圖片來源：haicontroversies.blogspot.com

　　近日，來自國外的研究人員在國際雜誌The BMJ上刊文稱，糞便移植在治療嚴重感染的使用越來越成為患者的療法選擇，但隨著使用的增加以及捐助者篩查範圍的擴大，進行良好的長期試驗及監測也非常必要，目的在於為病人提供最為合理的選擇和建議。

　　腸道微生物群落在我們機體免疫係統和健康中扮演著重要角色，而將糞便物從一個人移植到另一個人目前被人們越來越多地用於治療嚴重的危及生命的感染性疾病，比如難辨梭狀芽胞杆菌感染的複發等，這種細菌每年會引發成千上萬人死亡。移植的操作步驟包括，將健康供體液化的糞便引入患者的腸道中，從而使健康的細菌菌群在受體腸道中重新定植，通常患者進行長期的抗生素療法後腸道菌群就會被破壞。

　　大量數據分析得知，標準化的抗生素療法治療嚴重感染性疾病的成功率僅為20%，而糞便移植的成功率則可以達到85%，近來有一項試驗提前終止了，因為糞便移植的成功率達到了90%，而抗生素療法僅為26%，因此糞便移植的成功率以絕對優勢戰勝了抗生素治療。

　　研究者Tim Spector指出，截止到目前位置，有超過7000名接受糞便移植的患者並沒有不良的副作用報道，盡管這是早先的數據，而且糞便移植在成年患者或免疫係統受損的患者機體中都表現相對安全；如今在美國有超過500個提供糞便移植的中心，在波士頓大多數移植都配備有實驗室進行，而且糞便移植用於治療難辨梭狀芽胞杆菌的感染已經得到了美國胃腸病學學會和歐洲微生物學和傳染病學會的謹慎認可。

　　相比抗生素治療而言，糞便移植具有較高的成功率，而且糞便移植的使用目前也應用於其它疾病中，比如肥胖、糖尿病、腸易激綜合征等，當然研究者還指出，由於存在明顯的感染風險，長期以來將糞便微生物移植入一個新的宿主也存在潛在的風險，這就包括增加對肥胖的易感性甚至是心理疾病等，這些潛在的風險就表明，糞便移植盡管作為一種新型工具，其也應當被進行仔細監測，同時也應當盡可能地提純出真正的有益細菌。

　　doi:10.1136/bmj.h5149

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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