Outcomes and prognostic factors of fecal microbiota transplantation in patients with slow transit constipation:results from a prospective study with long-term follow-up

粪菌移植应用于慢传输型便秘的临床疗效及疗效影响因素:一项前瞻性研究的长期随访结果

Background and aim:Gutmicrobiotamay contribute to regulate colonicmotility,which is involved in the etiology of constipation.Fecalmicrobiota transplantation(FMT)has been demonstrated to restore intestinal homeostasis.The aimof this study was to evaluate the clinical outcomes and prognostic factors of FMT for the treatment of slow transit constipation(STC).Methods:Fifty-two patients with STC received standardized FMT and were followed up for 6 months.Bowel habit,colonic transit time,constipation-related symptoms(PAC-SYM score),quality of life(PAC-QOL score),treatment satisfaction scores and adverse events were monitored.The primary efficacy endpoint was the proportion of patients having on average three or more complete spontaneous bowel movements(CSBMs)per week.Results:The primary efficacy endpoint was achieved in 50.0%,38.5%and 32.7%of patients over week intervals 3–4,9–12 and 21–24,respectively(P<0.01 for all comparisons).Significant improvements were also observed in other bowel movement assessments,colonic transit time,constipation-related symptoms and quality of life;but all improvements diminished at weeks 12 and 24.Incompleteness of evacuation served as the only factor associated with efficacy.No serious treatmentrelated adverse events were observed.Conclusion:This study suggested FMT was effective and safe for STC,while a late loss of efficacy was also observed.A lower degree of sensation of incompleteness predicted a better outcome.

背景和目的肠道菌群参与结肠动力的调控,菌群失调是便秘是病因之一。粪菌移植被证实可以恢复肠道平衡。本研究旨在评估粪菌移植治疗慢传输型便秘(STC)的临床疗效和预后影响因素。方法:52例STC患者接受标准的粪菌移植入组研究,对其进行至少6个月的随访。记录入组患者的排便习惯、结肠传输时间、便秘相关的症状(PAC-SYM评分)、生活质量(PAC-QOL评分)、治疗满意度和不良反应。主要疗效指标是平均每周完全自主排便≥3次的患者比例。结果:治疗后34周、912周、2124周,每周完全自主排便≥3次患者的比例分别为50.0%、38.5%和32.7%,均较治疗前显著提高(均P<0.01)。其他排便情况、结肠传输时间、便秘相关症状和生活质量方面,治疗后亦有显著改善;但这些短期改善在治疗后12周和24周逐渐减小。治疗前排便不尽是唯一的疗效影响因素。治疗和随访期间未发现任何治疗相关的不良反应。结论:本研究显示粪菌移植治疗STC安全有效,但远期疗效有所降低。治疗前排便不尽感较少甚至没有的患者接受粪菌移植的治疗效果更佳。