肠易激综合征的粪便微生物群移植：随机对照试验的系统评价和荟萃分析。
Fecal microbiota transplantation for irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China.
Department of Histology and Embryology, Medical College of Northwest Minzu University, Lanzhou, China.
出版信息
Front Immunol. 2023 May 18;14:1136343. doi: 10.3389/fimmu.2023.1136343. eCollection 2023.
OBJECTIVE
Whether fecal microbiota transplantation (FMT) in patients with irritable bowel syndrome (IBS) is effective in improving outcomes remains controversial. We assessed the safety and efficacy of FMT for patients with IBS.
METHODS
In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, the Cochrane Library, the clinicaltrials.gov and International Clinical Trials Registry Platform (ICTRP) up to February 25, 2022, updated to March 28, 2023. Randomized controlled trials (RCTs) compared the stool and capsule FMT with placebo in patients with IBS were included. Two authors independently assessed study eligibility, extracted the data, and assessed risk of bias. We did meta-analysis with RevMan, and the Stata software was used for sensitivity analysis and meta-regression. The GRADE system was used to assess the quality of evidences. Mean difference (MD) or standardized Mean difference (SMD) with 95% CI for continuous data, and risk ratios (RR) with 95% CI for dichotomous data were used with random-effects models. The primary outcomes included the clinical response rate and IBS-SSS score. This study is registered with PROSPERO: CRD42022328377.
RESULTS
Nineteen reports from nine RCTs were included finally. Compared with the placebo, a single stool FMT could significantly decrease the IBS-SSS score at 1 month (MD=-65.75, 95%CI [-129.37, -2.13]), 3 months (MD=-102.11, 95% CI [-141.98, -62.24]), 6 months (MD=-84.38, 95%CI [-158.79, -9.97]), 24 months (MD=-110.41, 95%CI [-145.37, -75.46]), and 36 months (MD=-104.71, 95%CI [-137.78, -71.64]). It also could improve the clinical response rate at 3 months (RR=1.91, 95% [1.12, 3.25]), 24 months (RR=2.97, 95% [1.94, 4.54]), and 36 months (RR=2.48, 95% [1.65, 3.72]), and increase the IBS-QoL score at 3 months, 24 months, and 36 months. FMT did not increase the serious adverse event. The risk of bias was low, and the quality of evidence based on GRADE system was moderate in the stool FMT group. However, we did not find positive effect of capsule FMT on patients with IBS based on the current available data.
CONCLUSION
A single stool FMT is effective and safe for patients with IBS. However, some factors may affect the effectiveness of FMT, and the relationship between the gut microbiome and the effect of FMT for IBS is still unclear.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022328377.
目的
粪便微生物群移植（FMT）在肠易激综合征（IBS）患者中的疗效是否能改善仍存在争议。我们评估了 FMT 对 IBS 患者的安全性和疗效。
方法
本系统评价和荟萃分析检索了 PubMed、Embase、Web of Science、Cochrane 图书馆、clinicaltrials.gov 和国际临床试验注册平台（ICTRP），截至 2022 年 2 月 25 日，2023 年 3 月 28 日更新。纳入了比较 FMT 粪便和胶囊与安慰剂治疗 IBS 患者的随机对照试验（RCT）。两名作者独立评估研究入选标准、提取数据，并评估偏倚风险。我们使用 RevMan 进行荟萃分析，使用 Stata 软件进行敏感性分析和荟萃回归。使用 GRADE 系统评估证据质量。连续数据采用均数差（MD）或标准化均数差（SMD），95%CI；二分类数据采用风险比（RR），95%CI。主要结局包括临床缓解率和 IBS-SSS 评分。本研究已在 PROSPERO 注册：CRD42022328377。
结果
最终纳入了来自 9 项 RCT 的 19 份报告。与安慰剂相比，单次粪便 FMT 可显著降低 1 个月（MD=-65.75，95%CI [-129.37，-2.13]）、3 个月（MD=-102.11，95%CI [-141.98，-62.24]）、6 个月（MD=-84.38，95%CI [-158.79，-9.97]）、24 个月（MD=-110.41，95%CI [-145.37，-75.46]）和 36 个月（MD=-104.71，95%CI [-137.78，-71.64]）的 IBS-SSS 评分。它还可以提高 3 个月（RR=1.91，95% [1.12，3.25]）、24 个月（RR=2.97，95% [1.94，4.54]）和 36 个月（RR=2.48，95% [1.65，3.72]）的临床缓解率，并增加 3 个月、24 个月和 36 个月的 IBS-QoL 评分。FMT 并不增加严重不良事件。偏倚风险低，基于 GRADE 系统的证据质量为中等，在粪便 FMT 组。然而，根据目前可用的数据，我们没有发现胶囊 FMT 对 IBS 患者有积极的影响。
结论
单次粪便 FMT 对 IBS 患者有效且安全。然而，一些因素可能会影响 FMT 的效果，肠道微生物群与 FMT 对 IBS 的效果之间的关系仍不清楚。
系统评价注册
https://www.crd.york.ac.uk/prospero/，标识符 CRD42022328377。
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