粪菌移植治疗溃疡性结肠炎疗效的Meta分析
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摘要
[目的]系统评价粪菌移植治疗溃疡性结肠炎(UC)的有效性和安全性。[方法]系统检索PubMed、Embase、The Cochrane Library、Web of Science、Medline、WANFANG和CNKI数据库,查找关于粪菌移植治疗UC疗效评价随机对照试验,检索时间均从建库至2018年9月10日前发表的,文献检索及筛选、数据提取和文献偏倚评估均由2位研究者独立进行。应用RevMan 5.3软件进行Meta分析。[结果]共纳入4个研究,共计277例患者。Meta分析结果表示,结合临床缓解和内镜缓解,粪菌移植治疗UC的缓解率为28%(39/140),与安慰剂的缓解率9.5%(13/137)比较,差异有统计学意义[OR=3.67,95%CI(1.82,7.39),P<0.01]。与安慰剂比较,在临床缓解方面[OR=2.41,95%CI(1.27,4.56),P<0.01]和内镜缓解方面[OR=3.27,95%CI(1.62,6.59),P<0.01]上,差异有统计学意义。[结论]粪菌移植能明显提高UC的治愈率,是一种治疗UC的有效手段。
[Objective]To systematically review the clinical efficacy and safety of fecal microbiota transplantation in patients with ulcerative colitis.[Methods]Databases such as PubMed,Embase,The Cochrane Library,Web of Science,Medline,WANFANG and CNKI were searched for the randomized controlled trials about Fecal Microbiota Transplantation as the interventions for ulcerative colitis from database creation on September 10 th,2018.Two reviewers independently conducted literature search and screening,date extraction and literature bias evaluation.The Meta-analysis was conducted using RevMan 5.3software.[Results]A total of 4studies involving 277 patients were included.The results of meta-analysis showed that,compared with clinical remission and endoscopic remission,the response rate of Fecal Microbiota Transplantation in the treatment of ulcerative colitis was 28%(39/140),and the difference was statistically significant compared with the placebo response rate of 9.5%(13/137)[OR=3.67,95%CI(1.82,7.39),P<0.01].Compared with placebo,the difference was statistically significant in terms of clinical remission[OR=2.41,95%CI(1.27,4.56),P<0.01]and endoscopic remission[OR=3.27,95%CI(1.62,6.59),P<0.01].[Conclusion]Fecal microbiota transplantation can significantly improve the cure rate of ulcerative colitis,and is an effective means of treating UC.
[Objective]To systematically review the clinical efficacy and safety of fecal microbiota transplantation in patients with ulcerative colitis.[Methods]Databases such as PubMed,Embase,The Cochrane Library,Web of Science,Medline,WANFANG and CNKI were searched for the randomized controlled trials about Fecal Microbiota Transplantation as the interventions for ulcerative colitis from database creation on September 10 th,2018.Two reviewers independently conducted literature search and screening,date extraction and literature bias evaluation.The Meta-analysis was conducted using RevMan 5.3software.[Results]A total of 4studies involving 277 patients were included.The results of meta-analysis showed that,compared with clinical remission and endoscopic remission,the response rate of Fecal Microbiota Transplantation in the treatment of ulcerative colitis was 28%(39/140),and the difference was statistically significant compared with the placebo response rate of 9.5%(13/137)[OR=3.67,95%CI(1.82,7.39),P<0.01].Compared with placebo,the difference was statistically significant in terms of clinical remission[OR=2.41,95%CI(1.27,4.56),P<0.01]and endoscopic remission[OR=3.27,95%CI(1.62,6.59),P<0.01].[Conclusion]Fecal microbiota transplantation can significantly improve the cure rate of ulcerative colitis,and is an effective means of treating UC.
引文
[1] Ungaro R,Mehandru S,Allen PB,et al.Ulcerative colitis.[J].Lancet,2017,389(10080):1756-1770.
[2] Ford AC.Antibiotic therapy in inflammatory bowel disease:a systematic review and meta-analysis.[J].Am J Gastroenterol,2011,106(4):661-673.
[3] Chibbar R,Dieleman LA.Probiotics in the Management of Ulcerative Colitis[J].J Clin Gastroenterol,2015,49Suppl 1(1):S50.
[4] Khoruts A,Weingarden AR.Emergence of fecal microbiota transplantation as an approach to repair disrupted microbial gut ecology[J].Immunol Lett,2014,162(2):77-81.
[5]中国中西医结合学会消化系统疾病专业委员会.溃疡性结肠炎中西医结合诊疗共识意见(2017年)[J].中国中西医结合消化杂志,2018,26(2):105-111.
[6] Higgins J,Green S.Cochrane handbook for systematic reviews of interventions.Version 5.1.0[M].Oxford:The Cochrane Collaboration,2011.
[7] Rossen NG,Fuentes S,Mj VDS,et al.Findings From a Randomized Controlled Trial of Fecal Transplantation for Patients With Ulcerative Colitis[J].Gastroenterology,2015,149(1):110-118.e4.
[8] Moayyedi P,Surette MG,Kim PT,et al.Fecal Microbiota Transplantation Induces Remission in Patients with Active Ulcerative Colitis in a Randomized,Controlled Trial[J].Gastroenterology,2015,149(1):102-109.e6.
[9] Paramsothy S,Kamm MA,Kaakoush NO,et al.Multidonor intensive faecal microbiota transplantation for active ulcerative colitis:a randomised placebo-controlled trial[J].Lancet,2017,389(10075):1218.
