肠道菌群移植治疗免疫介导性皮肤病指南（2025版）

doi:10.35541/cjd.20240644

Abstract

Abstract: 【Abstract】 Immune-mediated skin diseases refer to a group of disorders driven by immune dysfunction, leading to skin damage with or without involvement of other tissues or organs. They mainly include atopic dermatitis, psoriasis, alopecia areata, lupus erythematosus, Sj?gren's syndrome, etc. These diseases are characterized by complex pathogenesis, diverse clinical manifestations, and challenging treatment. Recent studies have increasingly confirmed that alterations in the composition and function of the gut microbiota are present in various immune-mediated skin diseases. Fecal microbiota transplantation （FMT） may restore the patients′ gut microenvironment and systemic immune balance by transplanting the gut microbiota from healthy donors into the patients′ gastrointestinal tract, and has become an important method for the treatment of immune-mediated skin diseases, but currently there is a lack of standardized guidelines on its clinical application. Therefore, based on the latest research advancements worldwide and evidence-based medical studies, the “guidelines for fecal microbiota transplantation in the treatment of immune-mediated skin diseases （2025 edition）” has been formulated. This guideline addresses specific issues faced by dermatologists in China regarding the clinical application of FMT, and provides scientific and detailed evidence-based recommendations, aiming to promote the standardization of FMT therapy.

Key words: Fecal microbiota transplantation, Immune-mediated skin diseases, Dermatitis, atopic, Lupus erythematosus, systemic, Therapeutics, Guidelines

Immunology Group, Chinese Society of Dermatology. Immunology Group, Chinese Society of Dermatology[J]. Chinese Journal of Dermatology,2025,e20240644. doi:10.35541/cjd.20240644

References ［65］

［1］	Vesely MD. Getting under the skin: targeting cutaneous autoimmune disease［J］. Yale J Biol Med, 2020,93（1）:197⁃206.
［2］	Diotallevi F, Campanati A, Martina E, et al. The role of nutrition in immune⁃mediated, inflammatory skin disease: a narrative review［J］. Nutrients, 2022,14（3）:591. doi: 10.3390/nu14030591.
［3］	Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990⁃2013: a systematic analysis for the Global Burden of Disease Study 2013［J］. Lancet, 2015,386（9995）:743⁃800. doi: 10.1016/S0140⁃6736（15）60692⁃4.
［4］	Karimkhani C, Dellavalle RP, Coffeng LE, et al. Global skin disease morbidity and mortality: an update from the global burden of disease study 2013［J］. JAMA Dermatol, 2017,153（5）:406⁃412. doi: 10.1001/jamadermatol.2016.5538.
［5］	Schett G, McInnes IB, Neurath MF. Reframing immune⁃mediated inflammatory diseases through signature cytokine hubs［J］. N Engl J Med, 2021,385（7）:628⁃639. doi: 10.1056/NEJMra1909094.
［6］	Raimondo A, Lembo S. Immuno⁃pathogenesis of chronic inflammatory skin diseases: novel molecular targets and biomarkers［J］. Life （Basel）, 2022,12（6）:891. doi: 10.3390/life12060891.
［7］	Kobayashi T, Naik S, Nagao K. Choreographing immunity in the skin epithelial barrier［J］. Immunity, 2019,50（3）:552⁃565. doi: 10.1016/j.immuni.2019.02.023.
［8］	Oray M, Abu Samra K, Ebrahimiadib N, et al. Long⁃term side effects of glucocorticoids［J］. Expert Opin Drug Saf, 2016,15（4）:457⁃465. doi: 10.1517/14740338.2016.1140743.
［9］	Wojciechowski D, Wiseman A. Long⁃term immunosuppression management: opportunities and uncertainties［J］. Clin J Am Soc Nephrol, 2021,16（8）:1264⁃1271. doi: 10.2215/CJN.15040920.
