粪便病毒组移植的研究进展

随着多重耐药菌的出现,粪菌移植已被批准应用于临床治疗难治性细菌感染。对于使用粪菌移植疗法的患者,无论疗效如何,均存在菌群易位、重症感染等风险,所以人们迫切需要新的规避这些危险的方式。粪便病毒组移植是近年来提出的新型治疗方法。该方法对多重耐药菌感染等疾病的疗效与粪菌移植相当,更重要的是,它可以规避细菌感染的风险。目前已有研究支持粪便病毒组移植也可用于治疗肥胖、2型糖尿病、炎症性肠病等疾病。现就国内外在该领域的研究,对粪便病毒组移植的研究进展作一概述。     

粪菌移植对肠易激综合征临床疗效和肠道菌群影响的非对照初步研究

目的:探讨粪菌移植治疗IBS的有效性、安全性及其对IBS患者肠道菌群的影响。方法:选择2016年9月至2017年8月在广州市第一人民医院行粪菌移植的IBS住院患者28例。所有IBS患者于粪菌移植前、粪菌移植后4和12周完成肠易激综合征生活质量量表(IBS-QOL)、肠易激综合征严重程度系统评分(IBS-SSS)和胃肠道...     

粪菌移植用于改善肿瘤患者预后的进展

肠道菌群在肿瘤治疗中发挥重要作用,不仅可提高抗癌效果,还可减轻相关毒副反应。粪菌移植(FMT)作为重建肠道菌群的重要方法,其治疗适应证已从肠道疾病(如艰难梭菌感染、炎症性肠病)扩展到肠道外疾病。除了适应证的拓展,FMT领域在应用策略和粪菌制备上更加标准化、安全、可控。肠道菌群在肿瘤治疗中的有益作用促使微生态制剂迅速发展,但肠道菌群的复杂性、矛盾性和特异性又增加菌株制品研发的难度以及疗效和安全性的不确定。本文就粪菌移植用于肿瘤治疗的研究证据和发展方向进行综述。     

粪菌移植治疗非酒精性脂肪性肝病研究与思考

<正>1粪菌移植的起源与现状粪菌移植(fecal microbiota transplantation,FMT),也被少数人称为粪便移植(fecal transplantation)、粪菌治疗(fecal bacteriotherapy)和肠菌移植(intestinal microbiota transplantation),是指将健康人粪便中的功能菌群移植到患者胃肠道内,重建具有正常功能的肠道菌群,实现对肠道及肠道外疾病的治疗。粪菌移植的起源可追溯到公元300多年的时候,中国一名医生用健康人的新鲜粪便治疗严重的腹泻患     

肠道菌群与疾病关系的研究进展

多种疾病与肠道菌群失衡有关。肠道微生物参与宿主新陈代谢和免疫系统的调节,并与环境因子相互作用决定机体的健康和疾病状态。本文就肠道菌群与代谢综合征、炎症性肠病和结直肠癌等疾病关系的研究进展作一综述,进一步揭示了肠道微生物在人类健康中起到的重要作用,并通过介绍益生菌和粪菌移植等方法,为探索治疗诸多疾病提供新的方向。     

肠道菌群在抗肿瘤坏死因子-α生物制剂治疗炎症性肠病中的作用

抗肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)生物制剂逐渐改变了炎症性肠病(inflammatory bowel disease,IBD)的管理及治疗策略,部分患者对其原发无应答或继发失效,基于粪菌移植(fecal microbiota transplantation,FMT)研究发现...     

粪肠球菌在酒精性肝病中的研究进展

酒精性肝病(ALD)是世界范围内最常见的慢性肝病之一，包括脂肪变性、脂肪性肝炎、纤维化和肝硬化不同阶段。粪肠球菌是医院常见获得性感染菌群，对于酒精性肝炎患者预后具有重要影响。本篇综述重点介绍了ALD的发病因素和粪肠球菌的致病机理，总结了粪肠球菌在ALD中的研究进展，简述了临床上对于粪肠球菌感染的检测和治疗方法。由于临床上感染溶细胞性粪肠球菌的ALD患者死亡率极高，因此深入认识粪肠球菌成为当下重要问题。     

粪肠球菌主要毒力因子研究进展

粪肠球菌为条件性致病菌,是许多国家医院内感染的主要病原菌,也是一种新的人畜共患病病原体。粪肠球菌感染和致死主要是由其毒力因子引起的,本文概述了粪肠球菌主要毒力因子尤其是溶血素的研究进展,为粪肠球菌致病机制的研究奠定基础。     

肠道微生态重建在炎症性肠病治疗中的意义

尽管炎症性肠病(inflammatory bowel disease,IBD)的病因和发病机制尚未完全明确,但肠道中定植的大量微生物在肠道疾病发生中有着重要作用已是共识。既往的研究大多只关注细菌导致肠道炎症,而忽略了肠道中真菌、病毒、寄生虫等其他微生物对IBD的影响;并且饮食因素在改善肠道微生态环境和IBD症状上的重要作用也被很多研究者所忽略。近年来,"粪菌移植"作为一种整体的改善患者肠道微生态环境的方法也在IBD治疗过程中有良好的疗效。因此,本文就肠道微生态重建在IBD治疗中的意义作一概述。     

