重复多次粪菌移植联合部分肠内营养作为活动期儿童克罗恩病的一线治疗。
Repeated and multiple fecal microbiota transplantations plus partial enteral nutrition as the first-line treatment in active pediatric Crohn's disease.
机构信息
Pediatric Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
出版信息
Front Cell Infect Microbiol. 2023 Feb 23;13:1083236. doi: 10.3389/fcimb.2023.1083236. eCollection 2023.
BACKGROUND
Most studies have reported fecal microbiota transplantation (FMT) as an effective secondary option for Crohn's disease (CD). However, there is little data on FMT as a first-line treatment for CD. In our study we explore the rates of clinical and endoscopic remission and mucosal healing after FMT plus partial enteral nutrition (PEN), as a first-line treatment for active CD in children.
METHODS
We retrospectively enrolled pediatric CD patients who underwent PEN or PEN plus FMT treatment at diagnosis from November 2016 to July 2019 at the Pediatric Department, Tongji Hospital. The two groups were defined as FMT group (repeated and multiple doses of FMT plus PEN) or PEN group (PEN alone). All the patients received PEN intervention. At baseline and week 8- 10, the FMT group was administered multiple doses of FMT to help induce and maintain remission. All patients were evaluated at week 8- 10 and 18-22 clinical and relevant laboratory parameters and endoscopic results. The clinical and endoscopic remission and mucosal healing rates were compared between the two groups at different time points after the therapy.
RESULTS
Twenty-five newly diagnosed active CD patients were included in the study, containing 7 females and 18 males with a median age of 11. 1 ± 2.3 years. 13 and 12 patients were assigned to the PEN and FMT groups, respectively. At week 8-10, clinical remission was obtained in 83.3% and 53.8% of the FMT and PEN groups, respectively (p=0.202). The endoscopic remission rates were 72.7% for FMT and 25.0% for PEN (p=0.039), whereas the mucosal healing rates were 27.2% for FMT and 0% for PEN (p=0.093). At week 18-22, clinical remission was achieved in 72.7% and 20.0% of patients in the FMT and PEN groups, respectively (p=0.03). Theendoscopic remission rates were 66.6% and 12.5% in the FMT and PEN groups, respectively (p=0.05), whereas the mucosal healing rates were 55.5% and 0% in FMT and PEN groups, respectively (p=0.029).
CONCLUSION
This study demonstrate that FMT plus PEN can be used as a first-line treatment for active CD in children.
背景
大多数研究报道粪便微生物群移植（FMT）是克罗恩病（CD）的有效二线选择。然而，关于 FMT 作为 CD 的一线治疗的数据很少。在我们的研究中，我们探索了 FMT 加部分肠内营养（PEN）作为儿童活动性 CD 的一线治疗后的临床和内镜缓解以及黏膜愈合率。
方法
我们回顾性纳入了 2016 年 11 月至 2019 年 7 月在同济医院儿科接受 PEN 或 PEN 加 FMT 治疗的儿科 CD 患者。两组分别定义为 FMT 组（重复和多次 FMT 加 PEN）或 PEN 组（单独 PEN）。所有患者均接受 PEN 干预。在基线和 8-10 周时，FMT 组接受多次 FMT 以帮助诱导和维持缓解。所有患者均在治疗后 8-10 周和 18-22 周评估临床和相关实验室参数及内镜结果。比较两组在不同时间点的临床和内镜缓解及黏膜愈合率。
结果
本研究共纳入 25 例新诊断的活动性 CD 患者，其中女性 7 例，男性 18 例，中位年龄 11.1±2.3 岁。13 例和 12 例患者分别被分配到 PEN 和 FMT 组。在 8-10 周时，FMT 和 PEN 组的临床缓解率分别为 83.3%和 53.8%（p=0.202）。FMT 的内镜缓解率为 72.7%，PEN 为 25.0%（p=0.039），而 FMT 的黏膜愈合率为 27.2%，PEN 为 0%（p=0.093）。在 18-22 周时，FMT 和 PEN 组的临床缓解率分别为 72.7%和 20.0%（p=0.03）。FMT 和 PEN 组的内镜缓解率分别为 66.6%和 12.5%（p=0.05），而 FMT 和 PEN 组的黏膜愈合率分别为 55.5%和 0%（p=0.029）。
结论
本研究表明，FMT 加 PEN 可作为儿童活动性 CD 的一线治疗方法。
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