溃疡性结肠炎患者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 patients with ulcerative colitis: a systematic review and meta-analysis of randomized control trials.
作者信息
Gefen R, Dourado J, Emile S H, Wignakumar A, Rogers P, Aeschbacher P, Garoufalia Z, Horesh N, Wexner S D
机构信息
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Department of General Surgery Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
出版信息
Tech Coloproctol. 2025 Apr 17;29(1):103. doi: 10.1007/s10151-025-03113-7.
BACKGROUND
Fecal microbiota transplantation (FMT) has been shown to restore gut microbiome composition with an acceptable safety profile. FMT in inflammatory bowel disease, specifically ulcerative colitis (UC), has been investigated. We aimed to assess the efficacy of FMT in inducing UC remission.
METHODS
PubMed, Scopus, Google Scholar, and clinicaltrials.gov were searched for randomized control trials that assessed FMT in inducing UC remission. The primary outcome was combined clinical and endoscopic remission. Secondary outcomes were clinical remission, endoscopic remission, post-treatment overall adverse events, and colitis. Sensitivity analyses, meta-regression, bias assessment, and grading of certainty of evidence were performed.
RESULTS
A total of 14 studies including 600 patients (55.8% male; median age 40.7 years) were assessed. FMT was used in 299 patients and associated with significantly higher odds of combined clinical and endoscopic remission (OR 2.25, 95% CI 1.54, 3.3; p < 0.0001), clinical remission (OR 2.02, 95% CI 1.4, 2.93; p = 0.0002), and endoscopic remission (OR 1.95, 95% CI 1.17, 3.28; p = 0.011). The odds of post-treatment overall adverse events (OR 1.24, 95% CI 0.79, 1.95; p = 0.34) and colitis (OR 0.85, 95% CI 0.52, 1.93; p = 0.512) were similar between groups. Compared with baseline, FMT was more effective when biologics (OR 2.71), steroids (OR 2.27), or methotrexate (OR 3.07) were used as pre-FMT treatment. Oral delivery of FMT (OR 3.15) and pooled donors (OR 3.32) led to higher odds of remission. On meta-regression, pooled donors and methotrexate pre-treatment were associated with an increased likelihood of remission.
CONCLUSIONS
FMT is promising in inducing UC remission. Administration of medical treatments before FMT may help achieve higher remission rates. Current evidence shows that oral delivery of FMT and multidonor FMT may confer better results.
背景
粪便微生物群移植（FMT）已被证明可恢复肠道微生物群组成，且安全性可接受。FMT在炎症性肠病，特别是溃疡性结肠炎（UC）中的应用已得到研究。我们旨在评估FMT诱导UC缓解的疗效。
方法
检索PubMed、Scopus、谷歌学术和clinicaltrials.gov，以查找评估FMT诱导UC缓解的随机对照试验。主要结局是临床和内镜联合缓解。次要结局是临床缓解、内镜缓解、治疗后总体不良事件和结肠炎。进行了敏感性分析、meta回归、偏倚评估和证据确定性分级。
结果
共评估了14项研究，包括600例患者（男性占55.8%；中位年龄40.7岁）。299例患者使用了FMT，其临床和内镜联合缓解（OR 2.25，95%CI 1.54，3.3；p<0.0001）、临床缓解（OR 2.02，95%CI 1.4，2.93；p=0.0002）和内镜缓解（OR 1.95，95%CI 1.17，3.28；p=0.011）的几率显著更高。治疗后总体不良事件（OR 1.24，95%CI 0.79，1.95；p=0.34）和结肠炎（OR 0.85，95%CI 0.52，1.93；p=0.512）的几率在两组之间相似。与基线相比，当使用生物制剂（OR 2.71）、类固醇（OR 2.27）或甲氨蝶呤（OR 3.07）作为FMT前治疗时，FMT更有效。口服FMT（OR 3.15）和汇集供体（OR 3.32）导致缓解几率更高。在meta回归中，汇集供体和甲氨蝶呤预处理与缓解可能性增加相关。
结论
FMT在诱导UC缓解方面很有前景。在FMT前给予药物治疗可能有助于实现更高的缓解率。目前的证据表明，口服FMT和多供体FMT可能会带来更好的结果。
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