肠菌移植：从经验治疗迈向精准规范化时代

Fecal microbiota transplantation: from empirical therapy to the era of precision and standardized medicine

摘要:

肠菌移植（FMT）作为重塑肠道微生态的重要生物治疗策略，已从早期经验性用于复发性艰难梭菌感染，逐步拓展至炎症性肠病、功能性胃肠疾病、慢性肝病以及神经精神疾病等多种肠内外疾病，并正在向精准化、规范化和机制导向的微生态治疗阶段发展。本文结合近十年来国内外FMT领域的重要研究进展及本团队的大规模临床实践经验，围绕“经验治疗—标准化实践—精准干预”的发展主线，系统综述FMT在供体筛选与质量控制、肠道微生物组检测、供受体精准配型、治疗时机与疗程优化、移植途径选择、疗效评估体系构建及长期随访管理等方面的关键问题与挑战，同时总结FMT在“菌-肠-器官轴”调控、活菌生物药、噬菌体疗法等新兴方向的研究进展。未来FMT的发展将更加依赖多组学技术、人工智能配型及功能菌群解析，推动FMT从经验性操作向精准、可控和可复制的微生态治疗模式转变。

Abstract:

Fecal microbiota transplantation (FMT), as an important biological strategy for reconstructing intestinal microecology, has evolved from an empirical therapy for recurrent Clostridioides difficile infection to a promising intervention for a wide range of intestinal and extraintestinal diseases, including inflammatory bowel disease, functional gastrointestinal disorders, chronic liver diseases, and neuropsychiatric disorders. FMT is currently transitioning toward an era of precision, standardization, and mechanism-oriented microecological therapy. Based on major advances in FMT research over the past decade and the extensive clinical experience of our team, this review systematically summarizes the developmental trajectory of FMT from "empirical treatment-standardized practice-precision intervention". Key issues and challenges are discussed, including donor screening and quality control, gut microbiome detection, donor-recipient matching, optimization of treatment timing and therapeutic courses, selection of transplantation routes, establishment of efficacy evaluation systems, and long-term follow-up management. In addition, recent progress in emerging fields such as the gut-organ axis, live biotherapeutic products, and bacteriophage therapy is highlighted. Future development of FMT will increasingly rely on multi-omics technologies, artificial intelligence-assisted matching strategies, and functional microbiota analysis, thereby promoting the transformation of FMT from an empirical intervention into a precise, controllable, and reproducible microecological therapeutic modality.