［10］	Yao Y, Ravn Jørgensen AH, Thomsen SF. Biologics for chronic inflammatory skin diseases: an update for the clinician［J］. J Dermatolog Treat, 2020,31（2）:108⁃130. doi: 10.1080/09546634. 2019.1589643.
［11］	McLornan DP, Pope JE, Gotlib J, et al. Current and future status of JAK inhibitors［J］. Lancet, 2021,398（10302）:803⁃816. doi: 10.1016/S0140⁃6736（21）00438⁃4.
［12］	Belkaid Y, Harrison OJ. Homeostatic immunity and the microbiota［J］. Immunity, 2017,46（4）:562⁃576. doi: 10.1016/j.immuni.2017.04.008.
［13］	Ivanov II, Honda K. Intestinal commensal microbes as immune modulators［J］. Cell Host Microbe, 2012,12（4）:496⁃508. doi: 10.1016/j.chom.2012.09.009.
［14］	De Pessemier B, Grine L, Debaere M, et al. Gut⁃skin axis: current knowledge of the interrelationship between microbial dysbiosis and skin conditions［J］. Microorganisms, 2021,9（2）:353. doi: 10.3390/microorganisms9020353.
［15］	Vindigni SM, Surawicz CM. Fecal microbiota transplantation［J］. Gastroenterol Clin North Am, 2017,46（1）:171⁃185. doi: 10.1016/ j.gtc.2016.09.012.
［16］	Allegretti JR, Mullish BH, Kelly C, et al. The evolution of the use of faecal microbiota transplantation and emerging therapeutic indications［J］. Lancet, 2019,394（10196）:420⁃431. doi: 10.1016/ S0140⁃6736（19）31266⁃8.
［17］	Lopetuso LR, Deleu S, Godny L, et al. The first international Rome consensus conference on gut microbiota and faecal microbiota transplantation in inflammatory bowel disease［J］. Gut, 2023,72（9）:1642⁃1650. doi: 10.1136/gutjnl⁃2023⁃329948.
［18］	Mullish BH, Merrick B, Quraishi MN, et al. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridioides difficile infection and other potential indications: second edition of joint British Society of Gastroenterology （BSG） and Healthcare Infection Society （HIS） guidelines［J］. Gut, 2024,73（7）:1052⁃1075. doi: 10.1136/gutjnl⁃2023⁃331550.
［19］	陈容平, 杨锐, 陈宏. 菌群移植干预肥胖糖尿病专家共识［J］. 华南预防医学, 2022,48（10）:1165⁃1169. doi: 10.12183/j.scjpm. 2022.1165.
［20］	Vernooij RW, Alonso⁃Coello P, Brouwers M, et al. Reporting items for updated clinical guidelines: checklist for the reporting of updated guidelines （CheckUp）［J］. PLoS Med, 2017,14（1）:e1002207. doi: 10.1371/journal.pmed.1002207.
［21］	Kayama H, Okumura R, Takeda K. Interaction between the microbiota, epithelia, and immune cells in the intestine［J］. Annu Rev Immunol, 2020,38:23⁃48. doi: 10.1146/annurev⁃immunol⁃070119⁃115104.
［22］	Salem I, Ramser A, Isham N, et al. The gut microbiome as a major regulator of the gut⁃skin axis［J］. Front Microbiol, 2018,9:1459. doi: 10.3389/fmicb.2018.01459.
［23］	Polkowska⁃Pruszyńska B, Gerkowicz A, Krasowska D. The gut microbiome alterations in allergic and inflammatory skin diseases ⁃ an update［J］. J Eur Acad Dermatol Venereol, 2020,34（3）:455⁃464. doi: 10.1111/jdv.15951.
［24］	Fang Z, Li L, Zhang H, et al. Gut microbiota, probiotics, and their interactions in prevention and treatment of atopic dermatitis: a review［J］. Front Immunol, 2021,12:720393. doi: 10.3389/fimmu.2021.720393.
