| ObjectivesThe normal intestinal flora of body can form a biological barrier on the surface of the intestinal mucosa to protect the intestinal tract from pathogens.Its metabolites not only participate in the formation and regulation of mucosal immunity,but also regulate intestinal motility.Intestinal dysbacteriosis is closely related to the occurrence and development of intestinal diseases.Therefore,the first part of this study aims at exploring the effect of clinical symptoms,quality of life,mental status,gastrointestinal motility,and intestinal microbiota of chronic functional constipation.At the same time,clearing the relationship between intestinal flora and CFC.The second part aims at investigating the effects of FMT on abdominal pain,diarrhea,bloody stools,intestinal mucosal lesions,and intestinal flora of ulcerative colitis,evaluating its clinical efficacy and safety,clearing the relationship between intestinal flora and UC.Thereby,provide a clinical basis for diagnosis and treatment of intestinal diseases.PartⅠ clinical study of fecal microbiota transplantation of chronic functional constipation MethodsThis study includes 34 patients diagnosed with chronic functional constipation,who were all treated with FMT.Wexner constipation score,constipation symptom self-assessment scale,Bristol stool form scale(BSFS),Patient assessment of constipation quality of life(PAC-QOL),Zung’s self-rating anxiety Scale(SAS)and Zung’s self-rating depression scale(SDS)were used to record constipation symptoms,fecal traits,quality of life and mental status before and after treatment,clinical efficacy and impact on mental status are assessed.The intestinal motility before and after treatment was observed by the electrogram to evaluate the effect of intestinal motility.By measuring the levels of serum motilin,gastrin,nitric oxide,and5-hydroxytry Ptamine,the mechanism of its influence on intestinal motility was explored.16 S r RNA sequencing technology was used to detect the changes of intestinal flora,and the relationship between chronic functional constipation and intestinal florawas explored.Results(1)Compared with pre-treatment,wexner constipation score,constipation patient self-rating scale score,PAC-QOL,SAS,SDS were significantly decreased,BSFS was increased(P <0.05).The result indicates that FMT can improve constipation symptoms,stool characteristics,improve quality of life,and mental status in patients diagnosed with constipation.(2)Electrogram examination shows that the intestinal average amplitude of the postprandial meal is significantly increased after the first treatment,and the average amplitude before meals was significantly increased after the second and third treatments,and the intestinal average frequency before meal was significantly accelerated after the second treatments.(P<0.05).The result indicates that FMT can enhance intestinal peristalsis.(3)Compared with pre-treatment,serum motilin and gastrin levels do not change significantly(P>0.05),serum 5-HT level is decreased,and NO level is increased (P<0.05),the result indicate that FMT maybe by affecting 5-HT and NO levels to promote intestinal dynamics.(4)The results of intestinal microbiota analysis showed that the intestinal flora in patients diagnosed with chronic functional constipation was different from that of the donor.After the FMT,the intestinal flora in the patient gradually approached to the level of the donor.In addition,Bacteroides and Phascolarctobacterium were the predominant microflora before treatment.After treatment,Megamonas,Acidaminococcus and Butyricimonas were the predominant microflora,this suggests that the bacteria above were secretly related to chronic functionalities.FMT could reconstruct the intestinal flora and improve constipation.ConclusionFMT can improve the stool characteristics of patients diagnosed with chronic functional constipation,relieve constipation symptoms,improve the patient’s quality of life,improve their anxiety and depression,and the mechanism of it may be by changingserum 5-HT and NO levels to accelerate intestine motility;FMT can improve constipation by regulating the intestinal microflora and changing the abundance of chronic functional constipation-associated bacterial flora,which provides new ideas for the treatment of this disease.Part II Clinical Study of fecal microbiota transplantation of Ulcerative Colitis MethodsIn this study,20 patients diagnosed with ulcerative colitis were treated with FMT.The abdominal pain,diarrhea score,constipation score,intestinal mucosal lesion score and Mayo score were used to record clinical efficacy after treatment.Changes in erythrocyte sedimentation rate,C-reactive protein,platelets,hemoglobin and leukocytes were recorded to evaluate the effect of FMT on systemic inflammatory responses and nutritional status.16 S r RNA sequencing technology was used to detect the changes of intestinal flora,and the relationship between chronic functional constipation and intestinal flora was explored.Results(1)Compared with pre-treatment,the diarrhea score,abdominal pain score,blood stool score decreased significantly(P<0.05),the result indicate that FMT can improve abdominal symptoms and defecation in patients diagnosed with ulcerative colitis.(2)Compared with pre-treatment,the erythrocyte sedimentation rate,C-reactive protein do not change significantly(P>0.05),but the scores of intestinal mucosal lesions and Mayo score decreased significantly after treatment(P<0.05), indicating that FMT can improve the mucosal lesions and activity of patients to a certain extent.(3)The intestinal microflora analysis showed that the intestinal flora in patients diagnosed with ulcerative colitis was different from that of donors.The relative abundance of Prevotella before treatment was decreased,and the relative abundance of Klebsiella and Streptococcus were increased,and gradually approached to the donor level after treatment.LEf Se analysis showed that Megadonas,Erysipelotrichaceae,Epulopiscium,Dorea were the dominant bacteria before treatment.This suggests that these bacteria may be biomarkers that cause ulcerative colitis.Phascolarctobacterium,Proteus,Lactobacillus and Clostitriaceae were the dominant bacteria in the intestine of patients after treatment,which may be closely related to the improvement of ulcerative colitis symptoms.ConclusionThe fecal microbiota transplantation reconstructs the structure of the intestinal microbiota and changes the abundance of bacterial flora closely related to ulcerative colitis,and improves the scores of diarrhea,abdominal pain,and mucous membrane lesions in patients diagnosed with ulcerative colitis.The treatment provides new ideas for ulcerative colitis. |
