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Investigation on the Awareness and Acceptance of Fecal Microbiota Transplantation Among Medical Students
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摘要:
目的 通过调查不同年级医学生对粪菌移植(fecal microbiota transplantation, FMT)的认知情况及接受程度，为该治疗手段的临床应用及未来发展提供启发。 方法 以电子问卷形式对北京协和医学院-清华大学医学部临床医学八年制2014—2021级医学生群体展开调查。按照学生所在年级分为临床组(2014—2016级)、过渡组(2017—2018级)和基础组(2019—2021级)，通过数据分析及组间比较，探讨不同组别医学生对FMT认知及接受情况。 结果 共发放问卷210份，回收有效问卷205份，有效回收率97.6%。不同年级医学生对FMT认知程度存在显著差异(P＜0.001)。35.6%(73/205)的医学生对FMT完全不了解，其中以基础组比例最高，与临床组和过渡组相比，差异均具有统计学意义(59.7%比10.3%，P＜0.001；59.7%比32.0%，P=0.001)。77.1%(158/205)的医学生同意将FMT用于患者疾病治疗，其中临床组(82.8%)和过渡组(82.7%)较基础组(66.7%)的比例更高，不同意将FMT用于患者疾病治疗的主要顾虑为“循证医学证据尚不足”“担心会感染其他未知疾病”等。78.0%(160/205)的医学生同意将FMT用于自身疾病治疗，临床组、过渡组、基础组的比例分别为77.6%、81.3%、75.0%。此外，83.7%(169/202)的医学生愿意捐赠自己的粪菌以供患者使用。 结论 医学生对FMT的整体认知不足，但随受教育年限的增加，其认知程度不断提高。同时，多数医学生愿意接受FMT作为患者及自身疾病治疗的一种探索性尝试且粪菌捐赠意愿积极，这将有助于推动FMT相关临床研究在国内的开展。未来应重视FMT相关研究在医学生群体中的推广工作，为相应新技术的发展与改进带来更多思考与建议。 Abstract:Objective To provide inspiration for the clinical application and development of fecal microbiota transplantation (FMT) by investigating the awareness and acceptance of this technology among clinical medical students of different grades. Methods An electronic questionnaire was used to investigate the group of eight-year medical students at Peking Union Medical College, Tsinghua University from Class 2014—2021. The students were divided into clinical medicine group (Class 2014—2016), transitional group (Class 2017—2018) and basic medicine group (Class 2019—2021) according to their grades. The awareness and acceptance of FMT among different groups of medical students were explored through data analysis and comparison between different groups. Results A total of 210 questionnaires were distributed and 205 valid questionnaires were recovered, with an effective recovery rate of 97.6%. There were significant differences in FMT awareness among medical students of different grades (P < 0.001). 35.6%(73/205) of the medical students did not know anything about FMT, among which the basic group had the highest proportion, compared with the clinical group and the transition group, and the difference was statistically significant(59.7% vs. 10.3%, P < 0.001; 59.7% vs. 32.0%, P=0.001). 77.1%(158/205) of medical students agreed to use FMT for disease treatment, and the proportion of clinical group(82.8%) and transition group (82.7%) was higher than that of basic group (66.7%). The main concerns of not agreeing to use FMT for the treatment of patients' diseases were "insufficient evidence of evidence-based medicine" and "fear of infection with other unknown diseases". 