系统评价和荟萃分析：粪便微生物移植治疗活动期溃疡性结肠炎。

Systematic Review and Meta-analysis: Fecal Microbiota Transplantation for Treatment of Active Ulcerative Colitis.

机构信息

*Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada; †OpenBiome, Somerville, Massachusetts; ‡Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; and §Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.

出版信息

Inflamm Bowel Dis. 2017 Oct;23(10):1702-1709. doi: 10.1097/MIB.0000000000001228.

DOI:10.1097/MIB.0000000000001228

PMID:28906291

Abstract

BACKGROUND

Changes in the colonic microbiota may play a role in the pathogenesis of ulcerative colitis (UC) and restoration of healthy gut microbiota may ameliorate disease. A systematic review and meta-analysis was conducted to assess fecal microbiota transplantation (FMT) as a treatment for active UC.

METHODS

A literature search was conducted to identify high-quality studies of FMT as a treatment for patients with UC. The primary outcome was combined clinical remission and endoscopic remission or response. Secondary outcomes included clinical remission, endoscopic remission, and serious adverse events. Odds ratios with 95% confidence intervals (CIs) are reported.

RESULTS

Overall, 4 studies with 277 participants were eligible for inclusion. Among 4 randomized controlled trials, FMT was associated with higher combined clinical and endoscopic remission compared with placebo (risk ratio UC not in remission was 0.80; 95% CI: 0.71-0.89) with a number needed to treat of 5 (95% CI: 4-10). There was no statistically significant increase in serious adverse events with FMT compared with controls (risk ratio adverse event was 1.4; 95% CI: 0.55-3.58).

CONCLUSIONS

Among randomized controlled trials, short-term use of FMT shows promise as a treatment to induce remission in active UC based on the efficacy and safety observed. However, there remain many unanswered questions that require further research before FMT can be considered for use in clinical practice.

摘要

背景

结肠微生物群的变化可能在溃疡性结肠炎（UC）的发病机制中起作用，而健康肠道微生物群的恢复可能改善疾病。系统评价和荟萃分析评估了粪便微生物群移植（FMT）作为治疗活动期 UC 的方法。

方法

进行文献检索，以确定 FMT 作为 UC 患者治疗方法的高质量研究。主要结局是联合临床缓解和内镜缓解或反应。次要结局包括临床缓解、内镜缓解和严重不良事件。报告了具有 95%置信区间（CI）的优势比。

结果

共有 4 项研究纳入了 277 名符合条件的参与者。在 4 项随机对照试验中，与安慰剂相比，FMT 与更高的联合临床和内镜缓解相关（UC 未缓解的风险比为 0.80；95%CI：0.71-0.89），需要治疗的人数为 5 （95%CI：4-10）。与对照组相比，FMT 并未导致严重不良事件显著增加（不良事件的风险比为 1.4；95%CI：0.55-3.58）。