［25］	Zhu L, Jian X, Zhou B, et al. Gut microbiota facilitate chronic spontaneous urticaria［J］. Nat Commun, 2024,15（1）:112. doi: 10.1038/s41467⁃023⁃44373⁃x.
［26］	Sikora M, Stec A, Chrabaszcz M, et al. Gut microbiome in psoriasis: an updated review［J］. Pathogens, 2020,9（6）:463. doi: 10.3390/pathogens9060463.
［27］	Liu X, Liu M, Zhao M, et al. Fecal microbiota transplantation for the management of autoimmune diseases: potential mechanisms and challenges［J］. J Autoimmun, 2023,141:103109. doi: 10. 1016/j.jaut.2023.103109.
［28］	Ye Z, Zhang N, Wu C, et al. A metagenomic study of the gut microbiome in Behcet's disease［J］. Microbiome, 2018,6（1）:135. doi: 10.1186/s40168⁃018⁃0520⁃6.
［29］	Debes KP, Evdina NA, Laigaard A, et al. Betamethasone treatment for atopic dermatitis in gut microbiota transplanted mice［J］. Comp Med, 2020,70（1）:6⁃15. doi: 10.30802/AALAS⁃CM⁃18⁃000136.
［30］	Chen HL, Zeng YB, Zhang ZY, et al. Gut and cutaneous microbiome featuring abundance of lactobacillus reuteri protected against psoriasis⁃like inflammation in mice［J］. J Inflamm Res, 2021,14:6175⁃6190. doi: 10.2147/JIR.S337031.
［31］	Ma Y, Guo R, Sun Y, et al. Lupus gut microbiota transplants cause autoimmunity and inflammation［J］. Clin Immunol, 2021,233:108892. doi: 10.1016/j.clim.2021.108892.
［32］	Schaefer L, Trujillo⁃Vargas CM, Midani FS, et al. Gut microbiota from sjögren syndrome patients causes decreased T regulatory cells in the lymphoid organs and desiccation⁃induced corneal barrier disruption in mice［J］. Front Med （Lausanne）, 2022,9:852918. doi: 10.3389/fmed.2022.852918.
［33］	Kim JH, Kim K, Kim W. Gut microbiota restoration through fecal microbiota transplantation: a new atopic dermatitis therapy［J］. Exp Mol Med, 2021,53（5）:907⁃916. doi: 10.1038/s12276⁃021⁃00627⁃6.
［34］	Sugita K, Shima A, Takahashi K, et al. Pilot evaluation of a single oral fecal microbiota transplantation for canine atopic dermatitis［J］. Sci Rep, 2023,13（1）:8824. doi: 10.1038/s41598⁃023⁃35565⁃y.
［35］	Paramsothy S, Nielsen S, Kamm MA, et al. Specific bacteria and metabolites associated with response to fecal microbiota transplantation in patients with ulcerative colitis［J］. Gastroenterology, 2019,156（5）:1440⁃1454.e2. doi: 10.1053/j.gastro.2018.12.001.
［36］	Chu ND, Crothers JW, Nguyen L, et al. Dynamic colonization of microbes and their functions after fecal microbiota transplantation for inflammatory bowel disease［J］. mBio, 2021,12（4）:e0097521. doi: 10.1128/mBio.00975⁃21.
［37］	Xu B, Ling S, Xu X, et al. A new formulation of probiotics attenuates calcipotriol⁃induced dermatitis by inducing regulatory dendritic cells［J］. Front Immunol, 2021,12:775018. doi: 10. 3389/fimmu.2021.775018.
［38］	Kassam Z, Dubois N, Ramakrishna B, et al. Donor screening for fecal microbiota transplantation［J］. N Engl J Med, 2019,381（21）:2070⁃2072. doi: 10.1056/NEJMc1913670.
［39］	中华医学会肠外肠内营养学分会, 中国国际医疗保健促进交流会加速康复外科分会, 中国微生态治疗创新联盟, 等. 菌群移植标准化方法学的建立与临床应用中国专家共识［J］. 中华胃肠外科杂志, 2020,23（1）:5⁃13. doi: 10.3760/cma.j.cn. 441530⁃20200420⁃00231.
