不同途径行粪菌移植治疗溃疡性结肠炎的疗效和安全性评价

Evaluation of the efficacy and safety of fecal microbiota transplantation in different ways on ulcerative colitis

目的评估中、下消化道两种方式行粪菌移植(fecal microbiota transplantation,FMT)治疗溃疡性结肠炎(ulcerative colitis,UC)的疗效及其安全性,并初步探究FMT治疗UC的机制。方法收集2017年5月至2019年10月在广东药科大学附属第一医院消化内科进行FMT治疗的UC患者资料,因移植途径不同分为中消化道FMT组和下消化道FMT组。以改良Mayo评分系统评估患者的疗效,并检测肠道屏障功能指标(二胺氧化酶、D-乳酸和细菌内毒素)、血常规、肝肾功能等指标。结果确诊为UC的患者14例,其中中消化道FMT组5例,下消化道FMT组9例。两组UC患者经FMT治疗后Mayo评分均下降(P<0.05),肠镜结果也显示,黏膜炎症情况好转,水肿、充血、糜烂等情况均有所改善;两组UC患者治疗前后的Mayo评分差值差异无统计学意义(P>0.05)。两组UC患者肠道屏障功能中的各项生化指标在FMT治疗后均下降,以细菌内毒素下降最明显;中消化道FMT组治疗后细菌内毒素下降差值与下消化道FMT组比较,差异有统计学意义(P<0.05)。结论FMT治疗UC具有较好的临床疗效,安全性良好,中消化道FMT与下消化道FMT疗效相当。

Objective To evaluate the efficacy and safety of fecal microbiota transplantation(FMT)in the treatment of ulcerative colitis(UC)through the middle and lower digestive tract and to explore the mechanism preliminarily.Methods From May 2017 to Oct.2019,UC patients who were treated with FMT in the Department of Gastroenterology,the First Affiliated Hospital of Guangdong Pharmaceutical University were divided into the middle gastrointestinal FMT group and the lower digestive tract FMT group according to the different ways of transplantation.The curative effect of the patients was evaluated by the modified Mayo scoring system,and the intestinal barrier function indexes(diamine oxidase,D-lactic acid and endotoxin),blood test,liver and kidney function were measured.Results Fourteen patients diagnosed as UC including 5 patients in the middle digestive tract FMT group and 9 patients in the lower digestive tract FMT group.The Mayo score of UC patients between the two groups decreased after FMT(P<0.05).The results of enteroscopy also showed that the inflammation of mucous membrane was improved,edema,congestion and festering were improved.There was no significant difference in Mayo score difference value of UC patients between the two groups before and after treatment(P>0.05).The biochemical indexes of intestinal barrier function of UC patients in the two groups were decreased after FMT treatment,and the bacterial endotoxin decreased obviously.Compared with the lower digestive tract FMT group,the difference value of bacterial endotoxin decrease in the middle digestive tract FMT group was statistically significant(P<0.05).Conclusion FMT has a good clinical effect and safety in the treatment of UC.FMT in the middle and lower digestive tract have the same effect.