菌群移植治疗肠道疾病406例疗效分析

Efficacy analysis of fecal microbiota transplantation in the treatment of 406 cases with gastrointestinal disorders

目的 探讨菌群移植治疗肠道疾病的有效性和安全性。方法 回顾性分析南京军区南京总医院肠道微生态治疗中心于2014年5月至2016年4月期间接受菌群移植治疗的406例患者的临床资料，其中便秘276例，复发性艰难梭菌感染（RCDI ）61例，溃疡性结肠炎44例，肠易激综合征15例，克罗恩病10例。供体采用一致非亲属健康成年供体，要求为18~ 50岁非孕期健康成年人，具有健康生活方式及良好饮食习惯，3个月内无服用抗生素、益生菌及其他微生态制剂史。菌群移植治疗途径包括胃镜下放置鼻肠管后接受6 d的经鼻肠管（入空肠）注射粪菌液移植治疗（319例）、连续6 d空腹接受口服粪菌胶囊治疗（46例）以及通过结肠镜一次性将600 ml处理后的粪菌液输入患者结肠至末端回肠（41例）3种方法。结果 接受菌群移植治疗的406例患者临床治愈率和改善率依次为：RCDI分别为85.2% （52/61）和95.1% （58/61），便秘40.2% （111/276）和67.4%（186/276），溃疡性结肠炎34.1%（15/44）和68.2%（30/44），肠易激综合征46.7%（7/15）和73.3%（11/15），克罗恩病30.0%（3/10）和60.0%（6/10）；RCDI疗效显著优于其他疾病（P 〈 0.01）。不同移植途径的临床治愈率和改善率分别为鼻肠管移植43.3%（138/319）和58.6%（187/319），结肠镜移植41.5% （17/41）和61.0%（25/41），口服胶囊37.0% （17/46）和63.0%（29/46），3种治疗方法的疗效差异无统计学意义（P= 0.716，P= 0.829）。随访期间未发生严重不良反应，鼻肠管移植最常见的不良反应为呼吸不适（27.3%，87/319）和排气增多（51.7%，165/319）；结肠镜移植以腹泻为主（36.6%，15/41）；口服胶囊则以排气增多（50.0%，23/46）和恶心（34.8%，16/46）为主；症状均于鼻肠管拔除、或治疗结束、或住院观察1~ 3 d内消失。结论 菌群移植技术治疗多种肠道疾病有效，未发现明显不良反应，但具体机制应进一步探讨。

Objective To evaluate the efficacy and safety of fecal microbiota transplantation （FMT） for gastrointestinal disorders.Methods Retrospective analysis of the clinical data of 406 patients who underwent FMT from May 2014 to April 2016 in the Intestinal Microenvironment Treatment Centre of Nanjing General Hospital was performed, including patients with constipation （276 cases） , recurrent Clostridium Difficile infection （RCDI, 61 cases） , ulcerative colitis （44 cases） , irritable bowel syndrome （15 cases） and Crohn＇s disease （10 cases）. Donors were completely unrelated, 18-to 50-year-old non-pregnant healthy adult, with healthy lifestyle and habits, without taking antibiotics, probiotics and other probiotics history within 3 months. There were three routes of FMT administration： patients received 6 days of frozen FMT by nasointestinal tube placed in the proximal jejunum under gastroscope （319 cases） ; patients received capsules FMT per day for 6 consecutive days （46 cases） or once 600 ml of treated fecal liquid infusion into colon and terminal ileum by colonoscopy （41 cases）.Results Clinical cure rate and improvement rate of different diseases receiving FMT were respectively as follows： RCDI was 85.2% （52/61） and 95.1% （58/61） ; constipation was 40.2% （111/276） and 67.4% （186/276） ; ulcerative colitis was 34.1% （15/44） and 68.2% （30/44） ; irritable bowel syndrome was 46.7% （7/15） and 73.3% （11/15） and Crohn disease was 30.0% （3/10） and 60.0% （6/10）. RCDI had the best efficacy among these diseases （P 〈 0.01）. There was no significant difference between the three routes of FMT administration （P = 0.829）. The clinical cure rate and improvement rate of different routes were 43.3% （138/319） and 58.6% （187/319） respectively in nasogastric transplantation group, 41.5% （17/41） and 61.0% （25/41） in colonoscopy group, 37.0% （17/46） and 63.0% （29/46） in the capsule transplantation group. There was no serious adverse event during the follow-up. The most common side effects were respiratory discomfort （27.3%, 87/319） and increased venting （51.7% , 165/319） in nasogastric transplantation group. Diarrhea was the most common complication in colonoscopy group （36.6%, 15/41）. The main symptoms were increased venting （50.0% , 23/46） and nausea （34.8% , 16/46） in oral capsule group. Side effect symptoms disappeared after the withdraw of nasogastric tube, or at the end of treatment, or during hospitalization for 1-3 days.Conclusions FMT is effective for many gastrointestinal disorders. No significant adverse event is found, while the associated mechanism should be further explored.