粪便微生物群移植治疗肝性脑病有效性及安全性Meta分析

Efficacy and safety of fecal microbiota transplantation for hepatic encephalopathy:a Meta-analysis

目的评价粪便微生物群移植(fecal microbiota transplantation,FMT)治疗肝性脑病的有效性及安全性。方法通过计算机检索PubMed、The Cochrane Library、Ovid、EmBase、中国生物医学文献数据库、知网、维普、万方数据库及追踪参考文献收集关于FMT治疗肝性脑病的相关研究,采用RevMan 5.3软件进行Meta分析。结果最终共纳入6项研究,共104例患者,FMT组61例、对照组43例。Meta分析结果显示,FMT组严重不良事件发生率低于对照组(P<0.05)。亚组分析显示,经上消化道行FMT的患者临床有效率22.22%低于经下消化道行FMT患者的临床有效率48.00%(P<0.05);对于再入院率,FMT组与对照组比较,差异无统计学意义(P>0.05)。在神经认知功能预后方面,与基线水平相比,FMT组的PHES总分降低,Stroop耗时缩短,而在对照组中EncephalApp耗时和PHES总分未见显著变化。在不良反应方面,如感染、便秘及胸痛可在短时间内缓解,经FMT治疗死亡的患者,未报道具体死亡原因,可能与患者合并症如脓毒血症、肾脏疾病等有关,但仍缺乏明确的证据证明与FMT治疗有关。结论FMT治疗HE安全有效,经下消化道临床有效率高于上消化道,对神经认识功能有良好的预后效果,可降低不良事件发生率。

Objective To evaluate the efficacy and safety of fecal microbiota transplantation(FMT)in the treatment of hepatic encephalopathy.Methods Relevant studies on FMT for hepatic encephalopathy were collected by searching of PubMed,Cochrane Library,Ovid,EmBase,CBM,CNKI,VIP,WanFang databases and tracking references.RevMan 5.3 software was used for Meta-analysis.Results Finally,6 studies were included,with a total of 104 patients,61 patients in the FMT group and 43 patients in the control group.The Meta-analysis results showed that the incidence of serious adverse events in the FMT group was lower than that in the control group(P<0.05).Subgroup analysis showed that the clinical effective rate of patients undergoing FMT through the upper digestive tract was 22.22%,which was lower than the clinical effective rate(48.00%)in patients undergoing FMT through the lower digestive tract(P<0.05).There was no statistically significant difference in readmission rate(P>0.05).In terms of neurocognitive function prognosis,compared to baseline levels,the FMT group showed a decrease in the total score of neuropsychological measurements(PHES)and a shorter Stroop time,while there was no significant change in the Encephal App time and PHES total score in the control group.In terms of adverse reactions,such as infection,constipation,and chest pain,they can be relieved in a short period of time.Patients who died after FMT treatment had not reported a specific cause of death,which may be related to patients′complications such as sepsis and kidney disease.However,there was still a lack of clear evidence to prove that FMT treatment was related.Conclusion FMT for hepatic encephalopathe is safe and effective.The clinical effectiveness through the upper digestive tract was higher than that through lower digestive tract.FMT can improve patients′cognitive dysfunction,and significantly reduced the incidence of adverse events.