[10]Costello S,Waters O,Bryant R,et al.OP036Short duration,low intensity pooled faecal microbiota transplantation induces remission in patients with mildmoderately active ulcerative colitis:a randomised controlled trial.[J].Gastroenterology,2017,152(5):S198-S199.
[11]Shah SC,Colombel J,Sands BE,et al.Systematic review with meta-analysis:mucosal healing is associated with improved long-term outcomes in Crohn's disease[J].Aliment Pharmacol Ther,2016,43(3):317-333.
[12]Shah SC,Colombel JF,Sands BE,et al.Mucosal Healing is Associated with Improved Long-term Outcomes of Patients With Ulcerative Colitis:a Systematic Review and Meta-analysis[J].Clin Gastroenterol Hepatol,2016,14(9):1245-1255.e8.
[13]Cammarota G,Ianiro G,Gasbarrini A.Fecal microbiota transplantation for the treatment of Clostridium difficile infection:a systematic review.[J].J Clin Gastroenterol,2014,48(8):693.
[14]Dutta SK,Girotra M,Garg S,et al.Efficacy of Combined Jejunal and Colonic Fecal Microbiota Transplantation for Recurrent Clostridium difficile,Infection[J].Clin Gastroenterol Hepatol,2014,12(9):1572-1576.
[15]Kellermayer R,Nagyszakal D,Harris RA,et al.Serial Fecal Microbiota Transplantation Alters Mucosal Gene Expression in Pediatric Ulcerative Colitis[J].Am J Gastroenterol,2015,110(4):604.
[16]Pamer EG.Fecal microbiota transplantation:effectiveness,complexities,and lingering concerns[J].Mucos Immunol,2014,7(2):210-214.
[17]Khoruts A,Weingarden AR.Emergence of fecal microbiota transplantation as an approach to repair disrupted microbial gut ecology[J].Immunol Lett,2014,162(2):77-81.
[18]Woting A,Blaut M.The Intestinal Microbiota in Metabolic Disease[J].Nutrients,2016,8(4):202.
[2] Ford AC.Antibiotic therapy in inflammatory bowel disease:a systematic review and meta-analysis.[J].Am J Gastroenterol,2011,106(4):661-673.
[3] Chibbar R,Dieleman LA.Probiotics in the Management of Ulcerative Colitis[J].J Clin Gastroenterol,2015,49Suppl 1(1):S50.
[4] Khoruts A,Weingarden AR.Emergence of fecal microbiota transplantation as an approach to repair disrupted microbial gut ecology[J].Immunol Lett,2014,162(2):77-81.
[5]中国中西医结合学会消化系统疾病专业委员会.溃疡性结肠炎中西医结合诊疗共识意见(2017年)[J].中国中西医结合消化杂志,2018,26(2):105-111.
[6] Higgins J,Green S.Cochrane handbook for systematic reviews of interventions.Version 5.1.0[M].Oxford:The Cochrane Collaboration,2011.
[7] Rossen NG,Fuentes S,Mj VDS,et al.Findings From a Randomized Controlled Trial of Fecal Transplantation for Patients With Ulcerative Colitis[J].Gastroenterology,2015,149(1):110-118.e4.
[8] Moayyedi P,Surette MG,Kim PT,et al.Fecal Microbiota Transplantation Induces Remission in Patients with Active Ulcerative Colitis in a Randomized,Controlled Trial[J].Gastroenterology,2015,149(1):102-109.e6.
[9] Paramsothy S,Kamm MA,Kaakoush NO,et al.Multidonor intensive faecal microbiota transplantation for active ulcerative colitis:a randomised placebo-controlled trial[J].Lancet,2017,389(10075):1218.
[10]Costello S,Waters O,Bryant R,et al.OP036Short duration,low intensity pooled faecal microbiota transplantation induces remission in patients with mildmoderately active ulcerative colitis:a randomised controlled trial.[J].Gastroenterology,2017,152(5):S198-S199.
[11]Shah SC,Colombel J,Sands BE,et al.Systematic review with meta-analysis:mucosal healing is associated with improved long-term outcomes in Crohn's disease[J].Aliment Pharmacol Ther,2016,43(3):317-333.
[12]Shah SC,Colombel JF,Sands BE,et al.Mucosal Healing is Associated with Improved Long-term Outcomes of Patients With Ulcerative Colitis:a Systematic Review and Meta-analysis[J].Clin Gastroenterol Hepatol,2016,14(9):1245-1255.e8.
[13]Cammarota G,Ianiro G,Gasbarrini A.Fecal microbiota transplantation for the treatment of Clostridium difficile infection:a systematic review.[J].J Clin Gastroenterol,2014,48(8):693.
[14]Dutta SK,Girotra M,Garg S,et al.Efficacy of Combined Jejunal and Colonic Fecal Microbiota Transplantation for Recurrent Clostridium difficile,Infection[J].Clin Gastroenterol Hepatol,2014,12(9):1572-1576.
[15]Kellermayer R,Nagyszakal D,Harris RA,et al.Serial Fecal Microbiota Transplantation Alters Mucosal Gene Expression in Pediatric Ulcerative Colitis[J].Am J Gastroenterol,2015,110(4):604.
[16]Pamer EG.Fecal microbiota transplantation:effectiveness,complexities,and lingering concerns[J].Mucos Immunol,2014,7(2):210-214.
[17]Khoruts A,Weingarden AR.Emergence of fecal microbiota transplantation as an approach to repair disrupted microbial gut ecology[J].Immunol Lett,2014,162(2):77-81.
[18]Woting A,Blaut M.The Intestinal Microbiota in Metabolic Disease[J].Nutrients,2016,8(4):202.