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[粪便细菌保存时间对慢传输型便秘患者粪便微生物群移植结局的影响]

[Effect of fecal bacterial preservation time on the outcomes of fecal microbiota transplantation for slow transit constipation].

作者信息

Lin Z L, Chen Q Y, Tian H L, Yang B, Zhao D, Ye C, Zhang X Y, Ma C L, Qin H L, Li N

机构信息

Department of Colorectum, Intestinal Microenvironment Treatment Center, the Tenth People's Hospital, Medical School of Tongji University, Shanghai 200072, China.

Department of Colorectum, Intestinal Microenvironment Treatment Center, the Tenth People's Hospital, Medical School of Tongji University, Shanghai 200072, China; Institute for Intestinal Diseases, Medical School of Tongji University, Shanghai 200072, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Jul 10;23(Z1):56-62. doi: 10.3760/cma.j.cn.441530-20200414-00207.

Abstract

To investigate the effect of different fecal bacterial preservation time on the efficacy and complications of FMT. A retrospective cohort study was carried out. Clinical data of 483 patients with slow transit constipation undergoing voluntary FMT at Intestinal Microecology Diagnosis and Treatment Center from August 2017 to October 2019 were retrospectively collected. According to the storage time of fecal bacterial samples used in FMT treatment, the cases were divided into fresh bacterial solution (=29), bacterial solution stored at -80℃ for 1 week (=187), 1 month (=121), 3 months (=89), 6 months (=38), and 12 months (n=19). The total number of complete bowel movement, Wexner constipation score, gastrointestinal quality of life index (GIQLI), FMT satisfaction score and related adverse reactions were summarized and compared among groups 1 week and 1 month after FMT treatment. There were no statistically significant differences in the baseline data of patients among different bacterial solution storage time (all >0.05). After 1 month of treatment, the overall frequency of defecation of all the patients was (3.83 ± 1.22) times/week, Wexner constipation score was (6.74 ± 3.56) points, GIQLI score was (108.76 ± 15.38) points, clinical cure rate was 57.8% (279/483). The improvement rate was 66.3% (320/483), and the treatment satisfaction was (3.85 ± 0.93) points. No severe FMT-associated complication and death were observed during treatment and follow-up period. FMT-related adverse events occurred in 115 cases (23.8%), including nausea in 25 cases (5.2%), vomiting in 13 (2.7%), diarrhea in 21 (4.3%), abdominal pain in 16 (3.3%), abdominal distension in 33 (6.8%), sore throat in 56 (11.6%) and fever in 16(3.3%), all of which relieved after symptomatic treatment. There were no statistically significant differences in the number of defecations, Wexner constipation scores, and GIQLI scores before FMT, 1 week and 1 month after FMT treatment among different bacterial solution storage groups (all >0.05). Differences of clinical cure rate, clinical improvement rate, and treatment satisfaction of patients 1 week and 1 month after treatment were not statistically significant (all >0.05). Among the groups, differences in the overall complications and types of complications after FMT treatment were not statistically significant (all >0.05). FMT is safe and effective in the treatment of slow transit constipation. Fresh fecal bacterial samples or fecal bacterial samples frozen at -80℃ for 1 year can be safely applied to FMT for the treatment of slow transit constipation, with stable short-term efficacy and without serious adverse reactions.

摘要

探讨不同粪便细菌保存时间对粪菌移植(FMT)疗效及并发症的影响。进行了一项回顾性队列研究。回顾性收集了2017年8月至2019年10月在肠道微生态诊疗中心自愿接受FMT治疗的483例慢传输型便秘患者的临床资料。根据FMT治疗中使用的粪便细菌样本储存时间,将病例分为新鲜菌液组(n=29)、-80℃保存1周的菌液组(n=187)、1个月组(n=121)、3个月组(n=89)、6个月组(n=38)和12个月组(n=19)。总结并比较了FMT治疗后1周和1个月时各组的完全排便总数、Wexner便秘评分、胃肠道生活质量指数(GIQLI)、FMT满意度评分及相关不良反应。不同菌液储存时间患者的基线数据无统计学差异(均>0.05)。治疗1个月后,所有患者的排便总频率为(3.83±1.22)次/周,Wexner便秘评分为(6.74±3.56)分,GIQLI评分为(108.76±15.38)分,临床治愈率为57.8%(279/483)。改善率为66.3%(320/483),治疗满意度为(3.85±0.93)分。治疗及随访期间未观察到严重的FMT相关并发症及死亡。FMT相关不良事件发生115例(23.8%),其中恶心25例(5.2%),呕吐13例(2.7%),腹泻21例(4.3%),腹痛16例(3.3%),腹胀33例(6.8%),咽痛56例(11.6%),发热16例(3.3%),经对症治疗后均缓解。不同菌液储存组在FMT治疗前、治疗后1周和1个月时的排便次数、Wexner便秘评分及GIQLI评分无统计学差异(均>0.05)。治疗后1周和1个月时患者的临床治愈率、临床改善率及治疗满意度差异无统计学意义(均>0.05)。各组间FMT治疗后总体并发症及并发症类型差异无统计学意义(均>0.05)。FMT治疗慢传输型便秘安全有效。新鲜粪便细菌样本或-80℃冷冻1年的粪便细菌样本可安全应用于FMT治疗慢传输型便秘,短期疗效稳定,无严重不良反应。

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