从肠道微生态角度探讨2型糖尿病的发病机制以及治疗措施

Discussion on Pathogenesis and Treatment of Type 2 Diabetes from Perspective of Intestinal Microecology

糖尿病是对人类健康构成极大威胁的一类疾病,其发生、发展往往与遗传和环境等多种因素有关。根据2017年第八版糖尿病联合会糖尿病图谱显示全世界约有4. 25亿糖尿病患者,预计到2045年,糖尿病患者将会增加到7亿,成为一个日益引起全世界关注的健康问题。其中,2型糖尿病患者人数占总人数的90%以上,因此,研究病理机制对于有效预防和治疗2型糖尿病具有重要意义。肠道菌群与人类共存,为人类重要的微生态系统,参与人体物质和能量代谢。近年来,随着高通量测序技术的发展,大量研究表明除了肥胖、遗传和胰岛素功能紊乱外,肠道菌群紊乱也可能导致糖尿病。2型糖尿病患者不平衡的饮食结构破坏了肠道菌群的平衡,一般认为,2型糖尿病的发生发展可能是营养过剩引起肠道微生物紊乱的结果之一。但是,肠道菌群是如何参与2型糖尿病的发生发展尚未有明确的机制。目前,普遍认为肠道菌群可能通过参与胆汁酸代谢、短链脂肪酸代谢、低水平的炎症反应等途径影响了机体的代谢。对于2型糖尿病的预防和治疗目前主要以药物控制为主,通过外科手术、增加益生菌、粪便移植等方法干预肠道菌群来调整肠道微生态为2型糖尿病的预防和治疗提供了新手段,本文就近年来有关2型糖尿病与肠道微生态之间的相互作用以及未来可能的治疗措施进行综述。

Diabetes is a kind of disease which poses a great threat to human health. Its occurrence and development are often related to many factors such as heredity and environment. According to the eighth edition of Diabetes Federation’s diabetes map in 2017,there are about 425 million diabetics in the world. It is estimated that by 2045,the number of diabetics will increase to 700 million,becoming a health problem that has attracted increasing attention all over the world,among which the number of type 2 diabetics(T2 DM)accounts for more than 90% of the total. Therefore,it is of great significance to study the pathological mechanism for the effective prevention and treatment of diabetes. Intestinal microflora coexists with human beings and forms an important micro ecosystem,which is involved in the metabolism of substance and energy. In recent years,with the development of high-throughput sequencing technology,a large number of studies have shown that in addition to obesity,genetic and insulin dysfunction,intestinal flora disorder may also lead to diabetes. The unbalanced diet structure of T2 DM patients destroys the balance of intestinal flora. It is generally believed that the occurrence and development of T2 DM may be one of the results of the intestinal microbial disorder caused by over nutrition.However,there is no clear mechanism of how intestinal flora participates in the development of T2 DM. At present,it is generally believed that the intestinal flora may affect the metabolism of the body through the participation in bile acid metabolism,short chain fatty acid metabolism,low-level inflammatory response and other ways. At present,the prevention and treatment of T2 DM is mainly based on drug control. Through surgical operation,increasing the number of probiotics,fecal transplantation and other methods to intervene the intestinal microflora to adjust the intestinal microflora,it provides a new means for the prevention and treatment of T2 DM. This paper discusses the interaction between T2 DM and intestinal microflora in recent years and the possible treatment measures in the future.