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系统评价与荟萃分析:胶囊化粪便微生物群移植——临床疗效证据

Systematic review with meta-analysis: encapsulated faecal microbiota transplantation - evidence for clinical efficacy.

作者信息

Cold Frederik, Baunwall Simon Mark Dahl, Dahlerup Jens Frederik, Petersen Andreas Munk, Hvas Christian Lodberg, Hansen Lars Hestbjerg

机构信息

Department of Plant and Environmental Sciences, Copenhagen University, 1871 Frederiksberg, Denmark.

Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Therap Adv Gastroenterol. 2021 Aug 31;14:17562848211041004. doi: 10.1177/17562848211041004. eCollection 2021.


DOI:10.1177/17562848211041004
PMID:34484424
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8414624/
Abstract

BACKGROUND: Faecal microbiota transplantation (FMT) is an effective treatment of recurrent infection (rCDI) and is being applied experimentally in other diseases. Encapsulated administration may be equivalent in efficacy to delivery through other routes. METHODS: A systematic review was undertaken of studies using encapsulated FMT up to 26 October 2020. Data on indication, clinical outcomes, safety, treatment protocol and capsule preparation were collected and reported. Pooled rates of clinical efficacy in rCDI were calculated using random-effects meta-analysis. The impact of single variables on clinical efficacy was evaluated using univariate meta-regression. RESULTS: A total of 35 studies reporting the treatment of 960 patients with encapsulated FMT for eight different indications met the inclusion criteria. Most studies ( = 18, 51%) and patients ( = 755, 79%) were from studies on rCDI. Cure rates after single and multiple courses of treatments with encapsulated FMT in rCDI were 85% (95% CI: 82%-88%) and 93% (95% CI: 88%-96%) respectively. The treatment outcome was not significantly affected by dose, number of delivered capsules, anaerobic/aerobic processing, single/multi-donor treatment, lyophilisation, or any other single factor in the production or delivery of encapsulated FMT. Promising but non-comparable results from the treatment of ulcerative colitis and multidrug-resistant organisms were reported. CONCLUSIONS: Encapsulated FMT is an effective and safe treatment of rCDI, with cure rates comparable to FMT delivered through other routes. The treatment is effective despite variations in donor screening, preparation and treatment protocol. For other indications, the role of FMT capsules is still not sufficiently examined, although some studies show promising results. PLAIN LANGUAGE SUMMARY: The bacteria and other microorganisms of the gut is different in patient with various diseases in comparison with healthy subjects.Therefore, ways to change the microorganisms of the gut in a beneficial direction has been the subject of various research projects within recent years.Faecal microbiota transplantation often referred as FMT is a method of transferring microorganisms from healthy donors to patients with various diseases and is seen as one way to change the microbial community of the gut in a beneficial direction.Faecal microbiota transplantation can be performed in different ways such as through endoscopy, enemas or capsules. The transfer through capsules is preferred by the patients and has advantages since it can be administered long-term and can be delivered to the patients in their home. In this paper, we evaluated all accessible research reporting treatment with encapsulated faecal microbiota transplantation in the treatment of various diseases. We report the following major findings:-Treatment with capsules is safe when guidelines for screening donors and testing faecal material is followed.-The treatment is highly effective in the treatment of recurrent infection, a disease with high mortality often caused by repeated antibiotic treatments. The treatment was effective in 596 of 723 patients following one course of capsule treatment.-Faecal microbiota transplantation delivered through capsules is as effective as treatment delivered through other routes in the treatment of infection.-The treatment is effective in the treatment of infection across studies and countries, despite great differences in the ways the capsules were prepared and delivered.-Increasing the amount of faecal material used in the production did not affect the efficacy of the treatment.-There are promising results in the treatment of other diseases such as liver disease, inflammatory bowel disease and the treatment of multi-drug resistant bacteria.

