益生菌治疗草酸钙结石的研究进展

Update on probiotics for the treatment of calcium oxalate stones

肾结石是泌尿系统常见疾病之一,其中草酸钙结石最常见且复发率高。肠道草酸吸收增加使得尿草酸排泄增多是形成草酸钙结石的重要病理因素。目前发现具有降解草酸功能的肠道菌群有产甲酸草酸杆菌、粪肠球菌、大肠埃希菌、迟缓真杆菌、雷氏普罗威登斯菌、乳酸杆菌和双歧杆菌类等,其中,产甲酸草酸杆菌是人类发现的第一个专门降解草酸的专性厌氧菌,其余均为条件性降解草酸的肠道定植菌。产甲酸草酸杆菌主要有3种酶参与代谢草酸:草酸-甲酸反向转运体(Oxl T)、甲酰基辅酶A转移酶(Frc)、草酰辅酶A脱羧酶(Oxc)。动物研究已经证实,产甲酸草酸杆菌除了能直接降解肠道中的草酸,还能通过促进肠道草酸分泌来减少肠道内草酸的吸收,从而降低尿液草酸排泄量。本综述主要阐述益生菌治疗草酸钙结石的研究进展,以期为其进一步研究开发提供参考。

Urolithiasis is one of the common diseases in urinary system, among which calcium oxalate stone is the most common one with a high recurrence rate. An important pathological factor for the formation of calcium oxalate stone is the increased absorption of oxalate from intestine, which leads to a high urine oxalate concentration. Intestinal bacteria known to be able to degrade oxalate includes Oxalobacter formigenes, Enterococcus faecalis, Escherichia coli, Eubacterium lentum, Providencia rettgeri, Lactobacillus and Bifidobacterium species, etc. Among those, Oxalobacter formigenes is the first oxalate-degrading obligate anaerobe found in human, while the rest are just conditioned bacteria with the function to degrade intestinal oxalate. There are three kinds of enzymes in Oxalobacter formigenes involved in the metabolism of oxalate, namely oxalate-formate antiporter（Oxl T）, formyl-Co A transferase（Frc） and oxalyl-Co A decarboxylase（Oxc）. Animal experiments have verified that Oxalobacter formigenes could reduce intestinal oxalate absorption by promoting the secretion of oxalate and degradation as well, thus decrease the excretion of urine oxalate. The present review will focus on the research progress of probiotics treatment for the calcium oxalate stones so as to provide reference for further research and development.