(inflammatory bowel disease) [11] (irritable bowel disease) 困難梭狀桿菌感染 [12] [13] (vancomycin) (metronidazole) 9 [14] [15] [10] [16] (Firmicutes

Transcription

1 醫 學 新 知 糞便如何能治病?-論糞便腸 道菌叢移植 黃家榆 吳雅婷 些腸道微生物可能和人體健康有關 [6,7] 介紹 其中 類桿菌屬(Bacteroides spp ) 雙 微生物可以分成細菌(bacteria) 古細 菌(archea) 病毒(viruses) 和真核微生 物(microeukaryotes)四類 而一個人身上 的各種微生物總稱為人體微生物叢(human microbiota) [1] 經預估 人體身上可以有 10兆到100兆個微生物存在 這比人體細 胞還要多出10倍 而腸道的微生物又是 佔最多的比例且歧異度也是最高 大約 有1,000多種的微生物分佈在腸道中 [2] 歧桿菌屬(Bifidobacterium spp )與梭菌屬 (Clostridium spp )菌叢 已經有比較明顯 的研究表示和身體的免疫系統 癌症治療 與內分泌傳導功能相關[1,8] 但盤踞在身體 某處的微生物並不是一成不變 假若它們 受到了傷害 如抗生素使用 疾病或飲食 生活環境的改變 它們是有可能被其他微 生物取而代之 而這樣的一個動態改變的 過程也對人類的健康產生一定的影響[1] 不同性別 種族或年齡的族群 身上所 帶有的微生物是不同的 而且飲食內容 的不同也會影響腸道微生物的種類 像 是飲食西化也會造成微生物種類的改變 [1,3] 有趣的是 這些微生物就算在腸道 中 也是各有各的地盤 就算在相同的 器官 不同的解剖深度也能看見不同的 微生物存在 [4] 以往認為這些腸道微生物 的主要功能和代謝吸收營養有關 [1,5] 但 現在根據混雜基因體學(metagenomic)的 研究 似乎發現到除了營養吸收外 這 糞便腸道菌叢移植 顧名思義 就是將捐贈者的糞便經 過處理後 將所需的部分導入受贈者的腸 道中 這樣的目的是要改變受贈者腸道 中的菌叢 進而讓受贈者獲得健康上的 效益 [9] 雖然中國醫療史上很早就有流傳 下以糞便來治病的紀錄 但大概要到50 年前 才比較有科學化的論文提出以糞 便來治療偽膜性大腸炎的案例 [10] 目前對 於糞便捐贈者的篩選條件為 1. 捐贈糞 佛教慈濟醫療財團法人台中慈濟醫院家庭醫學科主治醫師 便前6個月沒有使用過抗生素 沒有接受 關鍵詞 fecal microbiota transplantation 過刺青或身體穿刺傷 2. 沒有免疫功能 通訊作者 吳雅婷 缺陷 無癌症或其他代謝性疾病 3. 沒 228 家 庭 醫 學 與 基 層 醫 療 第三十三卷 第八期

2 (inflammatory bowel disease) [11] (irritable bowel disease) 困難梭狀桿菌感染 [12] [13] (vancomycin) (metronidazole) 9 [14] [15] [10] [16] (Firmicutes) (Bacteroidetes) (Proteobacteria) [17] [18] [19] 發炎性腸道疾病 [20] 家庭醫學與基層醫療 第八期 229

3 (Lachnospiraceae) (Actinobacteria) [21] 36% 22% 6 [22] [23] [24] 安全性 [27] (randomized controlled trial, RCT) 3 [15] [28] [27] [29] 大腸激躁症 15-20% [25] 9 6 [26] 結論 [30] 230 家庭醫學與基層醫療 第八期

