摘要
菌群移植（FMT）作为一种新型的重建肠道菌群的治疗手段，近年来受到国内外学者的广泛关注。美国胃肠医学会难辨梭状芽孢杆菌治疗指南推荐．FMT可作为复发性难辨梭状芽孢杆菌感染（CDI）治疗方案。近年来，FMT治疗领域扩展到了炎性肠病（IBD）、肠易激综合征（IBS）、慢性便秘及其他疾病，研究结果均显示有一定疗效，后续会开展更多关于上述疾病的基础与临床研究以验证疗效。作为一种古老而又新颖的治疗技术，FMT还存在诸如供体选择、粪便样本标准化处理、FMT移植途径建立等方法学问题需要完善。相对于FMT临床应用的快速发展，评估安全性的研究相对滞后。FMT存在的不良反应可以分为短期和长期，其中短期不良反应又可以分为移植途径引起的以及FMT自身引起的：长期不良反应包括FMT相关的病原体传播及肠道菌群改变引起的相关疾病。总结我们团队肠功能障碍诊疗的经验，即利用FMT、益生菌、益生元及营养支持治疗等技术．来改善患者肠道功能及微生态环境，从而实现对肠道内外疾病的有效治疗。这种新型的疗法我们命名为肠道微生态治疗，基于对肠道菌群在人体疾病中作用的认识，该疗法必将会给肠功能障碍疾病的诊疗开创新的局面。
Fecal microbiota transplantation （FMT）, also known as fecal bacteriotherapy or fecal infusion, consists of injection of a liquid filtrate of feces from a healthy donor into the gastrointestinaI tract of a recipient individual. FMT has been proposed as a therapeutic approach for functional diseases of the gastrointestinal tract by reestablishment of a wide diversity of intestinal flora. Clostridium difficile infection （CDI） treatment guideline from American Gastroenterology Association （AGA） recommends that FMT can be used as the treatment protocols of relapse CDI. Numerous case reports, retrospective case series, and randomized controlled trials have shown the benefit of FMT in patients with functional bowel disorders, including inflammatory bowel disease, irritable bowel syndrome and constipation, etc. Evidence regarding the safety of FMT is relatively limited because the very rapid adoption of FMT as a therapeutic modality for CDI occurred before the performance of large, long prospective trials that are typically conducted to assess the safety of new interventions. Potential adverse events can be categorized as short-term and long-term, and short-term events can further be divided into those related to the method of FMT delivery （colonoscopy, sedation） and those related to the FMT itself. Due to the recent emergence of FMT, little data exist regarding long-term events and many safety concerns are speculative. Capsulized FMT therapy solves the cliniea＇s problems associated with the use of fresh FMT suspensions for long-term maintenance i.e. repeat transplantation and invasive procedures, which is of great significance to optimize the traditional FMT clinical strategy. Future work will focus on establishing best practices and more robust safety data than exist currently, as well as refining FMT beyond current ＂whole-stool＂ transplants to increase safety and tolerability. Encapsulated formulations, full-spectrum stool-based products, and defined microbial consortia are all in the immediate future. Although challenges exist, regulatory agencies have been willing to work with stakeholders and will continue to evolve and adapt policy as therapeutics based on human gut microbiota research emerge.
作者
李宁
田宏亮
Li Ning Tian Hongliang(Intestinal Microenvironment Treatment Center, Shanghai Tenth People＇s Hosphal, Tong~i University, Shanghai 200072, China （Li N, Tian HL Institute of General Surgery, Nanjing General Hospital, Nanjing 210002, China （Li N)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第10期1104-1108,共5页
Chinese Journal of Gastrointestinal Surgery
基金
科技部临床医学研究（消化疾病）协同网络建设示范应用研究（2015BA113807）
国家自然科学基金面上项目（81670493）
关键词
菌群移植
肠道疾病
微生态治疗
Fecal microbiota transplantation
Gastrointestinal disorders
Intestinal microenvironment treatment
