新鲜粪菌移植在治疗艰难梭菌感染性腹泻方面的疗效及安全性的Meta分析

Efficacy and safety of fresh fecal microbiota transplantation for treatment of recurrent Clostridium difficile infection:A meta analysis

目的应用循证研究方法评价新鲜粪菌移植在治疗艰难梭菌感染相关性腹泻方面的效果及安全性。方法计算机检索中国生物医学文献数据库、中国学术期刊全文数据库、万方数据库、 PubMed、Embase、Web of Science、The Cochrane Library数据库,搜集关于新鲜粪菌移植治疗艰难梭菌感染的随机对照实验,检索时限均为建库至2019年7月30日。由2名研究者按照纳入和排除标准进行文献筛选、数据提取和质量评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入7个RCT,共543名患者。Meta分析结果显示:新鲜FMT比传统方法在治疗CDI引起的腹泻方面更有效(OR=6.70,95%CI:1.64~27.43,P=0.040),敏感性分析显示:此结果敏感性较低,结果较为稳定可信。多次输注方式比起单次输注在治愈率方面更显优势(OR=-0.09,95%CI:0.04~3.13,P<0.001)。结论新鲜粪菌移植能明显提高艰难梭菌感染性腹泻的治愈率,且在不同输注方式方面,多次输注更能提高治愈率,且不良反应较少,与FTM无直接关系,有一定的临床推广价值。

Objective To evaluate the efficacy and safety of fresh fecal microbiota transplantation(FMT)for treatment of Clostridium difficile infection(CDI)through meta analysis and systematic review. Methods We searched the Cochrane Library,PubMed,Web of Science,CNKI,CBM,WanFang Data,other sources and their references for randomized controlled trials(RCTs)about fresh FMT for treatment of CDI. Data searching,extracting and quality evaluation were conducted by 2 reviewers independently. RevMan 5.3 software was used to perform meta-analysis. Results A total of 7 RCTs involving 543 patients were included. Meta-analysis showed that fresh FMT was more effective than traditional methods in treating diarrhea caused by CDI(OR=6.70,95%CI:1.64~27.43,P=0.040). Sensitivity analysis showed that the sensitivity of the results was low,and the results were consistent and reliable. Multiple infusion was better than single infusion in terms of cure rate(OR=-0.09,95%CI:0.04~3.13,P<0.001). Conclusion Fresh fecal bacteria transplantation can obviously improve the cure rate of CDI,although the effect of which is not significantly different from freeze-dried FTM. Multiple infusion can improve the cure rate,with fewer adverse reactions directly related to FTM.