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  • 北美GMFH:访谈“粪菌移植升阶治疗策略”治疗炎症性肠病
  • 发表时间:2015-11-9 12:07:13
  • 点击打开链接为更深刻地理解专访内容,首先介绍下知识背景:

    1.激素依赖型结肠炎概念及治疗现状:

    激素依赖型溃疡性结肠炎是指长期使用激素治疗的溃疡性结肠炎患者无法顺利将激素减停下来,或激素减停后3个月内复发。长期使用激素给患者病情带来额外风险,如何有效控制溃结症状,又能使患者脱离激素依赖,是临床医生的棘手问题。“粪菌移植”作为重建肠道菌群的重要手段,已被用于溃疡性结肠炎的临床治疗,并使部分患者获益,但对于激素依赖型溃结患者,单次粪菌移植的价值却很有限。

    2.粪菌移植升阶治疗策略的定义及步骤:

    所谓“粪菌移植升阶治疗策略”,简单来说就是以短期内单次或连续多次粪菌移植为基础,进一步结合其他治疗手段,如激素,生物制剂等治疗,帮助患者控制肠道症状,并脱离激素依赖状态。整个治疗方案分三步:

    Step 1:第一次粪菌移植,治疗后观察3-7天,评估患者的临床反应;若改善不明显则进入第二步;

    Step 2:第二次粪菌移植治疗,继续观察3-7天,评估其临床疗效;若患者仍无法从第二次粪菌移植获益,则进入第三步;

    Step 3:短程激素治疗(2-4周后开始减量),继续观察其疗效,若治疗效果明显,则进入随访观察加维持治疗阶段,若治疗效果不佳,则转换其他治疗,如继续使用激素治疗或转换为生物制剂治疗。

    对于Step 1、Step 2及Step 3治疗过程中所有治疗效果不佳患者,均可选择直接进行转换治疗(激素、生物制剂等)。

    J Transl Med:粪菌移植升阶治疗策略

    该方案不是三个治疗步骤简单的叠加,而是起到1+1+1>3的效果。

    GMFH网站Kristina对张发明博士的专访内容翻译如下:

    Kristina:您为什么想到这些溃疡性结肠炎的治疗方法(这里指激素和FMT)能协同发挥治疗作用?

    张发明:粪菌移植升阶治疗策略的构想是源自我们对一位FMT治疗失败的激素依赖型溃结患者的观察,这位患者第一次FMT治疗效果不佳,只能选择继续激素治疗,但是让人意外的是,该患者却从随后的激素治疗中获益,并能顺利减停激素。这一现象让我们很振奋,于是,我们提出假设,一次或者连续两次FMT治疗再加一次激素治疗可能会给患者带来更大的益处。

    Kristina:您有没有发现分别对step1,step2,和step3治疗有反应的患者之间有什么不同?

    张发明:这是一个很难回答的问题。事实上,我们不知道他们之间有什么区别。但是,如果处于激素依赖状态的患者第一次FMT治疗失败,那么他在接下来的治疗中需要继续使用激素的可能性大大提高。

    Kristina:您给患者日常饮食建议,您认为这些饮食在该治疗策略获得成功的过程中发挥了什么作用?

    张发明:饮食管理对减少复发发挥了非常重要的作用,即使一些患者在FMT治疗后能维持缓解,还是需要告诫患者进行严格的饮食限制。一些患者可能在控制饮食方面存在困难,这需要我们给予他们足够的医学健康教育。


    以下是原文全文,欢迎阅读

    NEWSTRATEGY MAY INCREASE THE SUCCESS OF FMT FOR ULCERATIVE COLITIS

    Writtenon November 8 2015 at 7:56 PM

    By Kristina Campbell in Digestive Health

    Fecal microbiota transplantation (FMT) for patients with ulcerative colitis (UC) has shown mixed clinical results (see recent trials here and here). In a new pilotstudy, published as open access, Faming Zhang and colleagues tested the safety and efficacy of a "step-up" FMT strategy in 15 steroid-dependent UC patients.

    The step-up strategy was as follows: After all medications were discontinued, (1) patients received an initial FMT treatment; (2) patients who did not benefit from step 1 received a second FMT treatment one week later; and (3) patientswho did not improve after steps 1 and 2 were switched to a short course of steroid therapy alone. Patients could opt out, resuming steroid therapy or switching to biologic therapy, at any time.

    After applying the step-up FMT strategy, researchers found that 57% of the patients showed clinical improvement and discontinued steroid treatment. The gut microbiota composition of the FMT responders became similar to that of thedonor, and half of the responders maintained remission up to 18 months. The remaining patients in the study did not show clinical improvement and remained dependent on steroid medication.

    Below,Faming Zhang answers some questions about the study for GMFH editors.

    Why did you want to investigate how potential UC treatments (here,steroid medication and FMT) can work together?

    The idea of the step-up FMT strategy originated from our observation of one case who failed to FMT, but then benefited from the following steroid treatment.Therefore, we had the hypothesis that a combination of two FMTs followed by steroids might lead to better results.

    Did you note any differences between patients who responded at step 1, those who responded at step 2, andthose who responded at step 3?

    Thisis a tough question. Actually, we did not know the differences. However, if the patients in the steroid-dependent situation failed to respond to the first FMT, they would have a high possibility of needing steroids in the following treatment.

    You gave informal dietary recommendations to the patients. Do you think diet played a role in the success of this strategy?

    The management of diet appeared very important for reducing the risk of flare.Though some cases maintained the remission after FMT, strict requirement on the diet should probably be introduced. Some patients may have difficulty controlling diet, so enough medical education for patients has to be given.

    Reference:

    Cui B,Li P, et al. (2015) Step-up fecal microbiota transplantation strategy: a pilot studyfor steroid-dependent ulcerative colitis. Journal of Translational MedicineDOI:10.1186/s12967-015-0646-2


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