粪菌移植治疗溃疡性结肠炎临床缓解率的影响因素分析

Influence factor analysis of clinical remission rate of fecal bacteria transplantation for the treatment of ulcerative colitis

目的系统评价影响粪菌移植(fecal microbiota transplantation,FMT)治疗溃疡性结肠炎(ulcerative colitis,UC)临床缓解率的因素。方法通过计算机联机检索国内外文献数据库,应用Meta分析的方法对FMT治疗UC的研究进行整合分析,再进一步进行亚组分析以确定FMT治疗UC临床缓解率的影响因素。采用NICE质量评价清单对所纳入的文献进行质量评价。经异质性检验后选择合适的效应模型进行统计量的计算合并。结果最终筛选出11篇文献,共133名UC患者。Meta分析结果显示,FMT治疗UC的临床缓解率为28.6%(38/133),合并缓解率为30.4%(95%CI:22.6%~39.4%)。亚组分析结果显示,经下消化道输送的合并缓解率为29.8%(95%CI:20.2%~41.6%),经上消化道输送的合并缓解率为27.5%(95%CI:16.1%~42.9%),两组缓解率比较,差异无统计学意义(χ~2=0.002,P=0.963)。FMT治疗次数为1次的合并缓解率为28.2%(95%CI:20.5%~43.3%),治疗次数至少为2次的合并缓解率为28.9%(95%CI:20.1%~39.7%),两组缓解率比较,差异无统计学意义(χ~2=0.020,P=0.887)。结论 FMT在治疗UC方面具有一定疗效,但仍需通过开展大规模的多中心、大样本的随机对照试验研究来规范FMT治疗。

Objective This Meta-analysis aims to quantitatively evaluate the effects of different factors on the clinical remission rate of fecal microbiota transplantation for ulcerative colitis. Methods Domestic and international databases were screened and Meta-analysis was used to analyze the effects of different factors on the clinical remission rate of fecal microbiota transplantation for ulcerative colitis. The inventory of quality evaluation for cases recommended by National Institute for Health and Clinical Excellence（ NICE） of Britain was employed in the literature quality evaluation. Estimations were pooled by fixed effect models according to the results of heterogeneity test. Results A total of 11 literature involving 133 patients were included. Metaanalysis showed that the clinical remission rate of FMT for UC was 28. 6%（ 38/133）,and the remission rate was30. 4%（ 95% CI： 22. 6% ~ 39. 4%）. A subgroup analysissuggested that the clinical remission rate of lower gastrointestinal delivery and upper gastrointestinal delivery were 29. 8%（ 95% CI： 20. 2% ~ 41. 6%） and 27. 5%（ 95% CI： 16. 1% - 42. 9%） respectively,and there was no difference between the two groups（ χ~2= 0. 002,P = 0. 963）. Furthermore,subgroup analysis revealed that the clinical remission rate of single infusion and multiple infusions were 28. 2%（ 95% CI： 20. 5% ~ 43. 3%） and28. 9%（ 95% CI： 20. 1% ~ 39. 7%） respectively,and there was no difference between the two groups（ χ~2=0. 020,P = 0. 887）. Conclusions FMT has certain curative effect in the treatment of UC. It is necessary to carry out large-scale multicenter,large-sample randomized controlled trials to standardize FMT treatment.