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
4. 5. 6. (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
(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
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shifts in intestinal associated microbiota in inflammatory bowel diseases. Inflamm Bowel Dis 2011; 17:179-84. 22. Colman R, Rubin D: Fecal microbiota transplantation as therapy for inflammatory Bowel disease: a systematic review and metaanalysis. J Crohns Colitis 2014; 8:1569-81. 23. 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; 21:556-63. 24. 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; 108:1620-30. 25. Yao X, Yang Y, Cui L et al: Subtypes of irritable bowel syndrome on Rome III criteria: a multicenter study. J Gastroenterol Hepatol 2012; 27:760-5. 26. Pinn D, Aroniadis O,Brandt L: Is fecal microbiota transplantation (FMT) an effective treatment for patients with functional gastrointestinal disorders (FGID)? Neurogastroenterol Motil 2015; 27:19 29. 27. Kelly C, Kahn S, Kashyap P et al: Update on fecal microbiota transplantation 2015: indications, methodologies, mechanisms, and outlook. Gastroenterology 2015; 149:223-7. 28. 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:S360. 29. 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; 5:178ra141. 30. Petrof E, Gloor G, Vanner S et al: Stool substitute transplant therapy for the eradication of Clostridium difficile infection: repopulating the gut. Microbiome 2013; 1:3. 232 家庭醫學與基層醫療 第八期