4 參考資料 1. Hollister E, Gao C, Versalovic J: Compositional and functional features of the gastrointestinal microbiome and their effects on human health. Gastroenterology. 2014; 146: Qin J, Li R, Raes J et al: A human gut microbial gene catalogue established by metagenomics sequencing. Nature 2010; 464: David L, Maurice C, Carmody R et al: Diet rapidly and reproducibly alters the human gut microbiome. Nature 2014; 505: Eckburg P, Bik E, Bernstein C et al: Diversity of the human intestinal microbial flora. Science 2005;308: Harrell L, Wang Y, Antonopoulos D et al: Standard colonic lavage alters the natural state of mucosal associated microbiota in the human colon. PLoS One 2012; 7:e Gill S, Pop M, Deboy R et al: Metagenomic analysis of the human distal gut microbiome. Science 2006; 312: Wang Y, Hoenig J, Malin K et al: 16s rrna genebased analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitis. ISME J 2009; 3: Mills K: TLR-dependent T cell activation in autoimmunity. Nat Rev Immunol 2011; 11: Bakken J, Borody T, Brandt L et al: Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol 2011; 9: Eiseman B, Silen W, Bascom G et al: Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery 1958; 44: Ahm S: Fecal Microbiota Transplantation. Metabolism 2018; 31: Miller B, Chen L, Sexton D et al. Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infect Control Hosp Epidemiol 2011; 32: Bartlett J, Gerding D: Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis 2008; 46(Suppl. 1):S Van Nood E, Speelman P, Nieuwdorp M et al: Fecal microbiota transplantation: facts and controversies. Curr Opin Gastroenterol 2014; 30: Khoruts A, Dicksved J, Jansson J et al: Changes in the composition of the human fecal microbiome after bacteriotherapy for recurrent Clostridium difficile-associated diarrhea. J Clin Gastroenterol 2010; 44: Youngster I, Russell G, Pindar C et al: Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. JAMA 2014; 312: Shahinas D, Silverman M, Sittler T et al: Toward an understanding of changes in diversity associated with fecal microbiome transplantation based on 16s RRNA gene deep sequencing. MBio 2012; 3:e Weingarden A, Chen C, Bobr A et al: Microbiota transplantation restores normal fecal bile acid composition in recurrent Clostridium difficile infection. Am J Physiol Gastrointest Liver Physiol 2014; 306:G Ng K, Ferreyra J, Higginbottom S et al: Microbiota liberated host sugars facilitate postantibiotic expansion of enteric pathogens. Nature 2013; 502: Loftus E: Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 2004; 126: Frank D, Robertson C, Hamm C et al: Disease phenotype and genotype are associated with 家庭醫學與基層醫療 第八期 231

5 shifts in intestinal associated microbiota in inflammatory bowel diseases. Inflamm Bowel Dis 2011; 17: Colman R, Rubin D: Fecal microbiota transplantation as therapy for inflammatory Bowel disease: a systematic review and metaanalysis. J Crohns Colitis 2014; 8: Suskind D, Brittnacher M, Wahbeh G et al: Fecal microbial transplant effect on clinical outcomes and fecal microbiome in active Crohn's disease. Inflamm Bowel Dis 2015; 21: Angelberger S, Reinisch W, Makristathis A et al: Temporal bacterial community dynamics vary among ulcerative colitis patients after fecal microbiota transplantation. Am J Gastroenterol 2013; 108: Yao X, Yang Y, Cui L et al: Subtypes of irritable bowel syndrome on Rome III criteria: a multicenter study. J Gastroenterol Hepatol 2012; 27: Pinn D, Aroniadis O,Brandt L: Is fecal microbiota transplantation (FMT) an effective treatment for patients with functional gastrointestinal disorders (FGID)? Neurogastroenterol Motil 2015; 27: Kelly C, Kahn S, Kashyap P et al: Update on fecal microbiota transplantation 2015: indications, methodologies, mechanisms, and outlook. Gastroenterology 2015; 149: Vermeire S, Joossens M, Verbeke K et al: Sa1922 pilot study on the safety and efficacy of faecal microbiota transplantation in refractory Crohn's disease. Gastroenterology 2012; 142:S Liou A, Paziuk M, Luevano J et al: Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity. Sci Transl Med 2013; 5:178ra Petrof E, Gloor G, Vanner S et al: Stool substitute transplant therapy for the eradication of Clostridium difficile infection: repopulating the gut. Microbiome 2013; 1: 家庭醫學與基層醫療 第八期