粪菌移植在功能性便秘中的应用进展

<正>功能性便秘(functional constipation, FC)是在排除其他可能引发继发性便秘产生的原因及便秘型肠易激综合征,以排便困难、排便次数减少或排便不尽感为主要表现的现代常见肠道疾病之一^[1]。由于其具体发病机制暂未明确,导致难以根治,症状的反复严重影响了人类的生存质量。近年来,微生态制剂的贡献,使得FC与肠道菌群的认识不断深入,通过重建肠道固有微生态平衡,     

粪菌移植在老年慢性便秘中的应用现状

<正>便秘是临床上常见的一种疾病,根据罗马Ⅳ标准,当病程超过6个月,近3个月自主排便小于3次/w, 且排便时有至少1/4以上时间出现以下至少2项症状：排干球粪或硬块粪、排便不尽感、排便费力感、排便时直肠肛门梗阻感和(或)堵塞感、甚至需要用手来辅助排便者,即为慢性便秘^[1]。     

增液承气汤联合粪菌移植对慢性功能性便秘的疗效

目的:探讨增液承气汤联合粪菌移植对慢性功能性便秘的疗效。方法:选取2019年5月-2020年3月收治的124例慢性功能性便秘患者,按照随机数字表法分为研究组和对照组,对照组患者接受粪菌移植治疗,研究组患者在对照组基础上进行增液承气汤治疗,分析2组患者肠道菌群变化、胃肠电变化、症状改善情况以及相关积分改善情况。结果:研究组乙酰胆碱、c-kit原癌基因、血管活性肠肽、NO水平明显高于对照组(P<0.05);研究组餐前、餐后的胃肠电幅度以及频率均明显高于对照组(P<0.05);研究组Bristol粪便性状评分明显高于对照组(P<0.05),研究组便秘患者生活质量评价表评分、Wexner便秘评分得分明显低于对照组(P<0.05);研究组厌氧菌群乳杆菌、双歧杆菌水平高于对照组(P<0.05),肠杆菌、氧菌群酵母菌水平低于对照组(P<0.05);治疗期间2组患者均未出现明显不良反应。结论:对于慢性功能性便秘患者,在粪菌移植治疗的基础上联合进行增液承气汤治疗,可以有效改善肠道菌群分布,促进患者胃肠电恢复,改善临床症状,提高患者生存质量,具有较高的安全性,可以在临床中进行推广应用。     

慢性功能性便秘的微生态治疗进展

慢性功能性便秘是一种常见的肠道疾病,目前的治疗方法主要为药物治疗。肠道微生态的深入研究揭示了肠道微生态紊乱与肠道疾病的相互关联作用,而恢复肠道微生态平衡也逐渐成为疾病治疗的一种手段。近几年肠道微生态的治疗在慢性功能性便秘领域取得了一定的进展,口服益生菌以及粪菌移植等治疗手段均获得了良好的效果。本文对慢性功能性便秘的微生态治疗的研究进行初步总结,为后续的益生菌种类的完善和治疗手段的改进提供思路。     

粪菌移植治疗肝硬化的研究进展

<正>肝硬化是一种以肝脏弥漫性纤维化、假小叶和再生结节形成为病理特征的临床常见的慢性肝病,失代偿期肝硬化患者常死于感染、上消化道出血、肝性脑病(hepatic encephalopathy,HE)等并发症。肝硬化每年导致约116万人死亡,居全球常见死亡原因的第11位^[1]。2016年流行病学调查显示我国有近1 200万肝硬化及慢性肝病患者。     

粪菌移植与肝癌

<正>人体胃肠道栖息着大量的、种类繁多的微生物,其中最主要的是细菌,我们称之为肠道菌群。作为人体最复杂的微生态系统之一,肠道菌群对人类健康有着重要的影响。通过与肠粘膜相互作用,肠道菌群参与机体营养物质的新陈代谢和免疫调节等过程~([1])。不仅如此,肠道菌群和人体疾病的发生发展亦有重要的联系~([2])。肠道菌群失调不仅打破了所处肠道微环境的动态平衡,直接导致肠道疾病,而     

肠道菌群失调与慢性便秘的研究进展

慢性便秘患者存在肠道菌群失调,肠道菌群失调与慢性便秘的发生存在相关性,肠道微生态制剂对慢性便秘具有一定的治疗作用。该文就慢性便秘患者的肠道菌群改变、肠道菌群失调与慢性便秘的发生以及基于肠道微生态的治疗等方面的国内外研究进展作一综述。     

重视粪菌移植在血液系统疾病治疗中的价值

肠道菌群与人类健康和疾病密切相关.粪菌移植通过恢复肠道菌群稳态、调控肠道免疫应答等,可用于治疗多种疾病.近年来,随着相关基础和临床研究的开展,粪菌移植在血液系统疾病中的应用也有了很多的探索和突破.文章从粪菌移植在造血干细胞移植、免疫性血小板减少性紫癜、血液肿瘤免疫治疗、未来前景等方面,结合国内外最新研究进展进行阐述,为...     

