糞菌移植治療炎癥性腸病的臨床薈萃分析
發(fā)布時(shí)間：2018-11-27 13:59
【摘要】：背景和目的:炎癥性腸病(inflammatory bowel disease,IBD)為病因不明的腸道慢性炎癥性疾病,包括克羅恩病(crohn’s disease,CD)和潰瘍性結(jié)腸炎(ulcerative colitis,UC)。目前,IBD發(fā)病機(jī)制尚未完全明確,遺傳、環(huán)境、感染以及異常免疫等因素在其發(fā)生發(fā)展中發(fā)揮重要作用。并且,IBD患者腸道菌群存在異常,異常的腸道菌群可能通過誘導(dǎo)異常腸粘膜免疫反應(yīng)、增高腸道通透性等途徑,引起腸粘膜免疫失衡,誘發(fā)腸粘膜損傷,導(dǎo)致IBD發(fā)病。糞菌移植(fecal microbiota transplantation,FMT),即把處理后的健康人糞液移植到患者胃腸道內(nèi),建立新的腸道菌群。新近研究發(fā)現(xiàn),FMT能通過調(diào)節(jié)腸道菌群及腸道免疫功能,治療腸道感染性疾病,包括艱難梭菌性腸炎等。并且,目前已有FMT治療IBD的實(shí)驗(yàn)及臨床研究。為探討FMT治療IBD的臨床效果,我們進(jìn)行了該薈萃分析。方法:檢索PubMed、EMBASE和中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫等,檢索時(shí)限為建庫至今。收集FMT治療IBD的隨機(jī)對(duì)照實(shí)驗(yàn)、非隨機(jī)實(shí)驗(yàn)性研究,按照納入標(biāo)準(zhǔn)與排除標(biāo)準(zhǔn)篩選文獻(xiàn),主要結(jié)果為臨床緩解,次要結(jié)果為臨床有效,同時(shí)觀察不良反應(yīng)發(fā)生率及其他相關(guān)結(jié)果,分別用用Review Manager 5.2和StatsDirect 3軟件進(jìn)行Meta分析。結(jié)果:納入19篇文獻(xiàn),474例患者,包括隨機(jī)對(duì)照實(shí)驗(yàn)3篇,非隨機(jī)實(shí)驗(yàn)性研究16篇,其中隊(duì)列研究1篇。Meta分析顯示:對(duì)照研究中FMT組有效例數(shù)62例,對(duì)照組有效44例,p=0.008;對(duì)照研究中FMT組緩解例數(shù)40例,對(duì)照組有效21例,p=0.004;對(duì)照研究嚴(yán)重不良反應(yīng)5例,對(duì)照組3例,p=0.50,16項(xiàng)研究中糞菌移植總有效率57%(95%CI=[0.39,0.74]),總緩解率28%(95%CI=[0.12,0.46]),CD患者有效率78%(95%CI=[0.53,0.95]),緩解率51%(95%CI=[0.27,0.75]),UC患者有效率53%(95%CI=[0.33,0.73]),緩解率19%(95%CI=[0.07,0.34]),嚴(yán)重不良反應(yīng)發(fā)生率3%(95%CI=[0.01,0.07]),分析發(fā)現(xiàn)FMT治療對(duì)UC的治療緩解率及有效率高于對(duì)照組,嚴(yán)重不良反應(yīng)兩者無明顯差異,其余研究發(fā)現(xiàn)糞菌移植對(duì)UC和CD得治療都有效,嚴(yán)重不良反應(yīng)少見,臨床上不良反應(yīng)主要為發(fā)熱、腹脹、腹鳴、腹痛、腹瀉等,輕微且自限。結(jié)論:FMT治療IBD有一定的臨床價(jià)值,嚴(yán)重不良反應(yīng)相對(duì)少見,輕微的不良反應(yīng)多可自行緩解,進(jìn)一步的隨機(jī)對(duì)照實(shí)驗(yàn)進(jìn)行驗(yàn)證是必需的,關(guān)于FMT的標(biāo)準(zhǔn)化治療及相關(guān)倫理問題也是臨床工作中需要進(jìn)一步解決的。
[Abstract]:Background & AIM: inflammatory bowel disease (inflammatory bowel disease,IBD) is a chronic inflammatory bowel disease with unknown etiology, including Crohn's disease (crohn's disease,CD) and ulcerative colitis (ulcerative colitis,UC). At present, the pathogenesis of IBD is not completely clear, genetic, environmental, infection and abnormal immune factors play an important role in its occurrence and development. The abnormal intestinal flora may induce abnormal intestinal mucosal immune response, increase intestinal permeability and induce intestinal mucosal immune imbalance, induce intestinal mucosal injury, and lead to the pathogenesis of IBD. Fecal bacteria transplantation (fecal microbiota transplantation,FMT), namely, the feces of treated healthy people were transplanted into the gastrointestinal tract of patients, and a new intestinal flora was established. Recent studies have found that FMT can treat intestinal infectious diseases, including Clostridium difficulty enteritis, by regulating intestinal flora and intestinal immune function. In addition, there have been experimental and clinical studies on the treatment of IBD by FMT. To investigate the clinical efficacy of FMT in the treatment of IBD, we performed this meta-analysis. Methods: PubMed,EMBASE and Chinese biomedical literature database were searched. A randomized controlled trial of FMT for the treatment of IBD was collected. The non-randomized experimental study was used to screen the literature according to the inclusion criteria and exclusion criteria. The main results were clinical remission, and the secondary results were clinical efficacy. At the same time, the incidence of adverse reactions and other related results were observed. Meta analysis was performed with Review Manager 5.2 and StatsDirect 3 respectively. Results: 474 patients were included in 19 articles, including 3 randomized controlled trials and 16 non-randomized experimental studies, including 1 cohort study. Meta analysis showed that there were 62 effective cases in FMT group and 44 cases in control group. P0. 008; There were 40 cases of remission in the FMT group, 21 cases in the control group, and p0.004 in the control group. The total effective rate of fecal bacteria transplantation was 57% (95 CI = 0.39 0.74) and the total remission rate was 28% (95CI = [0.120.46]). The effective rate of CD patients was 78% (95 CI = 0.53%), the remission rate was 51% (95 CI = 0.270.75), the effective rate of), UC patients was 53% (95 CI = 0.33 0. 