248株肠球菌对抗菌药物的敏感性分析

目的了解全身感染和伤口分泌物感染的粪肠球菌、屎肠球菌对抗菌药物的敏感性,为临床提供治疗依据。方法采用微量稀释法对248株自临床送检的血液、尿液及其他标本分离的肠球菌进行药敏试验,测定其MIC值。结果248株肠球菌属中,粪肠球菌187株、屎肠球菌61株,两者的比例为3.06∶1。粪肠球菌对氨苄西林、环丙沙星、左氧氟沙星、青霉素G的敏感率为63.2%～99.1%,高于屎肠球菌的16.7%～31.9%;屎肠球菌对四环素的敏感率为40.3%,高于粪肠球菌的19.3%;2种肠球菌对红霉素的敏感率分别是13.9%和8.3%,对利奈唑烷和万古霉素的敏感性均＆gt;95%;分离自伤口分泌物的粪肠球菌对氨苄西林、环丙沙星、左氧氟沙星、青霉素G、四环素的敏感性略高于血液分离菌,分离自伤口分泌物的屎肠球菌对氨苄西林、红霉素、高浓度庆大霉素、青霉素G、四环素的敏感性低于血液分离菌,伤口分泌物和血液分离得到屎肠球菌对利奈唑烷均100.0%敏感。结论粪肠球菌、屎肠球菌对不同的抗菌药物的敏感性差异较大,治疗时应根据耐药特点及菌种间的耐药性差异选择相应的药物和方案,目前万古霉素和利奈唑烷仍然是治疗肠球菌属感染的有效药物。     

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.     

Therapies to modulate gut microbiota:Past,present and future

The human gut microbiota comprises of a complex and diverse array of microorganisms,and over the years the interaction between human diseases and the gut microbiota has become a subject of growing interest.Disturbed microbial milieu in the gastrointestinal tract is central to the pathogenesis of several diseases including antibiotic-associated diarrhea and Clostridioides difficile infection(CDI).Manipulation of this microbial milieu to restore balance by microbial replacement therapies has proven to be a safe and effective treatment for recurrent CDI.There is considerable heterogeneity in various aspects of stool processing and administration for fecal microbiota transplantation(FMT)across different centers globally,and standardized microbioal replacement therapies offer an attractive alternative.The adverse effects associated with FMT are usually mild.However,there is paucity of data on long term safety of FMT and there is a need for further studies in this regard.With our increasing understanding of the host-microbiome interaction,there is immense potential for microbial replacement therapies to emerge as a treatment option for several diseases.The role of microbioal replacement therapies in diseases other than CDI is being extensively studied in ongoing clinical trials and it may be a potential treatment option for inflammatory bowel disease,irritable bowel syndrome,obesity,multidrug resistant infections,and neuropsychiatric illnesses.Fecal microbiota transplantation for non-CDI disease states should currently be limited only to research settings.     

Step-up fecal microbiota transplantation (FMT) strategy

Gut dysbiosis is a characteristic of inflammatory bowel disease (IBD) and is believed to play a role in the pathogenesis of IBD. Fecal microbiota transplantation (FMT) is an effective strategy to restore intestinal microbial diversity and has been reported to have a potential therapeutic value in IBD. Our recent study reported a holistic integrative therapy called “step-up FMT strategy,” which was beneficial in treating steroid-dependent IBD patients. This strategy consists of scheduled FMTs combined with steroids, anti-TNF-α antibody treatment or enteral nutrition. Herein, we will elaborate the strategy thoroughly, introducing the concept, potential indication, methodology, and safety of “step-up FMT strategy” in detail.     

粪便微生物群移植在部分消化疾病治疗中的应用及安全性问题

肠道微生物是机体不可或缺的部分,与机体各种功能的正常发挥及多种疾病的发生有密切关系.粪便微生物群移植(faecal microbiota transplantation, FMT)是纠正肠道微生态失调的主要方法,目前食品与药品管理局已批准用于治疗难治/复发性艰难梭菌感染,大量的临床研究提示FMT或许对于其他多种疾病有一定疗效.本文对目前FMT临床应用研究较多的几种消化系统疾病如炎症性肠病、肝性脑病、肠易激综合征及肿瘤的研究状况进行了简要综述,总结了这些临床研究中发现的不良反应及并发症,结合对FMT的管理规范,对其安全性进行了讨论.     

Can control of gut microbiota be a future therapeutic option for inflammatory bowel disease?

