粪便微生物移植（FMT）成功根除艰难梭菌后胃肠道症状的危险因素。
Risk Factors for Gastrointestinal Symptoms Following Successful Eradication of Clostridium difficile by Fecal Microbiota Transplantation (FMT).
机构信息
Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital.
Harvard Medical School, Boston.
出版信息
J Clin Gastroenterol. 2019 Oct;53(9):e405-e408. doi: 10.1097/MCG.0000000000001194.
BACKGROUND
Fecal microbiota transplantation (FMT) is a promising therapy for recurrent Clostridioides difficile infection (CDI). Many patients report altered bowel habits including constipation, bloating, gas and loose stool post-FMT despite resolution of CDI, and the etiology remains unclear.
METHODS
This was a prospective cohort study of adult patients with recurrent CDI who underwent FMT (1) via colonoscopy with patient-selected donor stool, (2) via colonoscopy from a universal stool bank donor, or (3) via capsules from a universal stool bank. Reassessment occurred 8 weeks post-FMT. Those cured were assessed for gastrointestinal symptoms (bloating, loose stools, constipation). Multivariate logistic regression was performed to assess predictors of post-FMT gastrointestinal symptoms.
RESULTS
A total of 150 subjects underwent FMT for recurrent CDI, of which 68.7% (103) were female, mean age was 61.5 years±18.1 and 31 patients (20.7%) had preexisting irritable bowel syndrome. Thirty-six had FMT via colonoscopy with a patient-selected donor, 67 via colonoscopy with stool bank donors, and 47 via FMT capsules from stool bank donors. Among those cured, 41 (31.2%) had gastrointestinal symptoms post-FMT. The factors associated with symptoms included younger age (57.2 vs. 64.1 y, P=0.03), a baseline history of irritable bowel syndrome (36.6% vs. 13.3%, P=0.002) and preexisting inflammatory bowel disease (31.7% vs. 10%, P=0.002). Small bowel exposure to donor stool was not related to symptoms (63.4% vs. 62.2%, P=0.89).
CONCLUSIONS
Altered bowel habits are a consequence of CDI and are common after FMT. This study suggests that donor type and FMT delivery modality are not related to the presence of irregular gastrointestinal symptoms after FMT.
背景
粪便微生物群移植（FMT）是复发性艰难梭菌感染（CDI）的一种有前途的治疗方法。尽管 CDI 得到解决，但许多患者报告在 FMT 后出现排便习惯改变，包括便秘、腹胀、气胀和稀便，其病因仍不清楚。
方法
这是一项前瞻性队列研究，纳入接受 FMT 的复发性 CDI 成年患者，FMT 方法包括：（1）经结肠镜检查使用患者选择的供体粪便；（2）经结肠镜检查使用通用供体粪便库供体；或（3）使用通用供体粪便库胶囊。FMT 后 8 周进行重新评估。治愈患者评估胃肠道症状（腹胀、稀便、便秘）。采用多变量逻辑回归分析评估 FMT 后胃肠道症状的预测因素。
结果
共 150 例患者因复发性 CDI 接受 FMT，其中 68.7%（103 例）为女性，平均年龄为 61.5 岁±18.1 岁，31 例（20.7%）患有既往的肠易激综合征。36 例经结肠镜检查使用患者选择的供体进行 FMT，67 例经结肠镜检查使用粪便库供体进行 FMT，47 例经粪便库胶囊进行 FMT。在治愈的患者中，41 例（31.2%）在 FMT 后出现胃肠道症状。与症状相关的因素包括年龄较小（57.2 岁 vs. 64.1 岁，P=0.03）、基线时有肠易激综合征史（36.6% vs. 13.3%，P=0.002）和既往炎症性肠病（31.7% vs. 10%，P=0.002）。小肠接触供体粪便与症状无关（63.4% vs. 62.2%，P=0.89）。
结论
排便习惯改变是 CDI 的后果，在 FMT 后很常见。本研究表明，供体类型和 FMT 输送方式与 FMT 后不规则胃肠道症状的存在无关。
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