粪便移植治疗炎症性肠病疗效的系统评价及单个率的Meta分析

Fecal Microbiota Transplantation for the Treatment of Inflammatory Bowel Disease:a Systematic Review and a Meta-analysis of Single Rate

目的 系统评价粪便移植治疗炎症性肠病的疗效与安全性,为临床实践与研究提供参考.方法 计算机检索Medline（from 1948）,Embase （from 1947）,Cochrane Library （for all years）,Web of Science（from 1926）、CBM、CNKI,收集所有关于粪便移植治疗炎症性肠病的随机对照试验（RCT）、非随机对照研究、非随机实验性研究、病例对照研究、队列研究.案例系列研究等,最后检索截止2015年9月.由2名评价员按照纳入与排除标准筛选文献和提取资料,采用R软件进行Meta分析.结果 最终纳入30篇文献,包括343例患者,其中RCT研究2篇,队列研究1篇,非随机实验性研究11篇,案例或案例系列16篇.单组率的Meta分析结果显示：FMT总体有效率为79％ （95％ CI：0.66 ～0.93）,总体缓解率为43％（95％CI：0.29 ～0.64）,亚组分析显示CD患者缓解率74.00％（95％ CI：0.63～ 0.88）,UC患者缓解率25％ （95％ CI：0.15～0.42）,儿童组缓解率48％ （95％CI：0.21 ～1.00）,成人组缓解率33％ （95％ CI：0.18 ～0.61）,上消化道途径缓解率75％ （95％ CI：0.63 ～ 0.89）,下消化道途径35％ （95％ CI：0.21 ～0.58）.总体上,粪菌移植是可耐受且安全有效的,很少发生严重不良反应,最常见的不良反应分别是腹痛、腹胀、腹泻及发热.结论 当前证据显示,粪便移植治疗炎症性肠病是有效的、安全的.上述结论尚需进一步开展对照研究,尤其是RCT研究来进一步验证.

Objective To evaluate the efficacy and safety of fecal microbiota transplantation （FMT） for the treatment of inflammatory bowel disease,in order to provide reference for clinical practice and research.Methods We searched MEDLINE （from 1948）,EMBASE （from 1947）,Cochrane Library （for all years）,Web of Science（from 1926）,CBM and CNKI,and then collected all information about fecal microbiota transplantation for the treatment of inflammatory bowel disease in randomized controlled trials （RCT）,non-randomized experimental studies,case-control studies,cohort studies,case series reports and so on,and last search was updated on September,2015.Two reviewers screened documents and extracted information according to inclusion and exclusion criteria,and used the R software for Meta-analysis.Results Finally,30 studies,including 343 cases of patients,contained 2 RCT articles,1 cohort studies,11 non-randomized experimental studies and 16 cases or case series were selected.The results of Meta-analysis shown that total improvement rate of IBD patients with FMT treatment was 79％ （95％ CI：0.66-0.93） and the complete clinical remission rate was 43％ （95％ CI：0.29-0.64）.Subgroup analysis showed that the complete remission rate of CD patients was 74.00％ （95％ CI：0.63-0.88） and the remission rate in CD patients was 25％ （95％ CI：0.15-0.42）.Moreover,child remission rate was 48％ （95％ CI：0.21-1.00） and adult remission rate was 33％ （95％ CI：0.18-0.61）.The remission rate of FMT treatment through upper gastrointestinal route was 75％ （95％ CI：0.63-0.89） and the remission rate of FMT treatment through lower gastrointestinal approach was 35％ （95％ CI：0.21-0.58）.Overall,fecal microbiota transplantation was safe and effective,and had little side effects.The most common side effects were abdominal pain,bloating,diarrhea and fever.Conclusion Current evidence shows that fecal transplantation for the treatment of inflammatory bowel disease is effective and safe.Our findings still need more studies to verify in future,especially RCT.