粪菌移植替代多巴胺能药物治疗帕金森病案例分析

A case analyse of Parkinson’s disease treated with fecal microbiota transplantation instead of dopaminergic drugs

目的观察粪菌移植替代多巴胺能药物治疗帕金森病(PD)的疗效,探讨潜在的机制。方法为1例因服用多巴胺能药物出现幻觉而拒绝服药的PD患者行粪菌移植治疗,应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、PD问卷(PDQ39)、匹兹堡睡眠质量指数(PSQI)、Bristol便秘评分、统一PD评定量表Ⅲ(UPDRSⅢ量表)对患者移植治疗前及移植治疗后4周、8周、12周的相关症状进行评分,同时对患者移植治疗前和移植治疗后4周、12周的粪菌进行16 s rRNA高通量基因测序分析菌群。结果与移植治疗前相比,移植治疗后HAMD、HAMA、PDQ39、PSQI、Bristol便秘评分、UPDRSⅢ量表评分均明显降低,粪菌16 s rRNA高通量测序显示粪菌移植治疗后拟杆菌属丰度下降,而瘤胃、布劳特、普雷沃等菌属丰度增高。结论粪菌移植对PD患者的非运动症状和运动症状均显示出明显效果,其机理可能与重建正常功能的肠道菌群密切相关。

Objective To observe the efficacy of fecal microbiota transplantation instead of dopaminergic drugs in the treatment of Parkinson’s disease(PD) and explore the potential mechanism. Methods A patient with PD who refused to take drugs because of hallucination of dopaminergic drugs was treated with fecal microbiota transplantation. Scales of Hamilton depression scale(HAMD), Hamilton anxiety scale(HAMA), the 39-item PD questionnaire(PDQ39), Pittsburgh sleep quality index(PSQI), Bristol constipation score and unified PD rating scale Ⅲ(UPDRS Ⅲ) were used to evaluate the relevant symptoms before transplantation and 4, 8 and 12 weeks after transplantation. Meanwhile, microbiota communities in the feces before transplantation and 4, 12 weeks after transplantation were investigated using high-throughput sequencing targeting the 16 s ribosomal RNA(rRNA) gene. Results Scores of HAMD, HAMA, PDQ39, PSQI, Bristol’s constipation and UPDRS Ⅲ decreased significantly after transplantation. The 16 s high-throughput sequencing of the feces showed that the abundance of Bacteroides decreased after transplantation, while the abundance of Ruminococcus, Blautia and Prevotellaceae increased. Conclusion Fecal microbiota transplantation displays obvious effects on non-motor symptoms and motor symptoms in PD patients, and its mechanism may be closely related to the reconstruction of normal intestinal flora.