Abstract:

Effect analysis of 71 cases of refractory diarrhea with severe malnutrition treated by fecal microbiota transplantation (FMT) combined with enteral nutrition        CHEN Qi-yi * , TIAN Hong-liang , YANG Bo , et al.  Department of Colorectal Disease / Intestinal Microecology Diagnosis and Treatment Center. *Tenth People’s Hospital of Tongji University , Shanghai 200072, China
Corresponding author: LI Ning, E-mail：liningrigs@sina.vip.com
Abstract    Objective    To investigate the therapeutic effect of fecal microbiota transplantation（FMT）combined with enteral nutrition on patients with refractory diarrhea and severe malnutrition. Methods    Seventy-one patients with refractory diarrhea complicated with severe malnutrition in Department of Colorectal Disease，the Tenth People’s Hospital of Tongji University and Department of General Surgery, General Hospital of Eastern Theater Command from June 2014 to October 2018 were prospectively collected for basic information, symptoms and signs, number of bowel movements, Bristol stool scores, and nutritional indicators, which were followed up after bacterial transplantation combined with enteral nutrition. Results    After following up for 6 month, FMT combined with enteral nutrition in the treatment of severe diarrhea with severe malnutrition, the effective rate of treatment of diarrhea was 95.8%, of which the cure rate was 74.7%, and the remission rate was 21.1%. 3 cases (4.2%) were ineffective, 6 cases (8.5%) recurred. The frequency of bowel movements decreased from （8.3±2.2） before treatment to （5.3±1.3） after 1 month, （3.2±0.8 ）after 3 months, and （1.9±0.6）after 6 months. The Bristol score was reduced from （6.6±0.3）points before treatment to （4.8±0.7） points 1 month after treatment, （4.6±0.8） points after 3 months, and （4.3±0.8）points after 6 months. The body mass index (BMI) of the patients before treatment was 15.3±1.3, the BMI increased to 17.4±2.4 after 1 month of treatment, increased to 19.0±3.2 after 3 months, and 19.3±3.8 after 6 months. The total protein was increased from （48.6±4.7）g/L before treatment to （55.4±5.7）g/L after 1 month of treatment, increased to （60.3±5.4） g/L after 3 months, and （68.4±6.9 ）g after 6 months. Albumin increased from （22.4±1.7）g/L before treatment to （31.7±2.4）g/L after 1 month of treatment, increased to （35.8±2.7）g/L after 3 months, and （37.5±3.7）g/L after 6 months. Fibrinogen increased from （1.6±0.4）g/L before treatment to （2.0±0.7）g/L after 1 month of treatment, increased to （2.4±0.8）g/L after 3 months, and （2.4±0.7）g/L after 6 months. Prealbumin increased from （82.0±18.6）mg/L before treatment to （178.3±25.3）mg/L after 1 month of treatment, increased to （235.7±28.2）mg/L after 3 months, and （259.6±33.5）mg/L after 6 months. The were significant differences before and after treatment （All P＜0.05） Conclusion    After 6 months of follow-up, FMT combined with enteral nutrition can effectively reduce the number of diarrhea, improve stool characteristics, and improve nutritional indicators such as BMI, total protein, albumin, fibrinogen and prealbumin.

Key words: refractory diarrhea；malnutrition, fecal microbiota transplantation, intestinal microecology

摘要：

目的    探讨菌群移植（FMT）联合肠内营养对顽固性腹泻合并重度营养不良病人的治疗效果。方法    前瞻性收集2014年6月至2018年10月同济大学附属第十人民医院结直肠病专科和东部战区总医院普通外科71例顽固性腹泻合并重度营养不良病人的基本信息、症状体征、排便次数、Bristol粪便评分、营养指标等，给予菌群移植联合肠内营养治疗后对上述指标进行随访。结果    经6个月随访，FMT联合肠内营养治疗重度腹泻伴重度营养不良病人，治疗腹泻的有效率为95.8%，其中治愈53例（74.7%），缓解15例（21.1%），无效3例（4.2%），复发6例（8.5%）。排便次数由治疗前的（8.3±2.2）次减少至1个月后（5.3±1.3）次，3个月后（3.2±0.8）次，6个月后（1.9±0.6）次。Bristol粪便评分由治疗前（6.6±0.3）分，减少至治疗后1个月（4.8±0.7）分，3个月后（4.6±0.8）分，6个月后（4.3±0.8）分。与治疗前比较差异均有统计学意义（P均＜0.05）。治疗前病人体重指数（BMI）为15.3±1.3，经治疗1、3、6个月分别增加至17.4±2.4、19.0±3.2、19.3±3.8。总蛋白由治疗前（48.6±4.7）g/L，经治疗后1、3、6个月后分别增加至（55.4±5.7）g/L、（60.3±5.4） g/L、（68.4±6.9）g/L。白蛋白由治疗前（22.4±1.7 ）g/L，治疗后1、3、6个月后分别增加至（31.7±2.4） g/L、（35.8±2.7） g/L、（37.5±3.7）g/L；纤维蛋白原由治疗前（1.6±0.4） g/L，治疗1、3、6个月后分别增加至（2.0±0.7）g/L、（2.4±0.8）g/L、（2.4±0.7）g/L；前白蛋白由治疗前（82.0±18.6） mg/L，治疗1、3、6个月后分别增加至（178.3±25.3）mg/L、（235.7±28.2） mg/L、（259.6±33.5） mg/L。与治疗前比较差异均有统计学意义（P均＜0.05）。结论    经6个月随访，FMT联合肠内营养治疗可有效减少顽固性腹泻合并重度营养不良病人腹泻次数、改善粪便性状，并明显增加BMI、总蛋白、白蛋白、纤维蛋白原和前白蛋白等营养指标。

关键词: 顽固性腹泻, 营养不良, 菌群移植, 肠道微生态