粪菌移植治疗肠易激综合征疗效的Meta分析  

Efficacy of fecal microbiota transplantation in irritable bowel syndrome: a systematic review and Meta-analysis

作　　者：余思芸 何平[1] 房殿亮 任宁川 田文广[2] YU Siyun;HE Ping;FANG Dianliang;REN Ningchuan;TIAN Wenguang(Department of Gastroenterology,Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China;Department of Infectious Disease,Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院消化内科,重庆402160 [2]重庆医科大学附属永川医院感染科,重庆402160

出　　处：《胃肠病学和肝病学杂志》2020年第1期37-42,共6页Chinese Journal of Gastroenterology and Hepatology

基　　金：重庆市教委科学技术研究项目(KJ1600215)

摘　　要：目的系统评价粪菌移植(fecal microbiota transplantation,FMT)治疗肠易激综合征(irritable bowel syndrome,IBS)的疗效和安全性。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库,收集2019年3月1日前国内外公开发表的关于FMT治疗IBS的随机对照试验(RCTs),由2名评价者按照纳入和排除标准筛选、提取资料并进行方法学质量评价,采用RevMan 5.3软件对数据进行Meta分析。结果最终纳入5篇RCTs,共288例患者。结果显示:IBS总体症状改善率在FMT组与对照组中差异无统计学意义(RR=1.04,95%CI:0.63~1.72,P=0.88)。研究之间存在显著异质性(I 2=76%)。亚组分析显示采用结肠镜、鼻空肠管灌注可显著改善IBS的临床症状(RR=1.57,95%CI:1.15~2.14,P<0.05);而口服FMT胶囊可能存在相反的效果(RR=0.54,95%CI:0.36~0.82,P<0.05)。各研究中均无严重不良反应。结论当前证据不足以证明FMT对所有亚型IBS患者有效,但采用结肠镜、鼻空肠管灌注等方式进行FMT可显著改善结局,且FMT治疗方案本身是安全可行的。Objective To systematically evaluate the efficacy and safety of fecal microbiota transplantation(FMT)in irritable bowel syndrome(IBS).Methods All relevant randomized controlled trials(RCTs)of FMT on IBS published before Mar.1st,2019 were collected by searching PubMed,Embase,the Cochrane Library,CNKI,VIP,CBM and WanFang Data.RevMan 5.3 was used to perform statistical analysis on the basis of literature screening,data extraction and quality evaluation by two independent researchers.Results Five RCTs included 288 patients.The results of Meta-analysis showed that there was no significant difference in the overall improvement of IBS between the two groups(RR=1.04,95%CI:0.63-1.72,P=0.88).Heterogeneity among studies was significant(I 2=76%).Subgroup analysis revealed that the clinical symptoms of IBS were significantly improved by colonoscopy and nasal jejunal tube perfusion(RR=1.57,95%CI:1.15-2.14,P<0.05).Oral administration of FMT capsules may had the opposite effect(RR=0.54,95%CI:0.36-0.82,P<0.05).No serious adverse reactions were reported in any of the studies.Conclusion Previous evidence is insufficient to prove that FMT is effective in patients with all subtypes of IBS.However,colonoscopy and nasal jejunal tube perfusion are used to improve the outcome of FMT.The FMT itself is safe and feasible.

关 键 词：粪菌移植 肠易激综合征 随机对照试验 META分析 

分 类 号：R574.4[医药卫生—消化系统]