肠-脑轴神经免疫通信在肝性脑病发病机制中的作用  

Role of neuroimmune communication via the gut-brain axis in the pathogenesis of hepatic encephalopathy

作　　者：林镛 李炯汾 李飞燕 杜沅沁 刘美燕 王明刚[2] 龙富立[2] 王娜[2] 毛德文[2] LIN Yong;LI Jiongfen;LI Feiyan;DU Yuanqin;LIU Meiyan;WANG Minggang;LONG Fuli;WANG Na;MAO Dewen(Graduate School of Guangxi University of Chinese Medicine,Nanning 530200,China;Department of Hepatology,The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,China)

机构地区：[1]广西中医药大学研究生院,南宁530200 [2]广西中医药大学第一附属医院肝病科,南宁530023

出　　处：《临床肝胆病杂志》2024年第12期2518-2523,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金(82260907,82260899,82274434);国家青年岐黄学者项目(国中医药人教函[2022]256号);广西青年岐黄学者项目(桂中医药科教发[2023]7号)。

摘　　要：肝性脑病(HE)是临床常见的严重肝病症候群,属内科危急重症之一。当前,在确诊显性HE的肝衰竭患者中,超过50%的存活时间不足1年。全面解析HE的复杂发病机制,形成具备循证医学证据的诊疗技术方案,对于缓解其造成临床上高医疗资源消耗、高医疗费用与高死亡率、高发病率叠加的严峻态势具有重要意义。最新研究发现,肠道与中枢神经系统可通过“肠-脑轴”进行双向、连续的交互反应和信号传递,并调节炎症信号、分子、细胞和器官功能状态,即神经免疫通信,与HE的主要病理特征高度一致。本文针对HE的神经免疫通信机制,总结了肠-脑轴炎症信号传导与神经递质调节的关系,以及其在HE神经免疫通信中的作用,为HE的临床诊疗和药物研发提供新思路。Hepatic encephalopathy(HE)is a common severe liver disease syndrome in clinical practice and is one of the critical and severe diseases in internal medicine,and more than half of liver failure patients diagnosed with overt HE have a survival time of less than 1 year.A comprehensive analysis of the complex pathogenesis of HE and the development of diagnosis and treatment regimens based on evidence-based medicine are of great importance for alleviating high medical resource consumption,high medical expenses,and high incidence and mortality rates in clinical practice.The latest studies have shown that the intestinal tract and the central nervous system can perform bidirectional continuous interaction and signal transmission and regulate the function of inflammation signals,molecules,cells,and organs,which is known as neuroimmune communication and is highly consistent with the main pathological features of HE.With a focus on the mechanism of neuroimmune communication in HE,this article reviews the association between inflammation signal transduction via the gut-brain axis and neurotransmitter regulation and its role in neuroimmune communication in HE,which provides new ideas for the clinical diagnosis and treatment of HE and the research and development of related drugs.

关 键 词：肝性脑病 神经免疫调节 胃肠道微生物组 

分 类 号：R575.3[医药卫生—消化系统]