生物与医学2019nature.com
微生物群移植疗法对自闭症症状与肠道菌群的改善作用
Benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota
入门 · 约 45 分钟读完前置知识：肠道菌群基础、自闭症谱系障碍基础、临床试验设计
导读
这篇发表于 Scientific Reports 的研究探讨了菌群移植疗法（MTT）能否改善自闭症谱系障碍（ASD）的症状和肠道菌群。研究对自闭症儿童进行了包含万古霉素预处理和粪菌移植的疗程，报告称参与者的胃肠道症状和自闭症相关行为指标均有改善，且肠道菌群多样性提升。
HN 关注点：菌群与自闭症之间的联系，同时讨论焦点也集中在研究方法学的可信度上——非盲、无对照试验及作者的利益冲突引发质疑。
HN 评论精选
这几条评论里：支持 1 质疑 1 亲历 1
质疑质疑期刊层级、万古霉素预处理的合理性以及作者利益冲突，认为研究方法学不可靠
(1) 这不是 Nature，是 SciRep，别被 URL 迷惑。(2) Nature 影响因子极高，但它其实是基础科学期刊，不是医学、精神科或发育儿科期刊——即使发在 Nature 上，临床医生也未必会去读并批评这项研究。(2a) 例如他们的肠道移植准备用了两周万古霉素做肠道清理。万古霉素实际只用于艰难梭菌结肠炎和金黄色葡萄球菌肠炎，因为它几乎不作用于其他常见肠道菌群——它吸收差，适合冲洗肠腔里的艰难梭菌，但对肠道其他细菌连二线用药都算不上。所以用它来清除原有肠道菌群、'抑制致病菌'很奇怪：艰难梭菌和 MRSA 并不是主要的肠道致病菌，原有菌群以厌氧菌为主。(3) 一项非盲、无对照的试验，研究的又是症状高度主观的疾病？太棒了。我确信他们采取措施保证主观评估不受影响——哦，资深作者手握一堆试图将自闭症益生菌商业化的专利。
arkades查看英文原文
(1) This isn't Nature, it's SciRep. Don't get distracted by the URL. (2) Nature is an extremely high impact factor journal. However, it's ... not really a medical journal. Nor a psych journal. Nor a developmental peds journal. It's a basic sciences journal. What I mean to say is, even if this were Nature, it'd be a super high-impact journal that isn't actually read by clinicians who would be best positioned to criticize the study. (2a) For instance, their bowel transfer prep involved a clean-out with a two week course of vanco. The only bowel bugs it's used for are c. diff colitis and staph aureus enterocolitis. The reason it's really only used for that is because it really doesn't touch any other common bowel inhabitants. It's useful for those because it doesn't absorbed very effectively, so if you've got C Diff sitting in the bowel lumen, great, send a wash of vanco down the pipe. But, uh, for any other bugs in the gut? It's not even second line. So, how weird that it would be used to knock out pre-existing gut flora and "suppress pathogenic bacteria." C Diff and MRSA are not the leading pathogenic gut bacteria. The pre-existing flora are predominantly anaerobes. (3) An unblinded, uncontrolled trial of a disease whose symptoms are highly subjective in measure? Excellent. I'm sure they took measures to ensure they weren't influenced in their subjective analys- (3a) Oh. The senior author has a bunch of patents out trying to commercialize probiotics for autism. (3b) Oh, they used the PGI3, CARS, SRS, and ABC scores. I guess if you fill out enough bubbles you can overcome the fact that those are still subjective enough that they're shit for an open-label trial. Whoops. I don't mean to be overly dismissive. It's a fine pilot. The results are interesting enough that I'd want to see a real study tackle this. My comments are mostly aimed at the prevailing sentiment here taking this at face value.
亲历轻度自闭症患者的亲历：渴望改善社交困难，但也纠结于'治疗'是否会抹去自我
我有非常轻微的自闭症，但我会说我确实受自闭症之苦。我对能高效工作的环境非常敏感，人际交往需要非常明确的规则。做工程没问题，但我也想更多与人打交道（这通常是职业晋升的方式），而我快 30 岁了仍然很难判断开会时什么时候该闭嘴、哪些话题不该提。如果能'正常'，我想我的生活会好很多。我说'我想'，是因为不确定失去那些构成'我'的东西是否值得。周五晚上读各种奇怪的书学新东西我完全乐在其中，虽然情绪调节有困难，但经过几十年的应对，我能把它们转化为做事的热情。不过我觉得如果小时候能接受某种干预，童年会容易得多——多年被霸凌、交不到朋友留下的创伤，至今影响我在商务场合面对陌生人的表现。
pimmen查看英文原文
I have a very mild form of autism but I would say that I suffer from autism. I'm very sensitive to which environment I can be productive in and I need very clear protocols for human interaction. It's fine for engineering but I want to work more with people too (that's generally how you advance career-wise) and I have big problems knowing when to keep quiet in meetings and what topics for discussion are poor choices, even though I'm close to 30 years old now. If I could just be "normal" I think my life would improve immensely. I say "I think" because I'm not sure if I would like losing the things that make me "me". A friday night just reading all kinds of odd books to learn new things is totally fine by me right now and even though I have problems regulating my emotions I can now, after decades of coping, channel them into passion to get stuff done. I do however think my childhood would've been much easier if I was somehow treated as a young child; the years of being bullied and not making friends have taken its toll on me, something I struggle with to this day in business settings when I have to deal with unfamiliar people.
支持引用数据强调疗效惊人：重度比例从 83% 降至 17%，44% 低于诊断阈值
研究开始前，83% 的参与者被评为'重度'自闭症。现在只有 17% 仍为重度，39% 为轻度或中度，更不可思议的是，44% 已低于轻度 ASD 的诊断阈值。https://newatlas.com/fecal-transplants-autism-symptoms-reduction/59278/
aussieguy1234查看英文原文
Prior to the study, 83 percent of participants had "severe" autism. Now, only 17 percent are rated as severe, 39 percent as mild or moderate, and incredibly, 44 percent are below the cut-off for mild ASD. https://newatlas.com/fecal-transplants-autism-symptoms-reduction/59278/
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- 2019Hacker News 讨论帖216 分 · 142 评
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