肠道菌群与免疫抑制剂相互作用研究进展

Advances in the study of interaction between intestinal flora and immunosuppressive agents

综述移植术后肠道菌群的变化、常用免疫抑制剂对肠道菌群的影响以及肠道菌群对免疫抑制剂药效药动的作用。在PubMed中检索关键词包括肠道菌群、免疫抑制剂、器官移植三者中两者以上的文献,并从中筛选出与三者之间相互作用有关的文献,并进行整理、讨论和总结。多个文献报道,在不同器官移植后均存在肠道菌群改变的情况。造血干细胞移植会影响到梭状芽孢杆菌的丰度;肝脏移植能影响到多个菌属的肠道菌群,并对肠道菌群的整体水平产生影响;肾脏移植也会影响到多种肠道菌群,研究也发现肠道菌群的组成与丰度改变与肾脏移植后腹泻的发生有明显相关性。肠道菌群和免疫抑制剂之间存在相互作用。研究发现包括霉酚酸、他克莫司、环孢素A等在内的多种临床常用免疫抑制剂在应用一段时间后会对机体肠道菌群组成、丰度产生影响。而肠道菌群对于免疫抑制剂的不良反应以及代谢吸收存在一定影响。免疫抑制剂的应用会影响到肠道菌群的组成与丰度,同时肠道菌群也可能会影响到免疫抑制剂药理或毒理学性质。故而在应用免疫抑制剂的时候需要考虑肠道菌群,从而更好、更安全地应用免疫抑制剂。

To review the changes of intestinal flora after transplantation,the interaction between common immunosuppressants and intestinal flora.The literatures including intestinal bacteria,immunosuppressive agents and organ transplantation were searched in PubMed,and the literatures related to the interaction between the three were selected,collated,discussed and summarized.Several literatures reported that there were changes of intestinal bacteria after different organ transplants.Hematopoietic stem cell transplantation will affect the abundance of Clostridium;liver transplantation can affect the intestinal bacteria of multiple genera and have an effect on the overall level of intestinal bacteria;kidney transplantation will also affect a variety of intestinal bacteria,and studies have also found that the composition and abundance changes of intestinal bacteria are significantly correlated with the occurrence of diarrhea after kidney transplantation.There is an interaction between intestinal bacteria and immunosuppressants.Studies have found that a variety of commonly used immunosuppressive agents in clinical practice,including mycophenolic acid,tacrolimus,and cyclosporine A,will have an effect on the composition and abundance of intestinal bacteria in the body after a period of application.Intestinal bacteria have some effects on the adverse reactions and metabolic absorption of immunosuppressive agents.The application of immunosuppressive agents would affect the composition and abundance of intestinal flora,and the intestinal flora could also affect the pharmacological or toxicological properties of immunosuppressive agents.Therefore,it is of necessity to consider the role of intestinal flora in the application of immunosuppressants,for a better and safe use of immunosuppressants.