粪便菌群移植治疗溃疡性结肠炎9例临床分析

Effect of fecal microbiota transplantation on uerative colitis: A study of 9 patients

目的明确粪便菌群移植(FMT)对溃疡性结肠炎疾病的影响及其治疗效果。方法回顾性分析2013年9月至2014年2月南京军区南京总医院收治的9例溃疡性结肠炎(UC)病人的病例资料。所有病人遵循标准粪便菌群移植路径实施移植。记录移植前、移植后4周病人Mayo评分、C反应蛋白(CRP)及红细胞沉降率(ESR)值;留取移植前、移植后4周病人粪便标本行钙卫蛋白检测。对比治疗前后病人疾病活动度及钙卫蛋白变化。结果所有病人均顺利完成移植过程。1例病人出现低热反应,其余病人无腹胀、腹泻、发热等不良反应。移植后病人Mayo评分由(5.89±1.96)分下降至(1.56±1.01)分(P<0.05),病人对粪便菌群移植治疗均有应答,66.7%病人临床缓解;钙卫蛋白由(542.30±519.44)μg/g下降至(122.89±110.80)μg/g(P<0.05);钙卫蛋白水平与Mayo评分显著相关。CRP、ESR在移植前后变化不明显。结论粪便菌群移植降低UC病人疾病活动度,钙卫蛋白能良好反应这一变化。粪便菌群移植治疗轻中度溃疡性结肠炎安全有效。

Objective To investigate the therapeutic effect of fecal microbiota transplantation on ulcerative colitis. Methods The clinical data of 9 patients with ucerative colitis （UC） accepted fecal microbiota transplantation following standard transplant path between September 2013 and February 2014 in Jinling Hospital, Medical School of Nanjing University were analyzed retrospectively. Patients＇ Mayo score, CRP and ESR before and after transplantation was recorded respectively and the patients＇ stool samples before and after 4 weeks of transplantation for fecal calprotectin detection were collected. Changes of disease activity and level of fecal calprotectin before and after treatment were compared. Results All patients were accepted the treatment successfully. One patient suffered from low fever but the rest of the patients had no adverse reactions such as-abdominal distention, diarrhea and fever. Mayo score and fecal calprotectin levels all declined, significantly [（5.89± 1.96）＆ （ 1.56± 1.01 ）, （542.30±519.44）μg/g＆ （122.89± 110.80） μg/g, P〈O.05] and there was a correlation between Mayo score and fecal calprotectin levels, which could reflect disease activity well. CRP and ESR didn＇ t change significantly before and after transplantation. Conclusion Fecal flora transplantation is a safe and feasible method to treat mild and moderate UC and fecal calprotectin level is a sensitive marker for the diseases.