Fecal microbiota transplantation (FMT) has the potential to rebuild the intestinal microbiome of patients, which can influence the disease course, alleviate symptoms, or even cure the disease. It is seen as a promising breakthrough for treating major chronic diseases that are difficult to manage. Currently, FMT therapy has been clinically studied for over 80 diseases and has led to significant breakthroughs. However, there are still four main challenges: (1) identifying the effective characteristics of donor microbiota and ensuring precise matching between donors and recipients; (2) understanding the pathways and molecular mechanisms by which key FMT bacteria and metabolites improve disease outcomes; (3) studying strain interactions and colonization mechanisms to restore intestinal microbiota balance; and (4) refining the precision of microbiome and functional microbiota transplantation. To address these clinical challenges, this article reviews the latest research both domestically and internationally, outlines the response patterns of FMT therapy, examines the reasons behind FMT failure, and explores future directions for the development of FMT. The aim is to accelerate the scientific and precise advancement of FMT technology in China.
肠菌移植（FMT）重建患者肠道微生物组可影响疾病进程，缓解甚至完全治愈疾病，被誉为人类难治性重大慢病治疗突破的新希望。当前FMT疗法已在超过80种疾病中开展临床研究，取得了一系列突破性进展，但仍存在四大“瓶颈”问题：供体菌群有效特征及供受体精准配型；FMT关键菌及代谢物改善疾病表型的作用途径及分子机制；FMT重构肠道稳态的菌株相互作用及定植拮抗机制；FMT精准微生物组移植和功能菌群移植。针对这些临床问题，本文结合国内外最新研究进展，总结FMT疗法的治疗响应规律，解析FMT失败的关键原因，寻求FMT未来发展的具体方向，以期加速我国FMT技术的科学化和精准化步伐。.