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不同移植途径的菌群移植对慢传输型便秘临床疗效的影响

Effects of fecal microbiota transplantation in different routes on the clinical efficacy of slow transit constipation

摘要:

目的:探讨不同移植途径的菌群移植(FMT)治疗慢传输型便秘(STC)的有效性和安全性。方法:采用回顾性队列研究方法。收集2018年5月至2019年5月期间,于同济大学附属第十人民医院自愿接受FMT治疗的270例STC患者的临床资料,供体采用非亲属健康成年标准供体。FMT治疗途径包括经鼻肠管(入空肠)输注肠菌溶液移植治疗(鼻肠管组,120例)、经口服肠菌胶囊治疗(口服胶囊组,120例)以及经结肠镜途径输注肠菌溶液移植治疗(结肠镜组,30例)3种方法。比较3组患者治疗的有效性和安全性。结果:3组移植菌群均为从100 g新鲜粪便提取出,3组患者均顺利完成菌群移植,鼻肠管组、口服胶囊组和结肠镜组治疗等待时间分别为(1.5±0.5)d、(0.4±0.3)d和(3.6±0.8)d( F=9.210, P=0.03)。移植途径建立费用分别为(495±20)元、(25±10)元和(1 420±45)元( F=10.600, P=0.01),差异均有统计学意义。鼻肠管组、口服胶囊组和结肠镜组FMT治疗后1个月临床改善率分别为74.2%(89/120)、60.0%(72/120)和53.3%(16/30)(χ 2=5.990, P<0.05);治疗后3个月临床改善率分别为71.1%(69/97)、53.6%(45/84)和44.0%(11/25)(χ 2=7.620, P<0.05),差异均有统计学意义。结肠镜组不良反应发生率为76.7%(23/30),高于鼻肠管组(39.2%,47/120)和口服胶囊组(21.7%,26/120)。鼻肠管组、口服胶囊组和结肠镜组患者最常见的不良反应分别为呼吸道不适(17.5%,21/120)、恶心呕吐(10.0%,12/120)和腹泻(36.7%,11/30)。治疗后随访3个月时,未有FMT相关的不良反应报告。 结论:鼻肠管途径具有稳定的临床疗效及可操作性,而口服胶囊途径的治疗等待时间更短且花费更少。但不同移植途径所带来不良反应有所不同,建议进行个性化移植途径选择。

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abstracts:

Objective:To evaluate the efficacy and safety of the fecal microbiota transplantation (FMT) in the different route administration for slow transit constipation (STC).Methods:A retrospective cohort study was conducted. The clinical data of 270 STC patients who voluntarily received FMT treatment in the Tenth People's Hospital of Tongji University from May 2018 to May 2019 were collected. Non-relative healthy adult standard donors were applied. The treatment routes of bacterial flora transplantation included nasojejunal tube (nasal enteral tube group, 120 cases), oral enterobacterial capsule treatment (oral capsule group, 120 cases), and colonoscopy infusion (colonoscopy group, 30 cases). The efficacy and safety of treatment among the three groups were compared.Results:Transplanted bacteria of three groups were extracted from 100 g of fresh feces. All the patients successfully completed the transplantation. The waiting time for the nasal enteral tube group, oral capsule group and colonoscopy group was (1.5±0.5) d, (0.4±0.3) d and (3.6±0.8) d respectively; the cost of establishing the transplantation path was (495±20) yuan, (25±10) yuan and (1420±45) yuan respectively, whose differences were statistically significant ( F=9.210, P=0.03; F=10.600, P=0.01). The clinical improvement rates at 1 month after FMT treatment in the nasojejunal tube group, oral capsule group and colonoscopy group were 74.2% (89/120), 60.0% (72/120) and 53.3% (16/30) respectively, whose difference was statistically significant (χ 2=5.990, P<0.05). The clinical improvement rates at 3 months after treatment were 71.1% (69/97), 53.6% (45/84), and 44.0% (11/25) respectively, whose difference was statistically significant (χ 2=7.620, P<0.05). The incidence of adverse reactions in the colonoscopy group was 76.7% (23/30), which was higher than that in the nasal nasojejunal group (39.2%, 47/120) and oral capsule group (21.7%, 26/120). The most common adverse reactions in the nasojejunal tube group, oral capsule group and colonoscopy group were respiratory discomfort (17.5%, 21/120), nausea and vomiting (10.0%, 12/120), and diarrhea (36.7%, 11/30). During the 3-month follow-up after treatment, no FMT-related adverse reactions were reported. Conclusions:The nasojejunal tube route has stable clinical efficacy and operability, while the oral capsule route has shorter waiting time and less cost. However, the adverse reactions caused by different transplantation methods are different, thus personalized transplantation method should be recommended.

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