摘要

背景:粪菌移植(FMT)是复发性艰难梭菌感染(rCDI)的有效治疗方法,目前正在其他疾病中进行实验性应用。胶囊给药在疗效上可能与其他给药途径相当。 方法:对截至2020年10月26日使用胶囊型FMT的研究进行系统评价。收集并报告有关适应证、临床结局、安全性、治疗方案和胶囊制备的数据。使用随机效应荟萃分析计算rCDI的临床疗效合并率。使用单变量荟萃回归评估单个变量对临床疗效的影响。 结果:共有35项研究报告了使用胶囊型FMT治疗960例患者的8种不同适应证,这些研究符合纳入标准。大多数研究(n = 18,51%)和患者(n = 755,79%)来自rCDI相关研究。rCDI患者接受单疗程和多疗程胶囊型FMT治疗后的治愈率分别为85%(95%CI:82%-88%)和93%(95%CI:88%-96%)。治疗结局不受剂量、给药胶囊数量、厌氧/需氧处理、单供体/多供体治疗、冻干或胶囊型FMT生产或给药中的任何其他单一因素的显著影响。有关于溃疡性结肠炎和多重耐药菌治疗的有前景但不可比的结果报道。 结论:胶囊型FMT是rCDI的一种有效且安全的治疗方法,治愈率与通过其他途径进行的FMT相当。尽管在供体筛选、制备和治疗方案方面存在差异,但该治疗方法仍然有效。对于其他适应证,尽管一些研究显示出有前景的结果,但FMT胶囊的作用仍未得到充分研究。 通俗易懂的总结:与健康受试者相比,患有各种疾病的患者肠道中的细菌和其他微生物存在差异。因此,近年来如何将肠道微生物向有益方向改变一直是各种研究项目的主题。粪菌移植通常称为FMT,是一种将微生物从健康供体转移到患有各种疾病患者体内的方法,被视为将肠道微生物群落向有益方向改变的一种方式。粪菌移植可以通过不同方式进行,如通过内窥镜检查、灌肠或胶囊。通过胶囊进行的移植受患者青睐且具有优势,因为它可以长期给药,并且可以在患者家中给药。在本文中,我们评估了所有可获取的关于使用胶囊型粪菌移植治疗各种疾病的研究报告。我们报告了以下主要发现: - 当遵循供体筛选和粪便材料检测指南时,胶囊治疗是安全的。 - 该治疗在复发性艰难梭菌感染的治疗中非常有效,这是一种常由反复抗生素治疗导致高死亡率的疾病。在723例患者中,596例患者在接受一个疗程的胶囊治疗后有效。 - 在治疗艰难梭菌感染方面,通过胶囊进行的粪菌移植与通过其他途径进行的治疗效果一样好。 - 尽管胶囊的制备和给药方式存在很大差异,但在不同研究和国家中,该治疗在治疗艰难梭菌感染方面都是有效的。 - 增加生产中使用的粪便材料量并不影响治疗效果。 - 在其他疾病如肝病、炎症性肠病以及多重耐药菌的治疗方面有有前景的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e659/8414624/66f42e2fe5b4/10.1177_17562848211041004-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e659/8414624/bcda0c899db0/10.1177_17562848211041004-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e659/8414624/66886da41f06/10.1177_17562848211041004-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e659/8414624/66f42e2fe5b4/10.1177_17562848211041004-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e659/8414624/bcda0c899db0/10.1177_17562848211041004-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e659/8414624/66886da41f06/10.1177_17562848211041004-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e659/8414624/66f42e2fe5b4/10.1177_17562848211041004-fig3.jpg

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引用本文的文献

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J Pediatr Gastroenterol Nutr. 2025-9

[2]
Faecal microbiota transplantation for eradicating Helicobacter pylori infection: clinical practice and theoretical postulation.

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[3]
Validation methods for encapsulated faecal microbiota transplantation: a scoping review.

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[4]
Should the Faecal Microbiota Composition Be Determined to Certify a Faecal Donor?

Diagnostics (Basel). 2024-11-22

[5]
Encapsulated donor faeces for faecal microbiota transplantation: the Glyprotect protocol.

Therap Adv Gastroenterol. 2024-10-13

[6]
Past, present, and future of microbiome-based therapies.

Microbiome Res Rep. 2024-3-18

[7]
The gut microbiome dysbiosis and regulation by fecal microbiota transplantation: umbrella review.

Front Microbiol. 2023-11-3

[8]
Fecal microbiota transplantation for the treatment of irritable bowel syndrome: A systematic review and meta-analysis.

World J Gastroenterol. 2023-5-28

[9]
Future Modulation of Gut Microbiota: From Eubiotics to FMT, Engineered Bacteria, and Phage Therapy.

Antibiotics (Basel). 2023-5-8

[10]
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[1]
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Endocrinology. 2021-7-1

[2]
Oral Fecal Microbiota Transplant Capsules Are Safe and Effective for Recurrent Clostridioides difficile Infection: A Systematic Review and Meta-Analysis.

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Oral Capsulized Fecal Microbiota Transplantation for Eradication of Carbapenemase-producing Enterobacteriaceae Colonization With a Metagenomic Perspective.

Clin Infect Dis. 2021-7-1

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