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BMJ:粪便移植有望替代抗生素治疗严重感染

来源:生物谷 2015-10-26 09:53

图片来源:haicontroversies.blogspot.com

2015年10月26日 讯 /生物谷BIOON/ --近日,来自国外的研究人员在国际杂志The BMJ上刊文称,粪便移植在治疗严重感染的使用越来越成为患者的疗法选择,但随着使用的增加以及捐助者筛查范围的扩大,进行良好的长期试验及监测也非常必要,目的在于为病人提供最为合理的选择和建议。

肠道微生物群落在我们机体免疫系统和健康中扮演着重要角色,而将粪便物从一个人移植到另一个人目前被人们越来越多地用于治疗严重的危及生命的感染性疾病,比如难辨梭状芽胞杆菌感染的复发等,这种细菌每年会引发成千上万人死亡。移植的操作步骤包括,将健康供体液化的粪便引入患者的肠道中,从而使健康的细菌菌群在受体肠道中重新定植,通常患者进行长期的抗生素疗法后肠道菌群就会被破坏。

大量数据分析得知,标准化的抗生素疗法治疗严重感染性疾病的成功率仅为20%,而粪便移植的成功率则可以达到85%,近来有一项试验提前终止了,因为粪便移植的成功率达到了90%,而抗生素疗法仅为26%,因此粪便移植的成功率以绝对优势战胜了抗生素治疗。

研究者Tim Spector指出,截止到目前位置,有超过7000名接受粪便移植的患者并没有不良的副作用报道,尽管这是早先的数据,而且粪便移植在成年患者或免疫系统受损的患者机体中都表现相对安全;如今在美国有超过500个提供粪便移植的中心,在波士顿大多数移植都配备有实验室进行,而且粪便移植用于治疗难辨梭状芽胞杆菌的感染已经得到了美国胃肠病学学会和欧洲微生物学和传染病学会的谨慎认可。

相比抗生素治疗而言,粪便移植具有较高的成功率,而且粪便移植的使用目前也应用于其它疾病中,比如肥胖、糖尿病、肠易激综合征等,当然研究者还指出,由于存在明显的感染风险,长期以来将粪便微生物移植入一个新的宿主也存在潜在的风险,这就包括增加对肥胖的易感性甚至是心理疾病等,这些潜在的风险就表明,粪便移植尽管作为一种新型工具,其也应当被进行仔细监测,同时也应当尽可能地提纯出真正的有益细菌。(生物谷Bioon.com)

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Faecal transplants Still need good long term trials and monitoring

Tim Spector, professor1, Rob Knight, professor2

Recurrent Clostridium difficile infection is a severe and often fatal condition, affecting up to 3000 people in the United Kingdom and 100 000 in the United States, where it kills an estimated 14 000 a year.1 About a quarter of patients experience a recurrence after an initial mild infection because treatment with antibiotics destroys the diversity of the normal gut microbes and allows C difficile to flourish. The standard of care is antibiotics such as vancomycin and metronidazole, with or without bowel lavage or probiotics. However, a meta-analysis that included two randomised controlled trials and multiple case series covering 516 patients found an 85% success rate with a new non-drug treatment compared with only 20% success for vancomycin.2 That treatment is called faecal microbial transplantation, whereby the liquidised stool (or its cryopreserved microbial content) of a healthy donor is introduced to the colon of the patient through a nasogastric tube or the rectum. A third recent randomised trial was stopped early because of the overwhelming superiority of faecal transplantation, with 90% success rate compared with 26% for vancomycin.3 So far, such transplants seem relatively safe in immunocompromised and elderly patients.4 5 Although faecal transplants are being used in people with the whole spectrum of C difficile infection, insufficient data exist on their effect in early or very resistant infections, and there are few comparisons between the many different inoculation methods and routes, including the recent cryopreserving of donor microbes in acid resistant oral capsules.6

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