| 摘要: | 背景：
宿主與腸道細菌間以及腸道環境的平衡稱為微菌叢生態平衡，生態平衡時，可以維繫宿主的正常生理功能，如營養、免疫、消化等。腸道微生態則可因慢性疾病免疫失調、癌症、手術及抗生素使用等原因而導致失衡。近年許多研究發現，腸道微生態的失衡，與人體許多疾病相關，如偽膜性腸炎便是困難梭菌的過度生長所導致的腸道發炎，也有愈來愈多的研究報告指出不只是腸道困難梭菌感染和微菌叢有關，許多腸胃道疾病，例如: 發炎性腸道疾病、大腸激躁症甚至是便秘的發生也都與常到胃菌叢失衡有關聯。腸道微菌叢植入治療(Fecal microbiota transplantation, FMT)已經有許多研究證實其在復發性和難治性困難梭狀桿菌感染 (recurrent or refractory Clostridium
difficile infection, rCDI) 可以得到極高的臨床治癒率。對於其他被認為與腸道微菌叢相關疾病也都有研究在進行中，或許可成為下一批適用此新療法的適應症，尤其是與腸道微菌叢失衡的疾病。隨著微菌叢植入治療發展即將成為數百萬患者潛在治療方法，對微菌叢植入治療的充分了解必能幫助我們更有效地將微菌叢植入治療納入臨床實務中
目的：
本研究以系統性回顧及統合分析的方法探討腸道微菌叢移植術對於微生態失衡相關腸道疾病的效果。
方法：
納入的研究必須探討腸道微菌叢移植術對於微生態失衡相關疾病的治療效果，例如困難梭狀桿菌感染、發炎性腸炎、大腸激躁症、便秘。同時，研究必須有明確地納入及排除條件標準。我們針對三大資料庫PubMed, Embase, Cochrane Library等資料庫。我們進行獨立執行搜尋、研究篩選、資料萃取及研究偏差的評估並且透過討論達成共識來化解相異之處。本研究分析主要是針對高品質的隨機對照試驗的文章進行分析以及次分析，進一步探討FMT與困難梭狀桿菌感染傳統抗生素vancomycin治療比較之臨床效果；FMT與發炎性腸炎(主要是潰瘍性結腸炎)的標準治療比較之差異；FMT與大腸激躁症標準治療療效之比較。本研究針對FMT在不同的腸道微菌叢相關疾病的治療進行比較利用隨機效應模型 (random-effect model) 進行進一步的統合分析。
結果：
本研究只針對高品質的隨機對照實驗來做分析，對於腸道菌叢失衡相疾
病，例如困難梭狀桿菌感染、發炎性腸炎、大腸激躁症、便秘；研究發現相較於傳統的治療，腸道微菌叢移植對於困難梭狀桿菌感染、發炎性腸炎甚至是便秘，有些分析上雖然沒達到統計學上的意義。研究結果顯示：現階段對於困難梭狀桿菌感染治療，腸道微菌叢移植似乎仍是非常有效且安全的做法；本文囊括的發炎性腸炎，特別指潰瘍性腸炎以及便祕，雖然現階段高品質的隨機分派臨床試驗的文章不多，但看起來這兩種疾病，將來以腸道微菌叢移植治療的可能性也不小，不過仍然有很多地方需要進一步研究來闡明，例如腸道微菌叢移植之後多久臨床有改善算是有效，要追蹤多久時間以及假使要執行第二次腸道微菌叢移植間隔需多久或是腸道微菌叢移植製成的標準化等都是未來研究可以努力的地方。
結論：
腸道微菌叢移植對於其他腸道菌叢失衡相關疾病有療效且安全性高，但是仍然缺乏大型的隨機對照實驗，臨床醫師未來可以更進一步往這方面研究室非常有展望的。
Background:
Fecal microbiota transplantation (FMT) is the transferal of feces from a healthy donor to a patient with disease associated with disturbances in the gut microbiota. Manipulating gut microbiota is a potential treatment for intestinal dysbiosis related disorder. This study aimed to elucidate whether fecal microbiota transplantation (FMT) would be alternative treatment in treating associated disease.
Methods:
We performed a systematic literature search of PubMed, EMBASE, Cochrane Library. Selection criteria included RCTs of FMT in gut dysbiosis related disorders, involving clostridium difficile infection, inflammatory bowel disease, irritable bowel syndrome and constipation. We used Cochrane Collaboration’s Risk of Bias tool to assess bias in the RCTs. We estimated the summary relative risk (RR) with 95% confidence interval (CI) for each outcome using a random effects model. P values of less than 0.05 were considered significant.
Results:
We included eleven RCTs comprising a total of 709 patients with recurrent CDI. Four studies revealed FMT with a significant trend toward resolution of rCDI compared with FMT and medical treatment [RR= 2.67, 95% confidence interval = 1.13–6.17, p=0.0003, I2 =37%] ; Three of five RCTs comprising a total of 217 patients with IBD. There was a nonsignificant trend toward resolution of UC compared with FMT and conventional therapy [ RR=1.90, 95% confidence interval (95% CI) = 0.94–3.83, p = 0.05, I2=66% ]；Two RCTs comprising a total of 100 patients with IBS. There was a no trend toward resolution of IBS compared with FMT and conventional therapy [ RR=0.80, 95% confidence interval (95% CI) = 0.23–2.80, p = 0.03, I2=89% ]. Most adverse events caused by FMT were mild and self-limited and could be quickly alleviated in few days; no severe adverse events happened because of FMT.
Conclusions:
Despite variation in processes, FMT appears to be effective and relatively safe treatment in treating gut dysbiosis related disorders. Furthermore, some studies revealed that FMT is more effective method than traditional medical treatment and should be referred to as first-line therapy. However, large scale randomized control trial might be launched to support this point. |
