Clinical Efficacy and Safety Evaluation of Fecal Bacteria Transplantation by Different Ways on Ulcerative Colitis
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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。 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. -
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
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 FMT前 FMT后 差值 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* *P < 0.05。 
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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
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