［40］	中华医学会肠外肠内营养学分会, 上海预防医学会微生态专业委员会. 肠道菌群移植供体筛选与管理中国专家共识（2022版）［J］. 中华胃肠外科杂志, 2022,25（9）:757⁃765. doi: 10.3760/cma.j.cn441530⁃20220606⁃00246.
［41］	何植, 张发明. 中华粪菌库的原则、方案和风险管理［J］. 胃肠病学, 2017,22（4）:193⁃198. doi: 10.3969/j.issn.1008⁃7125.2017. 04.001.
［42］	国家卫生健康委员会医院管理研究所, 中华医学会肠外肠内营养学分会, 中华医学会肠外肠内营养学分会肠道微生态协作组. 肠道菌群移植临床应用管理中国专家共识（2022版）［J］. 中华胃肠外科杂志, 2022,25（9）:747⁃756. doi: 10.3760/cma.j.cn441530⁃20220725⁃00324.
［43］	Cammarota G, Ianiro G, Tilg H, et al. European consensus conference on faecal microbiota transplantation in clinical practice［J］. Gut, 2017,66（4）:569⁃580. doi: 10.1136/gutjnl⁃2016⁃313017.
［44］	向丽园, 张发明. 粪菌移植在艰难梭菌感染治疗中的应用［J］. 临床荟萃, 2018,33（5）:385⁃389. doi: 10.3969/j.issn.1004⁃583X.2018.05.005.
［45］	Grosen AK, Mikkelsen S, Baunwall S, et al. Risk of Helicobacter pylori transmission by faecal microbiota transplantation via oral capsules［J］. Clin Microbiol Infect, 2023,29（6）:799.e1⁃799.e4. doi: 10.1016/j.cmi.2023.02.011.
［46］	Lee EH, Lee SK, Cheon JH, et al. Comparing the efficacy of different methods of faecal microbiota transplantation via oral capsule, oesophagogastroduodenoscopy, colonoscopy, or gastric tube［J］. J Hosp Infect, 2023,131:234⁃243. doi: 10.1016/j.jhin. 2022.11.007.
［47］	Iqbal U, Anwar H, Karim MA. Safety and efficacy of encapsulated fecal microbiota transplantation for recurrent Clostridium difficile infection: a systematic review［J］. Eur J Gastroenterol Hepatol, 2018,30（7）:730⁃734. doi: 10.1097/MEG. 0000000000001147.
［48］	Kao D, Roach B, Silva M, et al. Effect of oral capsule⁃ vs colonoscopy⁃delivered fecal microbiota transplantation on recurrent clostridium difficile infection: a randomized clinical trial［J］. JAMA, 2017,318（20）:1985⁃1993. doi: 10.1001/jama. 2017.17077.
［49］	Minkoff NZ, Aslam S, Medina M, et al. Fecal microbiota transplantation for the treatment of recurrent Clostridioides difficile （Clostridium difficile）［J］. Cochrane Database Syst Rev, 2023,4（4）:CD013871. doi: 10.1002/14651858.CD013871.pub2.
［50］	Xin Y, Huang C, Zheng M, et al. Fecal microbiota transplantation in the treatment of systemic lupus erythematosus: what we learnt from the explorative clinical trial［J］. J Autoimmun, 2023,141:103058. doi: 10.1016/j.jaut.2023.103058.
［51］	Yoon SS, Brandt LJ. Treatment of refractory/recurrent C. difficile⁃associated disease by donated stool transplanted via colonoscopy: a case series of 12 patients［J］. J Clin Gastroenterol, 2010,44（8）:562⁃566. doi: 10.1097/MCG.0b013e3181dac035.
