of ulcerative colitis.
- Ulcerative colitis /
- Fecal bacteria transplantation /
- Transendoscopic enteral tubing /
- Clinical curative effect

HTML全文

图 1 FMT改善粘膜炎症肠镜下表现代表图

A：经上消化道途径，B：经下消化道途径。

Figure 1. Representative images of FMT improving the performance of mucosal inflammation under colonoscopy

下载: 全尺寸图片幻灯片

表 1 2组患者 FMT 前后的 Mayo 评分比较[（ $\bar x \pm s $），分]

Table 1. Comparison of Mayo score before and after FMT between the two groups [（ $\bar x \pm s $），points]

组别		Mayo评分		P_前后值	P_组间值
组别	FMT前	FMT后	差值	P_前后值	P_组间值
上消化道组	5.64 ± 3.13	3.25 ± 2.59	2.39 ± 1. 53	0.001^*	0.451
下消化道组	6.32 ± 2.39	3.68 ± 2.74	2.64 ± 1.26	< 0.001^*	0.451
^*P < 0.05。

下载: 导出CSV

表 2 2组患者治疗前后的生化指标比较（ $\bar x \pm s $）

Table 2. Comparison of biochemical indexes before and after treatment between the two groups （ $\bar x \pm s $）

组别	HB（g / L）	WBC/（×10 ⁹/L）	ALT /（U / L）	AST /（U / L）	CR /（μmol / L）	BUN/（mmol / L）
上消化道组
FMT治疗前	110.30 ± 25.48	7.59 ± 2. 31	15.87 ± 5.64	20. 22 ± 4.73	68.34 ± 12.20	5.19 ± 2.15
FMT治疗后	110.50 ± 25.73	7.34 ± 2.50	16.49 ± 8.22	19. 78 ± 6.95	70. 12 ± 14.01	5. 71 ± 1.65
t	−0.033	0.435	−0.368	0.310	−0.567	−1.135
P	0.974	0.665	0.714	0.758	0.573	0.260
下消化道组
FMT治疗前	111. 44 ± 20.74	6.28 ± 2.01	16.69 ± 6.11	19.34 ± 2.09	67.70 ± 13.51	4.16 ± 1.35
FMT治疗后	111.35 ± 21.25	6. 30 ± 2.38	16.57 ± 4.80	18.88 ± 2.54	69.91 ± 12.06	4.28 ± 1. 74
t	0.018	−0.039	0.094	0.851	−0.742	−0.331
P	0.985	0.969	0.925	0.398	0.460	0.741

下载: 导出CSV

参考文献(18)

[1]	Farrell D,McCarthy G,Savage E. Self-reported Symptom Burden in Individuals with Inflammatory Bowel Disease[J]. J Crohns Colitis,2016,10(3):315-322. doi: 10.1093/ecco-jcc/jjv218
[2]	Yarlas A,Rubin D T,Panes J,et al. Burden of Ulcerative Colitis on Functioning and Well-being:A Systematic Literature Review of the SF-36® Health Survey[J]. J Crohns Colitis,2018,12(5):600-609. doi: 10.1093/ecco-jcc/jjy024
[3]	Gupta A,Khanna S. Fecal Microbiota Transplantation[J]. JAMA The Journal of the American Medical Association,2017,318(1):102. doi: 10.1001/jama.2017.6466
[4]	Mc Donald L C,Gerding D N,Johnson S,et al. Clinical practice guidelines for Clostridium difficile infection in adults and children:2017 update by the Infectious Diseases Society of America(IDSA)and Society for Heahhcare Epidemiology of America(SHEA)[J]. Clin Infect Dis,2018,66(97):987-994.
[5]	Gulati M,Singh S K,Corrie L,et al. Delivery routes for faecal microbiota transplants:Available,anticipated and aspired[J]. Pharmacol Res,2020,159:104954. doi: 10.1016/j.phrs.2020.104954
[6]	Wargo J A. Modulating gut microbes[J]. Science,2020,369(6509):1302-1303.
[7]	中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2018年,北京)[J]. 中华消化杂志,2018,38(5):292-311. doi: 10.3760/cma.j.issn.0254-1432.2018.05.002
[8]	KÖnig J,Siebenhaar A,HÖgenauer C,et al. Consensus report:faecal microbiota transfer-clinical applications and procedures[J]. Aliment Pharmacol Ther,2017,45(2):222-239. doi: 10.1111/apt.13868
[9]	Zhang T,Long C,Cui B,et al. Colonic transendoscopic tube-delivered enteral therapy (with video):A prospective study[J]. BMC Gastroenterology,2020,20(1):135. doi: 10.1186/s12876-020-01285-0
[10]	Cammarota G,Ianiro G,Tilg H,et al. European consensus conference on faecal microbiota transplantation in clinical practice[J]. Gut,2017,66(4):569-580.
[11]	Vindigni S M,Zisman T L,Suskind D L,et al. The intestinal microbiome,barrier function,and immune system in inflammatory bowel disease:a tripartite pathophysiological circuit with implications for new therapeutic directions[J]. Therap Adv Gastroenterol,2016,9(4):606-625.
[12]	Weisshof R,El Jurdi K,Zmeter N,et al. Emerging Therapies for Inflammatory Bowel Disease[J]. Adv Ther,2018,35(11):1746-1762. doi: 10.1007/s12325-018-0795-9
[13]	Zuo T,Ng S C. The Gut Microbiota in the Pathogenesis and Therapeutics of Inflammatory Bowel Disease[J]. Front Microbiol,2018,9:2247. doi: 10.3389/fmicb.2018.02247
[14]	Henson M A,Phalak P. Henson Michael A,Phalak Poonam,Microbiota dysbiosis in inflammatory bowel diseases:in silico investigation of the oxygen hypothesis[J]. BMC Syst Biol,2017,11(1):145. doi: 10.1186/s12918-017-0522-1
[15]	Heath R D,Cockerell C,Mankoo R,et al. Fecal microbiota transplantation and its potential therapeutic uses in gastrointestinal disorders[J]. North Clin Istanb,2018,5(1):79-88.
[16]	Paramsothy S,Paramsothy R,Rubin D T,et al. Faecal microbiota transplantation for inflammatory bowel disease:A systematic review and meta-analysis[J]. J Crohns Colitis,2017,11(10):1180-1199. doi: 10.1093/ecco-jcc/jjx063
[17]	Singh S,Feuerstein J D,Binion D G,et al. AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis[J]. Gastroenterology,2019,156(3):769-808. doi: 10.1053/j.gastro.2018.12.008
[18]	Sood A,Mahajan R,Singh A,et al. Role of Faecal Microbiota Transplantation for Maintenance of Remission in Patients With Ulcerative Colitis:A Pilot Study[J]. J Crohns Colitis,2019,13(10):1311-1317. doi: 10.1093/ecco-jcc/jjz060

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