菌群移植治疗艰难梭状芽胞杆菌感染18例临床观察

摘要

目的 探讨菌群移植(FMT)对艰难梭状芽胞杆菌感染(CDI)的治疗效果.方法 回顾性分析2015年4月至2016年7月南京总医院肠道微生态治疗中心收治的18例CDI病人的临床资料.所有病人均行FMT治疗,记录FMT治疗前后粪便CDI的检测结果及临床症状,治疗后至少随访3个月.结果 随访时间为7.6(3～16)个月.15例(83.3％)病人为初次治愈,其余3例为复发,其中2例在FMT治疗后3个月内再次出现腹泻、腹痛等症状,另1例在3个月后症状复发,复查CDI结果均为阳性.14例腹泻病人中12例(85.7％)治愈,l例症状改善,另1例病人自觉症状无明显好转;症状好转时间为1～15(7.4±4.1)d.11例腹痛病人中8例(72.7％)治愈,2例症状明显好转,l例无好转;症状好转时间为1～21(9.5±5.3)d.6例肠梗阻或腹胀病人中4例(66.7％)治愈,其余2例病人症状均好转;症状好转时间为6～30(16.5±9.0)d.13例(72.2％)病人体重较治疗前增加,其余2例病人体重下降或无变化.FMT治疗期间不良反应为12例病人咽喉部疼痛、5例肠鸣音活跃、4例胃肠胀气.整个随访期间无严重不良反应.结论 FMT是治疗CDI的有效方法,初次治愈率高,无严重不良反应,值得临床推广应用.%Objective To explore the clinical effect of fecal microbiota transplantation (FMT) on clostridium difficile infection(CDI).Methods The clinical and follow-up datas of 18 patients with clostridium difficile infection accepted fecal microbiota transplantation between April 2015 and July 2016 in the Intestinal Microenvironment Treatment Centre of Nanjing General Hospital were analyzed retrospectively.All the patients were performed FMT,the patients' stool samples for CDI and clinical symptoms before and after transplantation was recorded,follow-up of 3 months at least.Results The median of follow-up was 7.6(3-16)months.A total of 15 patients (83.3％) were cured initially;the other three patients had relapsed;two of them had diarrhea and abdominal pain in three months after FMT;another one had relapsed after three months;all of them got a positive result for CDI.Twelve of 14 patients (85.7％)with the symptoms of diarrhea were cured;one patient had symptomatic improvement;one patient had no improvement;the days to improvement/resolution were 1-15 (7.4±4.1)days.Eight of 11 patients (72.7％)with the symptoms of abdominal pain were cured;two patients had symptomatic improvement;one had no improvement;the days to improvement/resolution were 1-21 (9.5 ± 5.3) days.For the patients with intestinal obstruction or abdominal distension,4 of them (66.7％) were cured,two patients had symptomatic improvement;the days to improvement/resolution were 6-30 (16.5 ± 9.0) days.A total of 13 patients (72.2％)had weight gain compared with that before treatment,and the others had lost weight or no changes.During FMT,there were 12 patients had sore throat,5 patients had active bowel sounds and 4 patients had flatulence.There was no serious adverse event occurred during the whole follow-up.Conclusion FMT is an effective strategy to treat CDI;it has high initial cure rate and no serious adverse event.It's worthy of clinical promotion and application.