粪微生态移植治疗溃疡性结肠炎的初步研究

A pilot study of treating ulcerative colitis with fecal microbiota transplantation

目的 通过对溃疡性结肠炎（UC）患者实施粪微生态移植（FMT）治疗,探讨FMT治疗UC的方法、初步疗效和安全性.方法 对7例确诊的活动期UC患者行内镜下FMT治疗,记录治疗前后临床症状、实验室检查改变,用Mayo评分评估疾病缓解情况.供体为经过严格筛查的健康个体,当日采集新鲜粪便制备粪微生态移植物,经结肠镜、胃镜或两者联合于6h内灌入患者肠道内.结果 7例活动期UC患者病程0.5 ～24.0（9.1±8.5）年;1例行3次FMT,1例行2次FMT,5例行单次FMT;随访时间30 ～210（98.6 ±70.8）d.7例患者经FMT治疗后临床指标均有明显好转,Mayo评分分别降低7、4、6、5、6、9、9分.部分患者FMT治疗后出现一过性发热、腹泻、腹胀等症状,可自行缓解;1例患者出现机会致病菌奇异变形菌和白念珠菌感染,经抗菌药物治疗后治愈;未见其他严重不良反应.结论 FMT具有明显的临床疗效,安全性较高,是治疗活动期UC一项有前景的技术;但其长期疗效、不良反应等问题有待进一步研究.

Objective To explore the procedure,effectiveness and safety of fecal microbiota transplantation （FMT） in patients with ulcerative colitis （UC）.Methods Seven patients （6 men and 1 woman,aged 17-66 years） with active UC were treated with FMT through endoscopic duodenal infusion or combined endoscopic duodenal and colonic approaches.The clinical manifestations and laboratory results were recorded before and after FMT respectively.Disease response was evaluated with Mayo scores.Fresh fecal suspension prepared from healthy donors who were strictly screened,was infused into patients＇ intestinal tracts within 6 hours.Results The average disease duration of 7 patients with UC was （9.1 ± 8.5） years （range 0.5-24.0 years）.One patient underwent FMT for three times and one for twice,while the other five were treated for once.The follow-up time was （98.6 ± 70.8） days （30-210 days）.All patients achieved some extent of improvements with the reduction of Mayo scores 7,4,6,5,6,9 and 9,respectively.Transient fever,diarrhea and abdominal distension were observed in some patients after FMT,while alleviated spontaneously 2-3 days after the procedure.One patient had high fever and mild ascites caused by secondary infections,which were controlled by the symptomatic treatment and antibiotics.Severe adverse reactions were not found.Conclusions FMT is effective to active UC,the short-term side effects and complications are basically acceptable and controllable.The long-term efficacy and risks of FMT need to be verified further.