［52］	Yau YK, Lau L, Lui R, et al. Long⁃term safety outcomes of fecal microbiota transplantation: real⁃world data over 8 years from the HongKong FMT registry［J］. Clin Gastroenterol Hepatol, 2024,22（3）:611⁃620.e12. doi: 10.1016/j.cgh.2023.09.001.
［53］	Lee CH, Belanger JE, Kassam Z, et al. The outcome and long⁃term follow⁃up of 94 patients with recurrent and refractory Clostridium difficile infection using single to multiple fecal microbiota transplantation via retention enema［J］. Eur J Clin Microbiol Infect Dis, 2014,33（8）:1425⁃1428. doi: 10.1007/s10096⁃014⁃2088⁃9.
［54］	Bakken JS, Borody T, Brandt LJ, et al. Treating clostridium difficile infection with fecal microbiota transplantation［J］. Clin Gastroenterol Hepatol, 2011,9（12）:1044⁃1049. doi: 10.1016/j.cgh.2011.08.014.
［55］	Youngster I, Russell GH, Pindar C, et al. Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection［J］. JAMA, 2014,312（17）:1772⁃1778. doi: 10.1001/jama.2014.13875.
［56］	DeFilipp Z, Bloom PP, Torres Soto M, et al. Drug⁃resistant E. coli bacteremia transmitted by fecal microbiota transplant［J］. N Engl J Med, 2019,381（21）:2043⁃2050. doi: 10.1056/NEJMoa 1910437.
［57］	Liu X, Luo Y, Chen X, et al. Fecal microbiota transplantation against moderate⁃to⁃severe atopic dermatitis: a randomized, double⁃blind controlled explorer trial［J］. Allergy, 2025,80（5）:1377⁃1388. doi: 10.1111/all.16372.
［58］	Mashiah J, Karady T, Fliss⁃Isakov N, et al. Clinical efficacy of fecal microbial transplantation treatment in adults with moderate⁃to⁃severe atopic dermatitis［J］. Immun Inflamm Dis, 2022,10（3）:e570. doi: 10.1002/iid3.570.
［59］	Deng WY, Chen WJ, Zhong HJ, et al. Washed microbiota transplantation: a case report of clinical success with skin and gut microbiota improvement in an adolescent boy with atopic dermatitis［J］. Front Immunol, 2023,14:1275427. doi: 10.3389/fimmu.2023.1275427.
［60］	Huang C, Yi P, Zhu M, et al. Safety and efficacy of fecal microbiota transplantation for treatment of systemic lupus erythematosus: an EXPLORER trial［J］. J Autoimmun, 2022,130:102844. doi: 10.1016/j.jaut.2022.102844.
［61］	殷广, 李剑锋, 孙玉发, 等. 肠微生态移植重建治疗重度银屑病的临床研究［J］. 中华内科杂志, 2019,58（10）:782⁃785. doi: 10.3760/cma.j.issn.0578⁃1426.2019.10.011.
［62］	Kragsnaes MS, Kjeldsen J, Horn HC, et al. Safety and efficacy of faecal microbiota transplantation for active peripheral psoriatic arthritis: an exploratory randomised placebo⁃controlled trial［J］. Ann Rheum Dis, 2021,80（9）:1158⁃1167. doi: 10.1136/annrheumdis⁃2020⁃219511.
［63］	Rebello D, Wang E, Yen E, et al. Hair growth in two alopecia patients after fecal microbiota transplant［J］. ACG Case Rep J, 2017,4:e107. doi: 10.14309/crj.2017.107.
［64］	Xie WR, Yang XY, Xia HH, et al. Hair regrowth following fecal microbiota transplantation in an elderly patient with alopecia areata: a case report and review of the literature［J］. World J Clin Cases, 2019,7（19）:3074⁃3081. doi: 10.12998/wjcc.v7.i19. 3074.
［65］	Watane A, Cavuoto KM, Rojas M, et al. Fecal microbial transplant in individuals with immune⁃mediated dry eye［J］. Am J Ophthalmol, 2022,233:90⁃100. doi: 10.1016/j.ajo.2021.06.022.

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