73). The remission rate was 19% (95 CI = [0.07 鹵0.34]), and the incidence of severe adverse reactions was 3% (95 CI = [0.01-0.07]). It was found that the remission rate and the effective rate of FMT treatment for UC were higher than those in the control group. There was no significant difference in severe adverse reactions between the two groups. Other studies showed that fecal bacteria transplantation was effective in the treatment of UC and CD, and severe adverse reactions were rare. The main adverse reactions were fever, abdominal distension, abdominal pain, diarrhea and so on, which were mild and self-limiting. Conclusion: FMT has some clinical value in the treatment of IBD, severe adverse reactions are relatively rare, and mild adverse reactions can be alleviated by themselves. Further randomized controlled trials are necessary. The standardized treatment of FMT and related ethical issues also need to be further resolved in clinical work.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R574
[Abstract]:Background & AIM: inflammatory bowel disease (inflammatory bowel disease,IBD) is a chronic inflammatory bowel disease with unknown etiology, including Crohn's disease (crohn's disease,CD) and ulcerative colitis (ulcerative colitis,UC). At present, the pathogenesis of IBD is not completely clear, genetic, environmental, infection and abnormal immune factors play an important role in its occurrence and development. The abnormal intestinal flora may induce abnormal intestinal mucosal immune response, increase intestinal permeability and induce intestinal mucosal immune imbalance, induce intestinal mucosal injury, and lead to the pathogenesis of IBD. Fecal bacteria transplantation (fecal microbiota transplantation,FMT), namely, the feces of treated healthy people were transplanted into the gastrointestinal tract of patients, and a new intestinal flora was established. Recent studies have found that FMT can treat intestinal infectious diseases, including Clostridium difficulty enteritis, by regulating intestinal flora and intestinal immune function. In addition, there have been experimental and clinical studies on the treatment of IBD by FMT. To investigate the clinical efficacy of FMT in the treatment of IBD, we performed this meta-analysis. Methods: PubMed,EMBASE and Chinese biomedical literature database were searched. A randomized controlled trial of FMT for the treatment of IBD was collected. The non-randomized experimental study was used to screen the literature according to the inclusion criteria and exclusion criteria. The main results were clinical remission, and the secondary results were clinical efficacy. At the same time, the incidence of adverse reactions and other related results were observed. Meta analysis was performed with Review Manager 5.2 and StatsDirect 3 respectively. Results: 474 patients were included in 19 articles, including 3 randomized controlled trials and 16 non-randomized experimental studies, including 1 cohort study. Meta analysis showed that there were 62 effective cases in FMT group and 44 cases in control group. P0. 008; There were 40 cases of remission in the FMT group, 21 cases in the control group, and p0.004 in the control group. The total effective rate of fecal bacteria transplantation was 57% (95 CI = 0.39 0.74) and the total remission rate was 28% (95CI = [0.120.46]). The effective rate of CD patients was 78% (95 CI = 0.53%), the remission rate was 51% (95 CI = 0.270.75), the effective rate of), UC patients was 53% (95 CI = 0.33 0. 73). The remission rate was 19% (95 CI = [0.07 鹵0.34]), and the incidence of severe adverse reactions was 3% (95 CI = [0.01-0.07]). It was found that the remission rate and the effective rate of FMT treatment for UC were higher than those in the control group. There was no significant difference in severe adverse reactions between the two groups. Other studies showed that fecal bacteria transplantation was effective in the treatment of UC and CD, and severe adverse reactions were rare. The main adverse reactions were fever, abdominal distension, abdominal pain, diarrhea and so on, which were mild and self-limiting. Conclusion: FMT has some clinical value in the treatment of IBD, severe adverse reactions are relatively rare, and mild adverse reactions can be alleviated by themselves. Further randomized controlled trials are necessary. The standardized treatment of FMT and related ethical issues also need to be further resolved in clinical work.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R574
【參考文獻(xiàn)】
相關(guān)期刊論文 前5條
1 馬永慧;許鴻志;肖傳興;任建林;聶勇戰(zhàn);張發(fā)明;;糞菌移植的倫理、社會(huì)問題探討[J];中華消化雜志;2016年12期
2 戴婷;唐彤宇;;糞菌移植的研究進(jìn)展[J];中華胃腸外科雜志;2015年07期
3 張發(fā)明;李潘;崔伯塔;彭pぴ，
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