粪菌移植联合肠内营养治疗克罗恩病的初步研究  

Integration of fecal microbiota transplantation and enteral nutrition in the treatment of Crohn's disease:a pilot study

作　　者：张慧[1] 李潘[2] 徐海娥[1] 张发明[2] 崔伯塔[2] ZHANG Hui LI Pan XU Hai-e ZHANG Fa-ming CUI Bo-ta(Department of Clinical Nutrition Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, China)

机构地区：[1]南京医科大学第二附属医院临床营养科,江苏南京210011 [2]南京医科大学第二附属医院肠病中心,江苏南京210011

出　　处：《中国医学工程》2016年第12期1-4,共4页China Medical Engineering

基　　金：国家自然科学基金项目(81600417);南京医科大学第二附属医院肠病研究基金(公益捐赠)

摘　　要：目的粪菌移植(FMT)和肠内营养(EN)均被报道对克罗恩病(CD)有治疗价值。该研究拟探讨FMT联合EN的整合治疗策略治疗中、重度CD的临床疗效和安全性。方法选择21例对传统治疗无效的中、重度活动期CD患者(HBI评分≥5),经中消化道行单次FMT治疗,1周后加用肠内营养维持治疗12周。分别监测其在FMT后1周、12周临床症状、实验室检查指标及营养指标的变化,评价FMT联合EN的临床疗效。结果 FMT治疗后1周的临床有效率达到76.2%(16/21),其中52.4%(11/21)达临床缓解。FMT联合EN治疗后12周的有效率和缓解率分别为90.5%(19/21)和76.2%(16/21);治疗后12周HBI评分、C-反应蛋白均下降(P=0.017);营养相关指标(体重、BMI、血红蛋白、白蛋白)均显著增加。随访过程中无严重不良反应发生。结论 FMT联合EN可有效诱导并维持克罗恩病患者的临床缓解,并显著改善患者营养状态。【Objective】Fecal microbiota transplantation（FMT） and enteral nutrition（EN） was reported to have a potential role in the treatment of Crohn＇s disease.This study aims to investigate the clinical efficacy of FMT combined with EN in patients with moderate to severe Crohn＇s disease（CD）.【Methods】Twenty-one subjects with moderate to severe CD [Harvey-Bradshaw Index（HBI） ≥5] who were refractory to traditional therapies were involved in this study.Single FMT through mid-gut were performed to the subjects by gastroendoscopy,subsequently enteral nutrition was started at one week after FMT and sustained for at least 12 weeks.Clinical symptoms,laboratory test,and nutritional status were investigated at the follow-up points（baseline,one week,and twelve weeks after FMT） to evaluate the efficacy of this holistic strategy combining with FMT and sustained enteral nutrition.【Results】In total,the rate of the clinical improvement and clinical remission at one week after FMT were 76.2%（16/21） and 52.4%（11/21）,and the rates were elevated to 90.5%（19/21） and 76.2%（16/21） respectively at 12 weeks after FMT.At 12 weeks follow-up point,C-reactive protein was significantly decreased（P〈0.05）;body weight,hemoglobin,body mass index（BMI）,and serum albumin were increased obviously,and the nutrition status was improved.No severe adverse reaction was found during follow-up.【Conclusion】FMT combined with EN as a holistic integrative strategy showed benefits in inducing and maintaining the clinical remission of moderate to severe CD.

关 键 词：粪菌移植 肠内营养 克罗恩病 营养不良 整合医学 

分 类 号：R574.62[医药卫生—消化系统]