粪菌移植治疗帕金森病患者肠易激综合征样症状的有效性和安全性:一项单中心、自身前后对照临床研究

Efficacy and safety of fecal microbiota transplantation in treatment of irritable bowel syndrome-like symptoms in Parkinson’s disease: a single-center, self-controlled clinical trial

目的探讨粪菌移植(fecal microbiota transplantation,FMT)治疗帕金森病患者肠易激综合征(irritable bowel syndrome,IBS)样症状的有效性和安全性。方法选择2019年3-7月在陆军军医大学第一附属医院就诊的30例伴有便秘和/或腹泻症状的早期帕金森病(Parkinson’s disease,PD)患者,所有患者行连续3周,每周1次的FMT治疗,记录移植前后患者每周排便次数及性状、IBS相关评分量表、血常规、肝肾功指标以及相关不良反应,共随访8周。结果 30例患者中便秘患者26例,与治疗前比较,第8周每周排便次数明显增加[(1.31±0.67)vs(5.27±2.75)次],Bristol大便性状量表评分明显改善[(1.77±1.03)vs(3.81±0.68)分]。腹泻患者4例,每周排便次数明显减少[(18±1.87)vs(6.75±0.43)次],Bristol大便性状量表评分明显改善[(5.75±0.43)vs(4.25±0.43)分]。至随访第8周,所有患者胃肠道症状评定量表评分明显下降[(7.7±2.72)vs(2.72±2.23)分],IBS严重程度评分明显下降[(137.83±67.86)vs(46.67±64.52)分],IBS生活质量量表评分明显下降[(21.47±14.59)vs(5.47±6.48)分],差异均有统计学意义(P<0.05)。随访期间疗效稳定,未发生严重不良反应。结论粪菌移植对改善帕金森病患者的肠易激综合征样症状安全有效。

Objective To evaluate the efficacy and safety of fecal microbiota transplantation(FMT) in the treatment of irritable bowel syndrome(IBS)-like symptoms in Parkinson’s disease. Methods A total of 30 patients with early Parkinson’s disease accompanied with constipation and/or diarrhea who were admitted to the First Affiliated Hospital from March to July 2019 were recruited in this study. All patients were given 3 consecutive weeks FMT treatment(once per week). The frequency of voluntary defecation, stool characteristics, IBS related scale scores, blood routine, liver and kidney functions, and related adverse reactions before and after FMT were detected and recorded. All of them were followed up for 8 weeks. Results The 26 patients suffering from constipation had the times of defecation per week significantly increased from 1.31±0.67 times before treatment to 5.27±2.75 times in 8 week after treatment, and the score of Bristol stool trait scale improved from 1.77±1.03 to 3.81±0.68. In the 4 patients with diarrhea, the number of defecation per week was significantly reduced from 18±1.87 to 6.75±0.43 times, and the scores of Bristol stool traits scale were significantly improved from 4.25±0.43 to 5.75±0.43. Till the 8 th week of follow-up, the score of gastrointestinal symptoms rating scale were significantly reduced from 7.7±2.72 to 2.72±2.23, the scores of IBS severity from 137.83±67.86 to 46.67±64.52, and the scores of IBS quality of life scale from 21.47±14.59 to 5.47±6.48 in all the patients(P<0.05). Conclusion Oral FMT capsule is safe and effective in the improvement of IBS-like symptoms in Parkinson’s disease patients.