78.0%(160/205) agreed to use FMT for the treatment of their own diseases, and the proportions of clinical group, transition group and basic group were 77.6%, 81.3% and 75.0%, respectively. Moreover, 83.7%(169 / 202) of medical students were willing to donate their fecal microbiota for disease treatment. Conclusions The overall awareness of FMT among medical students is insufficient, but with the increase of years of education, the awareness continues to improve. Meanwhile, most medical students are willing to donate their fecal microbiota and accept FMT as an exploratory attempt for the treatment of patients' and their own diseases, which will help promote the development of FMT related clinical research in China. More attention should be paid to the promotion of FMT related research among medical students, in order to offer more insights and suggestions for the development and improvement of new technologies. -
Key words:
- fecal microbiota transplantation /
- medical students /
- recognition /
- acceptance
作者贡献：徐浩杰、戴依敏负责论文设计、初稿撰写及统计学分析；汤恺宸、钟逸霖、庞伊云、王璐负责资料收集；赵丽丹、李玥提出选题并审核、修订论文。利益冲突：所有作者均声明不存在利益冲突 -
表 1 不同年级医学生对FMT的认知度
选项 临床组
(n=58)过渡组
(n=75)基础组
(n=72)P值 认知程度[n(%)] ＜0.001 非常了解(n=2) 1(1.7) 1(1.3) 0(0.0) 基本了解(n=28) 12(20.7) 13(17.3) 3(4.2) 了解一点(n=102) 39(67.2) 37(49.3) 26(36.1) 完全不了解(n=73) 6(10.3) 24(32.0) 43(59.7) 认知问答得分(x±s) 2.85±0.78 2.80±0.90 1.56±1.06 ＜0.001 FMT: 粪菌移植 
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表 2 不同年级医学生对FMT用于患者疾病治疗的态度及原因分析
选项 临床组
(n=58)过渡组
(n=75)基础组
(n=72)1是否同意FMT用于患者疾病治疗？ 同意(n=158) 48(82.8) 62(82.7) 48(66.7) 不同意(n=7) 2(3.4) 1(1.3) 4(5.6) 不确定(n=40) 8(13.8) 12(16.0) 20(27.8) 2同意的原因 ①临床上有成功应用并达到治疗效果的报道
(n=143)46(79.3) 58(77.3) 39(54.2) ②移植流程规范，粪菌采集操作自动化程度较高
(n=111)32(55.2) 49(65.3) 30(41.7) ③存在粪菌库(n=79) 24(41.4) 39(52.0) 16(22.2) ④无其他可用手段的无奈之举(n=34) 11(20.0) 13(17.3) 10(13.9) ⑤其他(n=1) 0(0.0) 0(0.0) 1(1.4) 3不同意的原因 ①循证医学证据尚不足
(n=7)2(3.4) 1(1.3) 4(5.6) ②担心感染未知传染病
(n=4)1(1.7) 1(1.3) 2(2.8) ③技术尚不成熟(n=2) 2(3.4) 0(0.0) 0(0.0) ④原料为粪菌，使人感到难为情(n=1) 0(0.0) 0(0.0) 1(1.4) ⑤其他(n=1) 1(1.7) 0(0.0) 0(0.0) FMT: 同表 1
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表 3 不同年级医学生对FMT用于自身疾病治疗的态度、途径及粪菌供者来源
选项 临床组
(n=58)过渡组
(n=75)基础组
(n=72)1是否同意FMT用于自身疾病治疗？ 同意(n=160) 45(77.6) 61(81.3) 54(75.0) 不同意(n=10) 3(5.2) 4(5.3) 3(4.2) 不确定(n=35) 10(17.2) 10(13.3) 15(20.8) 2若同意FMT，将会选择哪些途径？ 口服胶囊(n=120) 34(58.6) 49(65.3) 37(51.4) 肠镜(n=108) 28(48.3) 51(68.0) 29(40.3) 鼻胃管(n=45) 8(13.8) 22(29.3) 15(20.8) 不知道(n=11) 1(1.7) 4(5.3) 6(8.3) 3若同意FMT，将如何选择供体来源？ 医师推荐(n=138) 37(63.8) 56(74.7) 45(62.5) 粪菌库(n=58) 16(27.6) 24(32.0) 18(25.0) 亲属(n=38) 13(22.4) 11(14.7) 14(19.4) 朋友(n=24) 4(6.9) 11(14.7) 9(12.5) FMT: 同表 1
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表 4 不同年级医学生健康自我感知情况及粪菌捐赠意愿
选项 临床组
(n=58)过渡组
(n=75)基础组
(n=72)1健康自我感知 健康(n=138) 46(79.3) 43(57.3) 49(68.1) 不健康(n=27) 4(6.9) 15(20.0) 8(11.1) 不确定(n=40) 8(13.8) 17(22.7) 15(20.8) 2是否愿意捐赠粪菌？ 愿意(n=169) 49(84.5) 58(77.3) 62(86.1) 不愿意(n=5) 1(1.7) 3(4.0) 1(1.4) 无所谓(n=31) 8(13.8) 14(18.7) 9(12.5)
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