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract encompassing two main clinical entities, Crohn’s disease and ulcerative colitis. Accumulated evidence indicates that an aberrant immune activation caused by the interplay of genetic susceptibility and environmental impact on the gut microbiota may be involved in the pathogenesis of IBD. Rapid advances in next-generation sequencing technology have enabled a number of studies to identify the alteration of the gut microbiota, termed dysbiosis, in IBD. Moreover, the alteration in the metabolites derived from the gut microbiota in IBD has also been described in many studies. Therefore, microbiota-based interventions such as fecal microbiota transplantation (FMT) have attracted attention as a novel therapeutic option in IBD. However, in clinical trials, the efficacy of FMT for IBD remains controversial. Additional basic and clinical studies are required to validate whether FMT can assume a complementary role in the treatment of IBD. The present review provides a synopsis on dysbiosis in IBD and on the association between the gut microbiota and the pathogenesis of IBD. In addition, we summarize the use of probiotics in IBD and the results of current clinical trials of FMT for IBD.     

Fecal microbiota transplantation for severe enterocolonic fistulizing Crohn’s disease

The concept of fecal microbiota transplantation(FMT)has been used in traditional Chinese medicine at least since the 4thcentury.Evidence from recent human studies strongly supports the link between intestinal bacteria and inflammatory bowel disease.We proposed that standardized FMT might be a promising rescue therapy for refractory inflammatory bowel disease.However,there were no reports of FMT used in patients with severe Crohn’s disease(CD).Here,we report the successful treatment of standardized FMT as a rescue therapy for a case of refractory CD complicated with fistula,residual Barium sulfate and formation of intraperitoneal large inflammatory mass.As far as we know,this is the first case of severe CD treated using FMT through mid-gut.     

Relationship between intestinal microbiota and ulcerative colitis: Mechanisms and clinical application of probiotics and fecal microbiota transplantation

Ulcerative colitis(UC) is an inflammatory disease that mainly affects the colon and rectum. It is believed that genetic factors, host immune system disorders, intestinal microbiota dysbiosis, and environmental factors contribute to the pathogenesis of UC. however, studies on the role of intestinal microbiota in the pathogenesis of UC have been inconclusive. Studies have shown that probiotics improve intestinal mucosa barrier function and immune system function and promote secretion of anti-inflammatory factors, thereby inhibiting the growth of harmful bacteria in the intestine. Fecal microbiota transplantation(FMT) can reduce bowel permeability and thus the severity of disease by increasing the production of short-chain fatty acids, especially butyrate, which help maintain the integrity of the epithelial barrier. FMT can also restore immune dysbiosis by inhibiting Th1 differentiation, activity of T cells, leukocyte adhesion, and production of inflammatory factors. Probiotics and FMT are being increasingly used to treat UC, but their use is controversial because of uncertain efficacy. Here, we briefly review the role of intestinal microbiota in thepathogenesis and treatment of UC.     

Gut microbiota in ulcerative colitis: insights on pathogenesis and treatment

Gut microbiota constitute the largest reservoir of the human microbiome and are an abundant and stable ecosystem—based on its diversity, complexity, redundancy, and host interactions This ecosystem is indispensable for human development and health. The integrity of the intestinal mucosal barrier depends on its interactions with gut microbiota. The commensal bacterial community is implicated in the pathogenesis of inflammatory bowel disease (IBD), including ulcerative colitis (UC). The dysbiosis of microbes is characterized by reduced biodiversity, abnormal composition of gut microbiota, altered spatial distribution, as well as interactions among microbiota, between different strains of microbiota, and with the host. The defects in microecology, with the related metabolic pathways and molecular mechanisms, play a critical role in the innate immunity of the intestinal mucosa in UC. Fecal microbiota transplantation (FMT) has been used to treat many diseases related to gut microbiota, with the most promising outcome reported in antibiotic‐associated diarrhea, followed by IBD. This review evaluated the results of various reports of FMT in UC. The efficacy of FMT remains highly controversial, and needs to be regularized by integrated management, standardization of procedures, and individualization of treatment.     

Future prospect of faecal microbiota transplantation as a potential therapy in asthma

There is convincing evidence from both human and animal studies suggesting that the gut microbiota plays an important role in regulating immune responses associated with the development of asthma. Certain intestinal microbial strains have been demonstrated to suppress or impair immune responsiveness in asthma experimental models, suggesting that specific species among gut commensal microbiota may play either a morbific or phylactic role in the progression of asthma. Evidence to date suggests that the intestinal microbiota represent fertile targets for prevention or management of asthma. The faecal microbiota transplantation (FMT) is a rather straightforward therapy that manipulates the human gastrointestinal (GI) microbiota, by which a healthy donor microbiota is transferred into an existing but disturbed microbial ecosystem. The FMT may therefore represent a therapeutic approach for asthma treatment in the foreseeable future. At present, FMT therapy for asthma is very limited and should be actively studied. Considerable efforts are needed to increase our knowledge in the field of FMT therapy for asthma. In this review, we aimed to provide several insights into the development of FMT therapy for asthma.