摘要
目的 观察菌群移植（FMT）联合水溶性膳食纤维和益生菌治疗慢传输型便秘（STC）的临床疗效和安全性。方法 前瞻性入组2015年4月2016年1月期间，南京大学医学院附属金陵医院收治的23例STC患者，予以FMT联合水溶性膳食纤维和益生菌治疗。具体方法：取标准健康供体新鲜粪便100 g置于无菌搅拌器内，加入500 ml无菌生理盐水，搅拌一定时间后将其依次通过孔径为2.0和0.5 mm的筛网，之后储存于-20℃冰箱内短期保存备用；制备流程时间≤1 h。FMT治疗共计9 d：前3 d为患者肠道准备阶段，每日口服万古霉素3 d（500 mg，2次/d）；置鼻肠管每日上午缓慢（5 min）注入100 ml粪菌液，连续6 d。之后回家服用水溶性膳食纤维（果胶8g）和益生菌（双歧杆菌三联活菌胶囊），2次/d，服用4周。比较联合治疗前和治疗后12周时的患者PAC-SYM便秘症状评分、每周自主排便次数、胃肠生活质量评分及相关不良反应。本临床试验（ClinicalTrials.gov）注册编码为NCT02016469。结果 全组23例，其中男性7例，女性16例，年龄（49.6 ± 14.7）岁，体质指数（BMI）（21.2 ± 2.2）kg/m2，治疗前便秘病史（8.3 ± 5.9）年，1周排便次数（1.8 ± 0.7）次。经FMT联合水溶性膳食纤维和益生菌治疗后，患者第12周PAC-SYM便秘症状评分较治疗前明显下降[（1.3 ± 0.4）分比（2.3 ± 0.5）分]，每周自主排便次数明显增加[（4.8 ± 2.0）次/周比（1.8 ± 0.7）次/周]，胃肠生活质量评分（GIQLI）明显升高[（120.8 ± 21.3）分比（78.5 ± 15.5）分]，差异均有统计学意义（均P 〈 0.01）。治疗后随访调查期间，患者治疗效果维持稳定，至第12周临床治愈率52.2%（12/23）（每周自主排便次数〉 3次），临床缓解率69.6%（16/23）（与治疗前相比有明显改善）。在治疗后及随访12周期间内患者均未出现严重不良反应。结论 FMT联合水溶性膳食纤�
Objective To evaluate the efficacy and safety of fecal microbiota transplantation （FMT） combined with soluble dietary fiber and probiotics for slow transit constipation （STC） . Methods Twenty-three patients with STC from Jinling Hospital, Medical School of Nanjing University were prospectively enrolled between April 2015 and January 2016. STC patients received FMT combined with soluble dietary fiber and probiotics. Fresh stool （100 g） was immediately mixed in a blender with 500 ml of 0.9% sterile saline for several seconds, which was then filtered through a gauze pad and a decreasing number of gauze screen （2.0 to 0.5 mm） . The fecal bacteria suspension was stored frozen at - 20℃. The preparation time of FMT material was less than 1 hour. Total time of treatment was 9 days. An initial oral antibiotics （vancomycin 500 mg orally twice per day） was given for 3 consecutive days. Then the fecal microbiota （100 ml） was infused slowly （5 min） through nasojejunal tube for 6 consecutive days. After FMT, patients were recommended to receive soluble dietary fiber （pectin, 8 g/d） and probiotics （bifid triple viable capsules, twice per day） for 4 weeks. Rates of clinical improvement and remission, adverse events, constipation-related symptoms （PAC-SYM scores） , bowel movements per week and gastrointestinal quality-of-life index （GIQLI） were recorded during the 12-week follow-up. This study was registered in the Clinical Trials.gov （NCT02016469） .Results Among 23 patients, 7 were male, 16 were female, the mean age was （49.6 ± 14.7） years, the body mass index was （21.2 ± 2.2） kg/m2, the duration of constipation was （8.3 ± 5.9） years, and the defecation frequency was 1.8 ± 0.7 per week. Compared with pre-treatment, PAC-SYM scores decreased significantly from 2.3 ± 0.5 to 1.3 ± 0.4 at week 12 （P 〈 0.01） , defecation frequency increased from 1.8 ± 0.7 per week to 4.8 ± 2.0 per week at week 12 （P 〈 0.01） , and patients felt satisfied with improved GIQ
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第12期1355-1359,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（2015BAI13B07）
国家自然科学基金（81670493）
关键词
慢传输型便秘
菌群移植
水溶性膳食纤维
益生菌
Slow transit constipation
Fecal microbiota transplantation
Soluble dietary fiber
Probiotics
