肠道菌群与慢性肾衰竭的相互作用及中药干预研究进展

Interaction Between Intestinal Flora and Chronic Renal Failure and Traditional Chinese Medicine Intervention:A Review

慢性肾功能衰竭(CRF)是各种慢性肾脏疾病持续进展的共同结局,是以代谢产物和毒素潴留,水、电解质紊乱,酸碱平衡失调和全身各系统症状为主要表现的临床综合征。CRF发病及病情进展受多种因素影响,其中肠道菌群变化是重要因素之一。研究表明,肠道菌群与CRF具有相互影响的作用,CRF患者因肾功能逐渐减退导致代谢废物不能及时清除而蓄积于体内,通过改变肠道菌群的组成,破坏肠道屏障,加剧肠源性尿毒素的合成并蓄积于血液中,进一步损害肾功能,肠道菌群失调可诱发急性肾损伤的发生,增加心血管系统并发症,刺激免疫炎症反应等加剧CRF的病程进展,通过调节肠道菌群靶向治疗CRF已成为研究的前沿方向。中医认为肾病及肠,从肠治肾,脾肾与CRF的发病及肠道菌群最为密切,中药以其多靶点、多效应及多成分作用于“肠-肾轴”在CRF临床治疗和肠道菌群的调节具有较大的优势,通过干预肠道菌群可明显延缓CRF的进程,该文就中医理论与肠道菌群和CRF的相关性,结合肠道菌群与CRF的相互作用,以肠道菌群作为切入点,系统地总结和梳理肠道菌群与CRF的相互作用及中药干预肠道菌群治疗CRF的研究现状,以期为临床治疗及药物研发提供新的研究思路和方法。

Chronic renal failure(CRF),a common outcome of various chronic kidney diseases,is characterized by retention of metabolites and toxins,water-electrolyte imbalance,acid-base disturbance,and various symptoms in diverse systems.The incidence and progression of this disease are influenced by many factors,particularly the change of intestinal flora.Previous research shows that the intestinal flora interacts with CRF.For CRF patients,the metabolic waste fails to be cleared in time due to the gradual decline of renal function and thus accumulates in vivo.Moreover,CRF changes the composition of intestinal flora,damages intestinal barrier,and accelerates the synthesis of intestinal uremic toxins and the accumulation in blood.As a result,the renal injury is aggravated.The imbalance of intestinal flora can induce acute kidney injury,increase cardiovascular complications,stimulate immune inflammatory responses,and thus aggravate the progression of CRF.Microbiota-targeted therapy for CRF has become the research focus.According to traditional Chinese medicine,kidney disease is related to the intestine and kidney disease should be treated from the intestine.Spleen and kidney are in the closest relationship with the pathogenesis of CRF and the intestinal flora.Chinese medicine,which features multiple targets,multiple effects,and multiple components,acts on the"gut-kidney axis".It is thus superior in the clinical treatment of CRF and the regulation of intestinal flora.To be specific,it intervenes in intestinal flora to delay the process of CRF.In this paper,based on the correlation of traditional Chinese medicine theory with intestinal flora and CRF,this paper reviewed the interaction between intestinal flora and CRF and traditional Chinese medicine intervention in the intestinal flora for the treatment of CRF,which is expected to serve as a reference for the clinical treatment of this disease and the drug development.