冰冻粪菌移植治疗艰难梭菌相关腹泻效果的Meta分析  

The effects of frozen fecal microbiota transplantation on C.difficile-related diarrhea:a meta-analysis

作　　者：韩露露 杨丽平[3] 张志刚[2] 蒋玲洁 丁楠楠 姚丽 李娜[2] HAN Lu-lu;YANG Li-ping;ZHANG Zhi-gang;JIANG Ling-jie;DING Nan-nan;YAO Li;LI Na(College of Nursing,Lanzhou University,Lanzhou,Gansu 730000,China;Department of Critical Care Medicine,the First Hospital of Lanzhou University,Lanzhou,Gansu 730000,China;不详)

机构地区：[1]兰州大学护理学院,甘肃兰州730000 [2]兰州大学第一医院重症医学科,甘肃兰州730000 [3]兰州大学第一医院神经外科,甘肃兰州730000

出　　处：《中国微生态学杂志》2021年第1期29-36,共8页Chinese Journal of Microecology

摘　　要：目的应用Meta分析评价冰冻粪菌移植(FMT)治疗艰难梭菌感染(CDI)相关腹泻的效果。方法计算机检索CNKI、CBM、WanFang Data、PubMed、EMbase、Web of Science、The Cochrane Library数据库关于冰冻FMT治疗CDI相关腹泻的随机对照试验,检索时限均为建库至2019年8月。结果共纳入8个研究,包括665例患者。Meta分析结果显示:冰冻FMT相比万古霉素/非达霉素治疗CDI相关腹泻差异有统计学意义[OR=23.94,95%CI=(6.80,84.34),P<0.001],但通过灌肠或结肠镜移植冰冻粪菌相比新鲜/冻干粪菌治疗CDI相关腹泻差异均无统计学意义(P>0.05)。多次FMT相比单次FMT能显著治愈CDI相关腹泻,差异有统计学意义[OR=9.79,95%CI=(4.27,22.46),P<0.001]。冰冻FMT相比万古霉素/非达霉素、新鲜/冻干FMT治疗CDI相关腹泻后患者不良反应的发生率和病亡率差异均无统计学意义(P>0.05)。结论冰冻FMT相比万古霉素/非达霉素治疗CDI相关腹泻有更好的疗效,且通过灌肠或结肠镜移植冰冻/冻干粪菌可以是一种替代新鲜粪菌的治疗方法,同时多次FMT治疗CDI相关腹泻的治愈率高于单次FMT,CDI患者不良反应和病亡率的发生与FMT无直接关系。以上结论需要更多高质量的研究加以证实。Objective To evaluate the effect of frozen fecal microbiota transplantation(FMT)in the treatment of Clostridium difficile infection-related diarrhea(CDI).Methods CNKI,CBM,WanFang Data,PubMed,EMbase,Web of Science and The Cochrane Library databases were searched for randomized controlled trials of frozen FMTs for CDI-related diarrhea from the time of database construction to August 2019.Results Eight studies,including 665 patients,were included.The results of meta-analysis showed that there was a statistically significant difference between frozen FMT and Vancomycin/Fidaxomycin in treating diarrhea caused by CDI[OR=23.94,95%CI=(6.80,84.34),P<0.001],but there was no statistically significant difference between frozen FMT through enema or colonoscopy and fresh/lyophilized FMT in treating diarrhea caused by CDI(P>0.05).Multiple fecal FMT significantly cured CDI induced diarrhea compared with single transplantation,with statistically significant difference[OR=9.79,95%CI=(4.27,22.46),P<0.001].There were no statistically significant differences in the incidence of adverse reactions and mortality in patients with CDI-related diarrhea treated with frozen FMT compared with Vancomycin/Fidaxomycin and fresh/lyophilized FMT(P>0.05).Conclusion The available evidence suggests that frozen FMT is more effective in treating CDI-related diarrhea than Vancomycin/Fidaxomycin.Frozen/lyophilized FMT through an enema or colonoscopy can be a therapeutic alternative to fresh FMT.The cure rate of multiple FMT for CDI-related diarrhea was higher than that of single transplantation,and adverse reactions and mortality in CDI patients did not increased.Due to the limited number and quality of included studies,the above conclusions need to be confirmed by more high-quality studies.

关 键 词：粪菌移植 艰难梭菌感染 随机对照试验 META分析 

分 类 号：R1[医药卫生—公共卫生与预防医学]