慢性功能性便秘相关粪性结肠炎1例报道

通过1例报道罕见的慢性功能性便秘所致结肠炎患者的临床诊疗,增强临床医师对粪性结肠炎的认识,并减少误诊。     

粪菌移植治疗HBeAg阳性慢性乙型肝炎的研究进展

HBeAg血清学转换是HBeAg阳性慢性乙型肝炎(CHB)患者抗病毒治疗的一个重要过程,而基于恩替卡韦和替诺福韦等一线抗病毒药物的治疗,HBeAg血浆清除率和(或)血清学转换率较低,目前仍缺乏有效的根治方案。最新的研究表明,粪菌移植(FMT)能诱导长期抗病毒治疗的HBeAg阳性CHB患者体内HBeAg的清除。对FMT诱导HBeAg阳性CHB患者HBeAg清除的研究进展进行综述,认为FMT有望成为HBeAg阳性CHB患者治疗方案的新选择。     

粪菌移植治疗非酒精性脂肪性肝病研究进展

非酒精性脂肪肝病（non-alcoholic fatty liver disease, NAFLD）的发病率在世界范围内呈明显上升趋势,由于目前尚无确切的特效治疗方式,严重影响人类健康。近年来,越来越多的研究表明肠道菌群通过肝-肠轴影响肝功能,肠道菌群失调是NAFLD发病的重要原因。因此,纠正肠道菌群失调,可以预防和减轻NAFLD的发生、发展。粪菌移植（fecal microbiota transplantation, FMT）被认为是纠正肠道菌群失调最有效的方法,但其在NAFLD中的治疗作用还未明确。此外,FMT治疗NAFLD的潜在分子机制也尚未阐明。本文就FMT治疗NAFLD的研究现状进行总结,并发掘其潜在的分子机制,为FMT作为治疗NAFLD的有效手段提供理论支持。     

功能性便秘和便秘型肠易激综合征的治疗研究进展

功能性便秘(FC)和便秘型肠易激综合征(IBS-C)是临床常见的功能性胃肠病,传统治疗方法往往无法有效解决患者的便秘及腹部症状,各种新的治疗方法值得关注.该文从生活方式干预、药物治疗、非药物治疗及精神心理干预方面综述了FC及IBS-C的治疗研究进展,以期为这两种疾病的治疗提供思路.     

The combined therapy of fecal microbiota transplantation and laxatives for functional constipation in adults: A systematic review and meta-analysis of randomized controlled trials

Objective:Functional constipation is a prevalent, burdensome gastrointestinal disorder whose treatment remains challenging. Combined therapy uniting multiple treatments may be promising. Fecal microbiota transplantation (FMT) which tends to be an etiological treatment has been increasingly investigated in its management. Meanwhile, laxatives are widely used to relieve constipation temporarily, but their overall efficacy is poor. Therefore, we performed meta-analyses of randomized controlled trials to evaluate the joint efficacy of FMT and laxatives in functional constipation.Methods:We performed a systematic literature search of 6 electronic databases as of August 11, 2020. Randomized controlled trial of FMT together with laxatives vs laxatives alone in functional constipation in adults were included. Two reviewers independently performed the screening, data extraction, and bias assessment. Dichotomous outcome data were synthesized by risk ratio, and measurement data by weighted mean difference (WMD).Results:A total of 1400 records were identified, of which 5 were eligible (409 patients). Overall, compared to laxatives alone, combined therapy of FMT and laxatives more significantly improved total effective rate (risk ratio: 1.35; 95% confidence interval [CI]: 1.14, 1.60; I² = 13%), Bristol stool form scale score (WMD: 1.04; 95% CI: 0.57, 1.51; I² = 76%), reduce Wexner score (WMD: −3.25; 95% CI: −5.58, −0.92; I2 = 92%), Knowles-Eccersley-Scott-Symptom (KESS) score (WMD: −5.65; 95% CI: −7.62, −3.69; I² = 0%) and patient assessment of constipation quality of life score (WMD: −18.56; 95%; CI: −26.43, −10.68; I² = 78%). No serious adverse events were reported. The majority of included studies had poor methodological quality.Conclusion:Combined therapy of FMT and laxatives may be a reasonably effective and safe treatment for people with functional constipation. However, caution is needed with the interpretation of these data due to the small sample size, high heterogeneity, and low quality of the studies. Besides, we expect that more studies will be performed exploring the efficacy and safety of combined therapy for functional constipation.     

Chinese physicians' perceptions of fecal microbiota transplantation

AIM: To explore Chinese physicians' perceptions towards fecal microbiota transplantation(FMT) and to provide information and an assessment of FMT development in China.METHODS: A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture(REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.RESULTS: Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647(76.7%) gastroenterologists and 197(23.3%) physicians in other departments(nongastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists'(54.3 vs 16.5%, P 0.001); however, acceptance of FMT was not statistically different(92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients(79.2%), absence of guidelines(56.9%), and administration and ethics(46.5%). On the basis of understanding, the FMT indications preferred byphysicians were recurrent Clostridium difficile infection(86.7%), inflammatory bowel disease combined with Clostridium difficile infection(78.6%), refractory ulcerative colitis(70.9%), ulcerative colitis(65.4%), Crohn's disease(59.4%), chronic constipation(43.7%), irritable bowel syndrome(39.1%), obesity(28.1%) and type 2 diabetes(23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment. CONCLUSION: Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.     

Role of fecal microbiota transplantation in inflammatory bowel disease

There is increasing evidence of the key role played by altered intestinal microbiota in the pathogenesis of inflammatory bowel disease (IBD). Management strategies involving immune modulation are effective and widely used, but treatment failures and side effects occur. Fecal microbiota transplantation (FMT) provides a novel, perhaps complementary, strategy to restore the normal gut microbiota in patients with IBD. This review summarizes the available efficacy and safety data on the use of FMT in patients with IBD. Several aspects remain to be clarified about the clinical predictors of the response to FMT, its most appropriate route of administration, and the most appropriate quantity and quality of microbiota to be transplanted. Further studies focusing on long‐term outcomes and safety are also warranted.