肠-脑轴与肠易激综合征研究近展  

Recent studies on gut-brain axis and irritable bowel syndrome

作　　者：池肇春[1] Zhao-Chun Chi(Department of Gastroenterology,Qingdao Municipal Hospital,Qingdao 266011,Shandong Province,China)

机构地区：[1]青岛市市立医院消化内科,山东省青岛市266011

出　　处：《世界华人消化杂志》2024年第7期468-483,共16页World Chinese Journal of Digestology

摘　　要：肠易激综合征是一种病因不明的功能性胃肠疾病.其发生的病理生理机制尚不完全明了.现今被认为是一种异质性疾病,涉及其病理生理的多种因素包括宿主和环境因素、肠道运动障碍、肠通透性增加、粘膜免疫功能障碍、脑-肠相互作用改变、肠道感染、内脏超敏反应和心理障碍.临床前和临床研究表明,大脑-肠道-微生物组轴之间存在双向相互作用. 肠道微生物通过平行和相互作用的通道与中枢神经系统沟通, 包括神经、内分泌和免疫信号机制. 大脑可以通过自主神经系统, 通过调节区域肠道运动、肠道运输和分泌、肠道通透性, 并可能通过直接调节微生物基因表达的激素的腔内分泌来影响肠道微生物群的群落结构和功能. 近年的研究表明, 肠易激综合征是由肠脑轴断裂引起的, 肠-脑轴失调在肠易激综合征的发病中具有核心作用. 本文综述肠道微生物-肠-脑轴与肠易激综合征新近研究进展、讨论免疫-脑-肠轴-炎症相互作用对肠易激综合征的影响、其在肠易激综合征疾病过程中的临床相关性, 旨在为开发更多而有效的肠易激综合征治疗策略提供依据.Irritable bowel syndrome(IBS)is a functional gastrointestinal disease of unknown etiology.The pathophysiological mechanism of IBS occurrence is not fully understood.It is now considered to be a heterogeneous disease with multiple pathophysiological factors including host and environmental factors,intestinal motility disorders,increased intestinal permeability,mucosal immune dysfunction,altered brain-gut interactions,intestinal infections,visceral hypersensitivity,and psychological disorders.Preclinical and clinical studies have shown that there is a bidirectional interaction within the brain-gut-microbiome axis.Gut microbes communicate with the central nervous system through parallel and interacting channels,including neural,endocrine,and immune signaling mechanisms.The brain can influence the community structure and function of the gut microbiota through the autonomic nervous system by regulating regional intestinal motility,intestinal transport and secretion,and intestinal permeability,and possibly through the cavitary secretion of hormones that directly regulate microbial gene expression.Recent studies have shown that IBS is caused by the rupture of the gut-brain axis,and gut-brain axis disorder plays a central role in the pathogenesis of IBS.This article reviews the recent progress in research of the gut microbial-gut-brain axis and irritable bowel syndrome,and discusses the influence of immune-brain-gut axis-inflammation interaction on IBS and its clinical relevance in the course of the disease,aiming to provide evidence for the development of novel effective treatments for IBS.

关 键 词：肠易激综合征 肠道微生物 肠-脑轴 发病机制 炎症 免疫 

分 类 号：R574[医药卫生—消化系统]