呼吸道菌群在呼吸机相关性肺炎中作用的研究进展  

Research progress on the role of respiratory microbiome in ventilator-associated pneumonia

作　　者：张博顺 柒晓玲 刘嘉琳[1] Zhang Boshun;Qi Xiaoling;Liu Jialin(Department of Critical Care Medicine,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院重症医学科,上海200025

出　　处：《中华危重病急救医学》2023年第8期889-892,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81970005);上海申康医院发展中心促进市级医院临床技能与临床创新三年行动计划重大临床研究项目(SHDC2020CR4075)

摘　　要：呼吸道菌群广泛参与人体的生命活动,通过代谢和免疫调节作用影响着肺部的健康与疾病状态。基于16S rRNA测序等手段发现,菌群多样性和结构的改变、致病菌的优势增殖均与呼吸机相关性肺炎(VAP)的发生发展及临床预后相关。呼吸道菌群促进病原菌清除的作用机制可能包括以下方面:①预刺激固有免疫系统,诱导免疫效应细胞的产生;②调节模式识别受体(PRR),适度促进炎症因子的表达;③诱导中性粒细胞向特定亚型分化,增加抗菌基因的表达;④产生游离脂肪酸及有机化合物,正向调节免疫系统。由此可见,菌群干预可使VAP患者受益。因此,本文围绕呼吸道菌群在VAP中的变化及其对宿主免疫的影响展开综述;同时,在回顾益生菌辅助治疗VAP的基础上,对呼吸道共生菌作为临床新型益生菌提出展望,以期深化临床对呼吸道菌群在VAP中作用的认识,继而在治疗和预后评估方面提供新的思路。Respiratory microbiome is extensively involved in human life activities and affects lung health and disease states through metabolism and immune regulation.Based on 16S rRNA gene sequencing and other methods,it is obvious that the diversity and the changes in the structure of respiratory microbiome and the dominant proliferation of pathogens are strongly related to the occurrence,development and clinical prognosis of ventilator-associated pneumonia(VAP).The mechanism by which respiratory microbiota promotes the clearance of pathogens may include the following aspects:①pre-stimulating innate immune system to increase the number of immune effector cells;②regulating pattern recognition receptor(PRR)to moderately promote the production of cytokines;③inducing the differentiation of neutrophils into specific subtypes and increasing the expression of antimicrobial genes;④producing free fatty acids and organic compounds that are capable of positively modulating the immune system.In conclusion,intervention of microbiome is beneficial to VAP patients.Therefore,this review illustrates the changes of respiratory flora in VAP and its effect on host immunity.At the same time,based on the review of the adjuvant treatment of VAP with probiotics,we put forward the prospect of respiratory commensal bacteria as a new clinical probiotic,in order to deepen the clinical understanding of the role of respiratory flora in VAP,and then provide new ideas for the evaluation of treatment and prognosis.

关 键 词：呼吸机相关性肺炎 微生物群 微生物免疫 微生物代谢 益生菌 

分 类 号：R563.1[医药卫生—呼吸系统]