菌群移植治疗脑出血患者继发急性肠假性梗阻1例并文献复习  

Fecal microbiota transplantation in the treatment of acute intestinal pseudo obstruction secondary to intracerebral hemorrhage: a case report and literature review

作　　者：严艺苓 彭晓洁[2,3] 陈烨 Yan Yiling;Peng Xiaojie;Chen Ye(Department of Gastroenterology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,Guangdong,China;Department of Intensive Care,Nanfang Hospital,Southern Medical University,Guangzhou 510515,Guangdong,China;Integrative Microecology Center,Shenzhen Hospital,Southern Medical University,Shenzhen 518000,Guangdong,China)

机构地区：[1]南方医科大学南方医院消化内科,广东广州510515 [2]南方医科大学南方医院重症医学科,广东广州510515 [3]南方医科大学深圳医院整合微生态诊疗中心,广东深圳518000

出　　处：《中华危重病急救医学》2022年第3期306-310,共5页Chinese Critical Care Medicine

基　　金：国家重点研发计划项目 (2021YFA0717001)。

摘　　要：目的:分析菌群移植(FMT)治疗脑出血继发急性肠假性梗阻(AIPO)患者的临床效果。方法:分析南方医科大学南方医院收治的1例脑干出血继发AIPO患者的临床资料,比较粪菌制剂供者与患者主要菌群组成,以及患者FMT治疗前和治疗后第25天菌群的变化情况。结果:该患者主要表现为严重腹胀、肠管扩张及腹腔高压,常规保守治疗1周仍无法缓解,并逐渐加重至影响呼吸功能,粪便菌群分析提示肠道菌群失调,遂尝试FMT挽救性治疗。经FMT治疗,患者消化道症状缓解明显;FMT后25 d随访,该患者未再次出现消化道症状;复查粪便菌群分析提示定植于肠道的菌群以益生菌阿克曼菌、双歧杆菌为主,潜在的促炎及产气菌明显减少,菌群多样性增加。患者在FMT治疗后的25 d部分菌群组成趋向于与供者一致;在门水平上,拟杆菌门、疣微菌门、厚壁菌门和放线菌门细菌大幅增加,变形菌门比例大幅下降;在纲水平上,疣微菌纲、拟杆菌纲、放线菌纲、红蝽菌纲和梭状芽孢杆菌均明显增加,丙型变形菌纲明显减少;在目水平上,拟杆菌目、疣微菌目、梭菌目、红蝽菌目增加,β-变形菌目和肠杆菌目减少;在科水平上,双歧杆菌科、阿克曼菌科、瘤胃菌科增加,肠杆菌科减少;在属水平上,阿克曼菌、双歧杆菌增加,埃希-志贺菌和克雷伯菌水平减少。1年后随访,该患者已生活自理,格拉斯哥预后评分(GOS)5分。结论:FMT治疗对脑出血继发AIPO患者可能有较好疗效,其可能是通过调节患者的肠道菌群,重建适宜的肠道屏障,从而维持肠道微生态的稳定。Objective To analyze the clinical effects of fecal microbiota transplantation(FMT)on the treatment of acute intestinal pseudo obstruction(AIPO)secondary to intracerebral hemorrhage.Methods The clinical data of a patient with AIPO secondary to intracerebral hemorrhage who was admitted to Nanfang Hospital of Southern Medical University was analyzed.The flora compositon between donor and patient was compared,finding the changes of intestinal flora before and after FMT(day 0 and day 25).Results The main clinical findings in the patient were serious bloating,expansion of the intestinal canal and intra-abdominal hypertension.A week of conventional therapy was not effective,and the symptoms became progressively worse,affecting respiratory function.The result of fecal flora suggested the intestinal microbiota dybiosis,so FMT was attempted.After FMT,the patient's gastrointestinal symptoms were significantly relieved,and there were no further episodes within 25 days.The new result of fecal flora showed that the flora colonizing the intestine was dominated by Akkermansia and Bifidobacterium,with a significant decrease in potential pro-inflammatory and gas-producing bacteria and an increased gut microbiota diversity.The results trended to be partly consistent with the donor at 25 days after FMT:at the phylum level,the relative abundance of Bacterioidetes,Vereucomicrobia,Firmicutes and Actinobacteria were increased while Proteobacteria was decreased;at the class level,the relative abundance of Verrucomicrobiae,Bacterioidia,Actinobacteria,Coriobacteriia and Clostridia were increased and Gammaproteobacteria was decreased;at the order level,the relative abundance of Bacterioidales,Verrucomicrobiales,Clostridiale,Coriobacteriales were increased and Betaproteobacteriales,Enterobacteriales were decreased;at the family level,the relative abundance of Bifidobacteriaceae,Akkermansiaceae,Ruminococcaceae were increased and Enterobacteriaceae was decreased;at the genus level,the relative abundance of Akkermansia,Bifidobacterium were incr

关 键 词：菌群移植 肠假性梗阻 脑出血 肠道菌群 肠道微生态 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R574.2[医药卫生—临床医学]