肠道菌群移植治疗溃疡性结肠炎的有效性和安全性:系统评价和Meta分析

Efficacy and safety of fecal microbiota transplantation in the treatment of ulcerative colitis:a systematic review and Meta-analysis

目的通过荟萃分析来评价肠道菌群移植(fecal microbiota transplantation,FMT)治疗溃疡性结肠炎(ulcerative colitis,UC)的有效性和安全性。方法运用计算机检索在PubMed、EmBase、The Cochrane Library、Web of Science四个数据库中检索关于FMT治疗UC的RCTs文献,时间范围为数据库建库至2024年2月。运用RevMan 5.3软件进行Meta分析。结果检索到文献2304篇,筛选后最终纳入14篇文献进行Meta分析,共726例患者。分析结果显示:FMT治疗组的临床反应率要显著高于对照组(MD=2.08,95%CI:1.45~3.00,P<0.0001);FMT治疗组的临床缓解率显著高于对照组(MD=2.67,95%CI:1.88~3.79,P<0.00001);FMT治疗组的内镜缓解率显著高于对照组(MD=2.19,95%CI:1.42~3.36,P=0.0004);FMT治疗组的不良反应发生率与对照组相比,差异无统计学意义(MD=1.27,95%CI:0.84~1.92,P=0.26)。结论FMT治疗UC可以显著提高患者的临床反应率、临床缓解率和内镜缓解率,且其安全性与对照组相比并无明显差异。但由于纳入文章的数量有限,未来需要更多高质量的RCTs来进一步证实其可靠性。

Objective To evaluate the efficacy and safety of fecal microbiota transplantation(FMT)for the treatment of ulcerative colitis(UC)by Meta-analysis.Methods A computerized search was used to retrieve literature on RCTs of FMT for UC in four databases:PubMed,EmBase,The Cochrane Library and Web of Science,with a timeframe from the beginning of the database construction to Feb.2024.Meta-analysis was performed using RevMan 5.3 software.Results The literature was retrieved from 2304 articles,and after screening,14 articles were finally included in the Meta-analysis,with a total of 726 patients.The results of the analysis showed that the clinical response rate in the FMT treatment group was significantly higher than that in the control group(MD=2.08,95%CI:1.45-3.00,P<0.0001);the clinical remission rate in the FMT treatment group was significantly higher than that in the control group(MD=2.67,95%CI:1.88-3.79,P<0.00001);and the endoscopic remission rate was significantly higher in the FMT treatment group than in the control group(MD=2.19,95%CI:1.42-3.36,P=0.0004);and the incidence of adverse reactions in the FMT treatment group was not statistically different from that in the control group(MD=1.27,95%CI:0.84-1.92,P=0.26).Conclusion The use of FMT for the treatment of UC significantly increased the clinical response rate,clinical remission rate and endoscopic remission rate of patients,and its safety is not significantly different from that of the control group.However,due to the limited number of included articles,more high-quality RCTs are needed in the future to further confirm the reliability of this Meta-analysis.