Zhang Xuelei, Tian Hongliang, Ma Chunlian, Yang Bo, Hua Yue, Zhu Yifan, Gu Lili, Li Ning
Department of General Surgery, Intestinal Microenvironment Treatment Center, Jinling Hospital, Nanjing 210002, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Dec 25;20(12):1355-1359.
To evaluate the efficacy of periodic fecal microbiota transplantation (FMT) for refractory constipation.
Clinical data of 49 patients with refractory constipation undergoing FMT through standard transplantation path of nasojejunal tube between April 2015 and April 2016 in Intestinal Microenvironment Treatment Centre of Nanjing General Hospital were analyzed retrospectively. Of 49 patients, 25 received single FMT for only 6 days (single group), and 24 received periodic FMT with another 6 days FMT 1 month after the first 6 days FMT (periodic group). The follow up was at 12 weeks after treatment. Autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index and related adverse reaction were evaluated and compared at 4-, 8- and 12-week after treatment. Statistical analysis was performed on the difference after treatment at each time point, and the greater difference indicated the better improvement.
There were no statistically significant differences in general characteristics between the two groups (all P<0.05). Before treatment, Wexner constipation score was 17.32±2.66 and 16.25±2.47, gastrointestinal quality of life index was 81.84±8.73 and 83.25±7.87, autonomous defecation frequency was (1.64±0.57) time/week and (1.42±0.65) time/week in single group and periodic group respectively, whose differences were not significant (all P>0.05). Compared with before FMT treatment, the autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index were obviously improved at the 4-, 8-, 12-week (all P=0.000). At the 4-week after FMT treatment, the improvement degree of autonomous defecation frequency, Wexner constipation score, gastrointestinal quality of life index was compared between two groups, and no statistically significant differences were found (all P>0.05). While at 8-week and 12-week after FMT treatment, as compared to single group, periodic group had greater Wexner constipation score (at 8-week: 7.29±2.05 vs. 5.96±2.30, t=2.135, P=0.038; at 12-week: 7.21±1.98 vs. 5.80±2.43, t=2.218, P=0.031), greater gastrointestinal quality of life index (at 8-week: 25.71±8.91 vs. 20.20±8.53, t=2.211, P=0.032; at 12-week: 24.16±8.99 vs. 18.92±8.28, t=2.127, P=0.039) and better autonomous defecation frequency [at 8-week: (2.42±0.93) time/week vs. (1.72±0.61) time/week, t=3.110, P=0.003; at 12-week: (1.37±0.88) time/week vs. (0.84±0.62) time/week, t=2.454, P=0.018].
Periodic FMT has better efficacy than single FMT in the treatment of refractory constipation.
评估周期性粪菌移植（FMT）治疗难治性便秘的疗效。
回顾性分析2015年4月至2016年4月在南京总医院肠道微生态治疗中心经鼻空肠管标准移植途径接受FMT的49例难治性便秘患者的临床资料。49例患者中，25例仅接受单次FMT共6天（单次组），24例接受周期性FMT，即在首次6天FMT后1个月再进行6天FMT（周期组）。治疗后12周进行随访。在治疗后4周、8周和12周评估并比较自主排便频率、Wexner便秘评分、胃肠道生活质量指数及相关不良反应。对各时间点治疗后的差异进行统计学分析，差异越大表明改善越好。
两组患者一般特征比较差异均无统计学意义（均P<0.05）。治疗前，单次组和周期组Wexner便秘评分分别为17.32±2.66和16.25±2.47，胃肠道生活质量指数分别为81.84±8.73和83.25±7.87，自主排便频率分别为（1.64±0.57）次/周和（1.42±0.65）次/周，差异均无统计学意义（均P>0.05）。与FMT治疗前比较，治疗后4周、8周、12周自主排便频率、Wexner便秘评分、胃肠道生活质量指数均明显改善（均P = 0.000）。FMT治疗后4周，比较两组自主排便频率、Wexner便秘评分、胃肠道生活质量指数的改善程度，差异均无统计学意义（均P>0.05）。而在FMT治疗后8周和12周，与单次组比较，周期组Wexner便秘评分更高（8周时：7.29±2.05比5.96±2.30，t = 2.135，P = 0.038；12周时：7.21±1.98比5.80±2.43，t = 2.218，P = 0.031），胃肠道生活质量指数更高（8周时：25.71±8.91比20.20±8.53，t = 2.211，P = 0.032；12周时：24.16±8.99比18.92±8.28，t = 2.127，P = 0.039），自主排便频率更好[8周时：（2.42±0.93）次/周比（1.72±0.61）次/周，t = 3.110，P = 0.003；12周时：（1.37±0.88）次/周比（0.84±0.62）次/周，t = 2.454，P = 0.018]。
周期性FMT治疗难治性便秘的疗效优于单次FMT。
