基于脑-肠轴理论探讨重症胰腺炎脑损伤“脑病治肠”的科学内涵

The scientific connotation of "treating encephalopathy through intestines" in severe pancreatitis brain injury based on the brain-gut axis theory

胰性脑病(pancreatic encephalopathy,PE)是重症胰腺炎患者病死的主要原因,目前尚无有效治疗手段。临床运用通腑泻下法进行“脑病治肠”的疗效确切,但其现代医学机制尚未完全阐明。肠道菌群与PE脑损伤的发生发展密切相关,且是脑-肠轴的核心通路,可通过迷走神经直接影响脑功能。通腑泻下代表方剂大承气汤可调节中枢神经系统炎症介质的释放,减轻PE脑损伤。以肠道菌群为切入点,从脑-肠轴调控机制的关键环节入手,全面分析肠道菌群构成、功能丰度及优势菌群,观察到胆碱能抗炎通路(cholinergic anti-inflammatory pathway,CAP)的活化程度影响中枢神经系统炎症因子的释放,最终改变PE脑损伤。本文阐述大承气汤通过肠道菌群调节CAP抗中枢神经系统炎症的分子机制,以期为中医以肠道菌群为靶点治疗PE提供理论依据,也为“脑病治肠”提供有力支持。

Pancreatic encephalopathy (PE) is an important cause of death in severe pancreatitis, for which there is currently no effective treatment. The method of Tong Fu Xie Xia (clearing the internal organs and promoting defecation) has shown a definite curative effect, but its modern medical mechanism has not been fully elucidated. Gut microbiota is closely related to the occurrence and development of PE brain injury, and is the core regulatory part of the brain-gut axis, which can directly affect brain function through vagus nerve. Da Chengqi Decoction (major purgative decoction), the representative formula of Tong Fu Xie Xia, can regulate the release of central inflammatory mediators and reduce PE brain injury. With intestinal flora as the starting point, by starting from the key link of the regulation mechanism of the brain-gut axis and comprehensively analyzing the composition, function and abundance of intestinal flora and verifying dominant flora, it was found that the activation degree of cholinergic anti-inflammatory pathway (CAP) affects the release of inflammatory factors in central nervous system (CNS), resulting in changes of PE brain injury. This paper clarified the molecular mechanism of Da Chengqi Decoction affecting intestinal flora to regulate CAP against inflammation of CNS, in order to provide an experimental basis for traditional Chinese medicine to treat PE with intestinal flora as a target, also a scientific basis for "treating encephalopathy through intestines".