Department of Microbiota Medicine & Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing 210011, China; Key Lab of Holistic Integrative Enterology, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing 210011, China.
Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing 210029, China.
Prog Neuropsychopharmacol Biol Psychiatry. 2023 Dec 20;127:110839. doi: 10.1016/j.pnpbp.2023.110839. Epub 2023 Aug 9.
OBJECTIVE: Fecal microbiota transplantation (FMT) has been reported with the treatment potential for irritable bowel syndrome (IBS). However, the knowledge of its effect on extraintestinal symptoms of IBS is limited. This study aimed to evaluate the efficacy of the improved methodology of FMT, washed microbiota transplantation (WMT), on sleep disturbances, and psychological and gastrointestinal symptoms among patients with IBS. METHODS: This was a prospective observational study involving patients with IBS who underwent WMT. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The Gastrointestinal Symptom Rating Scale (GSRS) and IBS Severity Scoring System (IBS-SSS) were used to evaluate gastrointestinal symptoms and IBS severity, respectively. The Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) were used to evaluate depression and anxiety, respectively. All the symptoms were evaluated at baseline and one month after WMT. A multiple logistic regression model was used to determine the predictive factors of sleep improvement one month after WMT. RESULTS: Seventy-three patients with IBS were included in the study. Sleep quality (Z = -4.211, P < 0.001), anxiety (Z = -4.775, P < 0.001), depression (Z = -4.610, P < 0.001), gastrointestinal symptoms (Z = -5.364, P < 0.001), and IBS severity (Z = -6.468, P < 0.001) significantly improved one month after WMT in all patients. The scores of the five components of PSQI including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, and sleep disturbances decreased in 52 patients with poor sleep quality (all P < 0.05). Baseline sleep duration scores were identified as an independent predictive factor of sleep improvement one month after WMT in patients with poor sleep quality (OR 2.180 [95% CI = 1.017-4.673]; P = 0.045). Patients that experienced sleep improvement demonstrated greater alleviation in depression (Z = -1.990, P = 0.047) and IBS severity (Z = -2.486, P = 0.013) compared with patients without sleep improvement. CONCLUSION: This study suggested that WMT might be a promising therapy for patients with IBS, especially those with comorbid sleep and psychological disorders.
目的：粪便微生物群移植（FMT）已被报道具有治疗肠易激综合征（IBS）的潜力。然而，其对 IBS 的肠道外症状的影响的相关知识是有限的。本研究旨在评估改良的粪便微生物群移植（WMT）方法对 IBS 患者的睡眠障碍、心理和胃肠道症状的疗效。
方法：这是一项前瞻性观察性研究，纳入了接受 WMT 的 IBS 患者。采用匹兹堡睡眠质量指数（PSQI）评估睡眠质量。采用胃肠道症状评分量表（GSRS）和 IBS 严重程度评分系统（IBS-SSS）分别评估胃肠道症状和 IBS 严重程度。采用抑郁自评量表（SDS）和焦虑自评量表（SAS）评估抑郁和焦虑。所有症状均在基线和 WMT 后 1 个月进行评估。采用多因素逻辑回归模型确定 WMT 后 1 个月睡眠改善的预测因素。
结果：本研究纳入了 73 例 IBS 患者。WMT 后，所有患者的睡眠质量（Z = -4.211，P < 0.001）、焦虑（Z = -4.775，P < 0.001）、抑郁（Z = -4.610，P < 0.001）、胃肠道症状（Z = -5.364，P < 0.001）和 IBS 严重程度（Z = -6.468，P < 0.001）均显著改善。在 52 例睡眠质量较差的患者中，PSQI 的五个组成部分（主观睡眠质量、睡眠潜伏期、睡眠时长、习惯性睡眠效率和睡眠障碍）的评分均降低（均 P < 0.05）。基线睡眠时长评分是睡眠质量较差的患者 WMT 后 1 个月睡眠改善的独立预测因素（OR 2.180 [95%CI = 1.017-4.673]；P = 0.045）。与未改善睡眠的患者相比，睡眠改善的患者抑郁（Z = -1.990，P = 0.047）和 IBS 严重程度（Z = -2.486，P = 0.013）的缓解程度更大。
结论：本研究表明，WMT 可能是治疗 IBS 患者的一种很有前途的治疗方法，尤其是伴有睡眠和心理障碍的患者。
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