Liu Xiaolei, Li Yan, Wu Kaichun, Shi Yongquan, Chen Min
Department of Medical Insurance, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province 710032, China.
Department of Gastroenterology, The Affiliated Hospital of Qinghai University, Xining, Qinghai Province 810001, China.
Gastroenterol Res Pract. 2021 Apr 23;2021:6612970. doi: 10.1155/2021/6612970. eCollection 2021.
Increasing evidence supports the role of the gut microbiota in the etiology of ulcerative colitis (UC). Fecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridium difficile infection; however, its efficacy in UC is still controversial. A systematic review and meta-analysis was conducted to evaluate the efficacy and safety of FMT for treatment of active UC.
We searched Cochrane, Medline, Web of Science, and Embase from inception to February 2020. Randomized controlled trials (RCTs) recruiting adults with active UC, which compared FMT with controls, were eligible. The primary outcome was combined clinical remission with endoscopic remission/response. Secondary outcomes included clinical remission, endoscopic remission, and serious adverse events. Relative risk (RR) with 95% confidence interval (CI) is reported.
Five RCTs with 292 participants were eligible for inclusion. When data were pooled for all patients, FMT was associated with a higher combined clinical remission with endoscopic remission/response; the RR of combined outcome not achieving after FMT vs. control was 0.79 (95% CI 0.70-0.88). FMT delivered via lower gastrointestinal route was superior to upper gastrointestinal route with regard to combined clinical remission with endoscopic remission/response (RR = 0.79, 95% CI 0.70-0.89). FMT with pooled donor stool (RR = 0.69, 95% CI 0.56-0.85) and higher frequency of administration (RR = 0.76, 95% CI 0.62-0.93) may be more effective with regard to clinical remission. There was no statistically significant difference in serious adverse events with FMT compared with controls (RR = 0.98, 95% CI 0.93-1.03).
FMT shows a promising perspective with comparable safety and favorable clinical efficacy for the treatment of active UC in the short term. However, further larger, more rigorously conducted RCTs of FMT in UC are still needed in order to resolve the controversial questions.
越来越多的证据支持肠道微生物群在溃疡性结肠炎（UC）病因学中的作用。粪便微生物群移植（FMT）是治疗复发性艰难梭菌感染的一种高效疗法；然而，其在UC中的疗效仍存在争议。进行了一项系统评价和荟萃分析，以评估FMT治疗活动期UC的疗效和安全性。
我们检索了Cochrane、Medline、Web of Science和Embase数据库，检索时间从数据库建立至2020年2月。纳入招募活动期UC成年患者并将FMT与对照组进行比较的随机对照试验（RCT）。主要结局为临床缓解与内镜缓解/反应的联合情况。次要结局包括临床缓解、内镜缓解和严重不良事件。报告相对风险（RR）及95%置信区间（CI）。
五项RCT（共292名参与者）符合纳入标准。对所有患者的数据进行汇总时，FMT与更高的临床缓解与内镜缓解/反应联合率相关；FMT组与对照组相比联合结局未达成的RR为0.79（95%CI 0.70-0.88）。就临床缓解与内镜缓解/反应联合情况而言，经下消化道途径进行的FMT优于经上消化道途径（RR = 0.79，95%CI 0.70-0.89）。使用混合供体粪便的FMT（RR = 0.69，95%CI 0.56-0.85）以及更高的给药频率（RR = 0.76，95%CI 0.62-0.93）在临床缓解方面可能更有效。与对照组相比，FMT组严重不良事件无统计学显著差异（RR = 0.98，95%CI 0.93-1.03）。
FMT在治疗活动期UC方面显示出有前景的前景，短期内安全性相当且临床疗效良好。然而，仍需要进一步开展更大规模、更严格的FMT治疗UC的RCT，以解决存在争议的问题。
