基于肠-肾轴学说探究肠道菌群失调与慢性肾脏病的交互影响

An analysis of the interaction between intestinal flora disorder and chronic kidney disease based on the theory of enteric-renal axis

肠道菌群参与疾病的进展、诊断、代谢、康复等多个重要环节,且已证实肠道菌群紊乱与慢性肾脏病发生率的增加直接相关。且在慢性肾脏病期间,菌群多样性改变伴不同程度内稳态失衡,可进一步加剧肾功能损伤并诱发病理恶变态势。此外,慢性肾脏病所引发的免疫失调、代谢紊乱、炎症应激亦被证实与肠道菌群失调存在密切关联,且这一特性具备双向结构关系。肠-肾轴理念地提出明确了肠道微生物失衡、肠屏障受损与毒素产物蓄积损害肾功能的可能,为急慢性肾损伤、肠道菌群失调及相关病理机制的阐释与研究提供了微观生物学基础,并不断衍生出“肾病治肠”的医疗干预靶标。慢性肾脏病与肠道菌群的交互作用将有利于机体微生态失衡回调和肾功能损伤的改善。因此,文章重点梳理肠道菌群与慢性肾脏病之间复杂的交互作用与代谢通路,总结肠道菌群与慢性肾脏病互相影响的内源性作用机制,以期通过肠-肾轴揭示菌群微生态失调在慢性肾脏病发生发展进程中的重要地位,以及二者之间维持动态平衡的策略与途径,进一步丰富肠-肾轴学说的科学内涵与物质基础,不断为肠道菌群失调及慢性肾病的预防及控制提供新思路与新方法。

Intestinal flora is involved in many important links such as disease progression,diagnosis,metabolism and rehabilitation,and it has been confirmed that the disturbance of the flora is directly related to the increase of the incidence of chronic kidney disease.On the other hand,during chronic kidney disease,changes in microbial diversity accompanied by varying degrees ofI homeostasis imbalance can further aggravate renal damage and induce pathological malignant changes.In addition,immune disorders,metabolic disorders and inflammatory stress caused by chronic kidney disease have also been confirmed to be closely related to intestinal flora disorders,and this feature has a bidirectional structural relationship.The proposal of the gut-kidney axis concept clarified the possibility of intestinal microbial imbalance,intestinal barrier damage and toxin product accumulation damaging renal function,providing a microbiological basis for the interpretation and research of acute and chronic kidney injury,intestinal flora imbalance and related pathological mechanisms,and constantly derived the medical intervention target of treating kidney disease from intestine.The interaction between chronic kidney disease and intestinal flora will help to ameliorate the microecological imbalance and renal function damage.Therefore,this paper focuses on sorting out the complex interaction and metabolic pathway between intestinal flora and chronic kidney disease,and summarizes the endogenous mechanism of interaction between intestinal flora and chronic kidney disease,with a view to revealing the important role of microbial microecological imbalance in the occurrence and development of chronic kidney disease through the entero-renal axis,as well as the strategies and ways to maintain dynamic balance between the two,so as to further enrich the scientific connotation and material basis of the gut-kidney axis theory,and constantly provide new ideas and new methods for the prevention and control of intestinal flora disorders and chronic kidney disease.