| Background and PurposeUlcerative colitis is a chronic inflammatory disease of the colon with its highest incidence in early adulthood,presenting with symptoms such as abdominal pain,anemia and bloody diarrhea,and resulting in a large number of lifetime morbidity.Despite decades of research,little is known about the etiology and pathogenesis of the disease.Therefore,there is not a drug that can meet the criteria of high efficacy and low side effects.Currently,the popular hypothesis about the etiology of UC believes that the pathogenesis of UC is that the mucosal immune system driven by intestinal microorganisms is unwell and continuously activated in genetically susceptible individuals.As a candidate factor that may drive the UC immune response is colonic microbiome-induced inflammation,since the colonic microbiome is altered in patients with the disease compared to healthy controls,and colitis in animal models requires intestinal bacteria to induce inflammation.Fecal microbiota transplantation has become a new method to change the colon microbiome.Many studies,including systematic review of randomized controlled trials and meta-analysis,have shown that FMT is effective in patients with active UC.FMT appears to be more effective than other microbial manipulation methods,including antibiotic probiotics and prebiotics.However,the potential predictors of microbial-based treatment outcomes and the ultimate active ingredients for FMT-mediated UC benefits remain largely unknown.The main content of this study was to conduct a meta-analysis of the efficacy of FMT in the treatment of UC.Meanwhile,we attempted to describe the changes in bacterial classification and function related to UC after FMT,especially those changes that predicted the success or failure of treatment.MethodPub Med,Embase,Cochrane,Clinicial Trails.Gov,CNKI,Wanfang.com,VIP,and Chinese biomedical literature database were searched.The deadline was February2021,and clinical trials using FMT for UC were included.Randomized controlled trials(RCTs)were Randomized for Meta-analysis using STATA15.1 software.Odds ratio(OR)was used to evaluate the efficacy of FMT transplantation.By analyzing and summarizing the changes of intestinal flora in all the included literatures,the conclusions were drawn by comparing the similarities and differences of intestinal flora changes in all the literatures.ResultA total of 13 clinical studies were included,including 562 patients with UC,including 7 RCT studies and 6 non-randomized controlled trials.In the RCT study,the grade of outcome variables was classified into clinical remission,clinical response and clinical ineffectiveness.Logistic regression was used to calculate the grade effect size of ordered variables :OR=3.680,95%CI:2.373-5.710,Z =5.82 P<.0.05,which was statistically significant.The results showed that the therapeutic effect of FMT group on UC was significantly better than that of the control group.From the analysis of intestinal flora in various literatures,it can be concluded that the intestinal flora of patients with UC all showed a decrease in the diversity and richness of intestinal microbes,and the proportion of bacterial flora was unbalanced,which was shown as:the abundance of members of Clostridium cluster IV Xiva and XVIII was significantly reduced,while that of Bacteroidetes Enterococcus The abundance of members of Clostridium cluster IX and XI was higher.The intestinal flora with clinical response after FMT transplantation was as follows: the diversity and richness of intestinal flora tended to be similar to those of donors;Among them: Clostridium cluster IV and Xiva(including Eubacterium hallii,Roseburia intestinalis,Butyrivibrio crossotus and Ruminococcus gnavus)increases,deformation of enterococcus bacteria doors down;The patients with no response were those with no significant change in intestinal flora and UC patients.The intestinal flora that recurred after clinical remission was characterized by increased abundance of Proteobacteria(Escherichia coli or Aeromonas)and Bacteroidetes(including Bacteroidetes common and Bacteroidetes fragilis).ConclusionFMT can significantly improve the clinical efficacy of UC patients;FMT can increase the richness and diversity of intestinal microflora in patients with UC,including Clostridium cluster IV and Xiva(including Eubacterium hallii,Roseburia intestinalis,Butyrivibrio crossotus and Ruminococcus gnavus)such as the increase of beneficial bacteria,deformation bacteria door and enterococcus harmful bacteria. |
