| Background: Ulcerative colitis(UC)is a chronic non-specific inflammatory disease of the rectum and colon.The pathogenesis is still unclear.It was found that intestinal flora disorder is one of the related factors for the occurrence and development of ulcerative colitis.Fecal microbial transplantation(FMT)refers to a treatment method in which the feces of healthy individuals are processed into fecal bacteria liquid,infused into the digestive tract of the patient to rebuild the intestinal flora to restore intestinal function.It has achieved excellent results in the treatment of clostridium difficile infection,but the clinical treatment effect of fecal transplantation in UC is still controversial,and stays in the clinical research stage.Objective: To evaluate the therapeutic effect and adverse reaction of fecal microbial transplantation on ulcerative colitis systematically,and to explore the effect of donor selection,pre-transplant preparation,transplantation pathway,frequency of transplants,fecal fluid preparation and other factors on FMT treatment of UC.Methods: We searched the databases including PubMed,Embase,Cochrane,WOS,CBM and CNKI and the search time was from the construction of the database until April 2018.Randomized controlled trials,non-randomized controlled studies and non-randomized experimental studies of FMT in the treatment of UC were collected and filtered according to inclusion and exclusion criteria,which were used to extract the information of clinical remission rate,clinical efficiency,adverse reaction rate,transplantation strategy and other data.We use review Manager 5.3 software and R software for Meta analysis.Results: Finally,23 studies,including 583 cases of UC patients,containing 4 RCT articles,3 non-randomized controlled studies,and 16 non-randomized experimental studies were selected.Meta analysis shows:1)In the control study,the efficiency and remission rate of the fecal bacteria transplantation group were higher than those of the control group.101 patients in FMT group and 66 patients in control group got clinical improvement(OR=2.57,95%CI:1.61-4.12,p<0.01),49 patients in FMT group and25 patients in control group achieved clinical remission(OR=2.40,95%CI:1.38-4.19,p<0.01);2)Non-controlled trials showed a total clinical improvement rate of 50%(95%CI:0.37-0.64)and a total clinical remission rate of 30%(95%CI:0.24-0.37)for FMT treatment of UC;3)Subgroup analysis was carried out according to intestinal preparation,pre-transplant antibiotic treatment,transplantation pathway,transplant frequency and donor,The effective rate was 58%(95% CI: 0.43-0.71)in the non-intestinal preparation group and 49%(95% CI: 0.32-0.66)in the intestinal preparation group.There was no significant difference between the two groups(P=0.47);the effective rate was 50%(95% CI: 0.35-0.64)in the non-antibiotic group and53%(95% CI: 0.16-0.87)in the antibiotic group.There was no significant difference between the two groups(p= 0.88);the effective rate of upper gastrointestinal route group was 37%(95% CI: 0.05-0.85),the effective rate of lower gastrointestinal route group was 48%(95% CI: 0.32-0.65),and the effective rate of mixed route group was64%(95% CI: 0.26-0.90),the difference between the three groups was not statistically significant(P = 0.69);the effective rate of single transplantation group was 43%(95%CI: 0.28-0.60),the effective rate of multiple transplantation group was 51%(95% CI:0.07-0.93),the effective rate of mixed transplantation group was 66%(95% CI:0.54-0.77).There was no significant difference between the three groups(P=0.15);The effective rate was 32%(95% CI: 0.11-0.64)in the healthy relatives group and 47%(95% CI: 0.31-0.64)in the unrelated donor group.There was no significant difference between the two groups(p=0.20).4)The common adverse reactions of FMT were fever and diarrhea,the incidence of fever was 18%(95% CI:0.12-0.26),and the incidence of diarrhea was 18%(95%CI:0.09-0.33);5)There was no significant publication bias in the effective rate and remission rate in the control study.There was the publication bias in the remission rate and diarrhea rate of UC patients treated with FMT in non-controlled studies.There was no significant publication bias in the effective rate and fever incidence rate of UC patients treated with FMT in non-controlled studies.Conclusion: FMT is effective for UC treatment,with common adverse reactions,fever and diarrhea,which may become a new way of UC treatment in the future.There was no uniform standard for bowel preparation before transplantation,whether to give antibiotics before transplantation,route of transplantation,number of transplants,and donor selection.Although the study had showed that the above factors have no significant effect on the efficacy,more evidence is needed to confirm. |
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