目的:分析粪菌移植(FMT)治疗脑出血继发急性假性肠梗阻(AIPO)的临床疗效。
方法:分析南方医科大学南方医院收治的1例AIPO继发脑出血患者的临床资料。比较了供体和患者之间的菌群组成,发现FMT前后(第0天和第25天)肠道菌群的变化。
结果:患者的主要临床表现为严重腹胀,肠管扩张和腹内高压。一周的常规治疗无效,症状逐渐恶化,影响呼吸功能。粪便菌群的结果表明肠道微生物群的菌群失调,所以FMT被尝试。FMT之后,患者的胃肠道症状明显缓解,在25天内没有进一步的发作。粪便菌群的新结果表明,肠道定植的菌群以Akkermansia和双歧杆菌为主,潜在的促炎和产气细菌显着减少,肠道微生物群多样性增加。在FMT后25天,结果与供体部分一致:在门水平,拟杆菌的相对丰度,维科霉素,厚壁菌和放线菌增加,而变形菌减少;在班级一级,微生物的相对丰度,细菌,放线菌,CoriobacteriiaandClostridiaareincreasedandGammaproteobacteriaisdecreased;attheorderlevel,细菌的相对丰度,Verrucologiales,梭菌,Coriobacteriales增加,而Betaproteobacteriales,肠杆菌减少;在家庭层面,双歧杆菌科的相对丰度,Akkermansiaceae,Ruminoccaceae增加,肠杆菌科减少;在属水平上,阿克曼西亚的相对丰度,双歧杆菌增加,大肠杆菌-志贺氏菌,克雷伯氏菌减少。在1年的随访中,患者生活自理,格拉斯哥结局量表(GOS)评分为5分.
结论:FMT可能在脑出血继发AIPO的治疗患者中提供临床益处,可能是通过调节肠道菌群,重建适当的肠道屏障,维持肠道稳态.
OBJECTIVE: To analyze the clinical effects of fecal microbiota transplantation (FMT) on the treatment of acute intestinal pseudo obstruction (AIPO) secondary to intracerebral hemorrhage.
METHODS: The clinical data of a patient with AIPO secondary to intracerebral hemorrhage who was admitted to Nanfang Hospital of Southern Medical University was analyzed. The flora compositon between donor and patient was compared, finding the changes of intestinal flora before and after FMT (day 0 and day 25).
RESULTS: The main clinical findings in the patient were serious bloating, expansion of the intestinal canal and intra-abdominal hypertension. A week of conventional therapy was not effective, and the symptoms became progressively worse, affecting respiratory function.The result of fecal flora suggested the intestinal microbiota dybiosis, so FMT was attempted. After FMT, the patient\'s gastrointestinal symptoms were significantly relieved, and there were no further episodes within 25 days. The new result of fecal flora showed that the flora colonizing the intestine was dominated by Akkermansia and Bifidobacterium, with a significant decrease in potential pro-inflammatory and gas-producing bacteria and an increased gut microbiota diversity. The results trended to be partly consistent with the donor at 25 days after FMT: at the phylum level, the relative abundance of Bacterioidetes, Vereucomicrobia, Firmicutes and Actinobacteria were increased while Proteobacteria was decreased; at the class level, the relative abundance of Verrucomicrobiae, Bacterioidia, Actinobacteria, Coriobacteriia and Clostridia were increased and Gammaproteobacteria was decreased; at the order level, the relative abundance of Bacterioidales, Verrucomicrobiales, Clostridiale, Coriobacteriales were increased and Betaproteobacteriales, Enterobacteriales were decreased; at the family level, the relative abundance of Bifidobacteriaceae, Akkermansiaceae, Ruminococcaceae were increased and Enterobacteriaceae was decreased; at the genus level, the relative abundance of Akkermansia, Bifidobacterium were increased and Escherichia-Shigella, Klebsiella were decreased. At 1-year follow-up, the patient lived with self-care and scored 5 points in Glasgow outcome scale (GOS).
CONCLUSIONS: FMT may provide clinical benefit in treated patients with AIPO secondary to intracerebral hemorrhage, probably by regulating the intestinal microflora, and re-establishing proper intestinal barrier, to maintain intestinal homeostasis.