从肠道微生态看中医肾病学的发展机遇
|
摘要
慢性肾病及其迁延进展所致的终末期肾病(ESRD)是危害人类健康、消耗大量卫生资源的重大慢性病。新近诸多研究证实,肠道菌群即"肠黏膜生物屏障",作为慢性肾脏病中"肾-肠轴"的中心环节,其结构功能改变及紊乱可能参与并导致了慢性肾功能衰竭的进展。中医药对肠道微生态的调节研究日益受关注,理论研究及临床、动物实验研究,均证实中药有助于调节肠道菌群,维持肠道微生态的平衡,并有望成为防治慢性肾功能衰竭进展的新干预靶点。立足中医讨论背景,文章从证候、药物、治疗、潜在新疗法等诸多方面论述中医肾病学与肠道微生态的相关性,为揭示肠道微生态的桥梁作用和中医本质提供一定的理论依据,并为转化医学的开展提供必要的理论基础和思路。
End-stage renal disease(ESRD) caused by chronic kidney disease(CKD) and its delayed progress is a major chronic disease that endangers human health and consumes a large number of health resources. Recent studies have confirmed that intestinal flora, the 'intestinal mucosal membrane biological barrier', is the central link of the 'kidney-intestinal axis' in CKD. Its structural and functional changes and disorders may participate in and lead to the progress of chronic renal failure. The regulation of intestinal microecology by traditional Chinese medicine(TCM) has attracted more and more attention. Theoretical research, clinical and animal experiments have proved that TCM can help regulate intestinal microflora and maintain the balance of intestinal microecology, and it is expected to become a new intervention target for preventing and curing CRF progress. Based on the background of TCM discussion, this paper discussed the correlation between nephrology and intestinal microecology in TCM from many aspects, such as syndrome, medicine, treatment, a potential new therapy, etc. It provided a theoretical basis for revealing the bridge role of intestinal microecology and the essence of TCM and provided the necessary theoretical basis and ideas for the development of transformational medicine.
End-stage renal disease(ESRD) caused by chronic kidney disease(CKD) and its delayed progress is a major chronic disease that endangers human health and consumes a large number of health resources. Recent studies have confirmed that intestinal flora, the 'intestinal mucosal membrane biological barrier', is the central link of the 'kidney-intestinal axis' in CKD. Its structural and functional changes and disorders may participate in and lead to the progress of chronic renal failure. The regulation of intestinal microecology by traditional Chinese medicine(TCM) has attracted more and more attention. Theoretical research, clinical and animal experiments have proved that TCM can help regulate intestinal microflora and maintain the balance of intestinal microecology, and it is expected to become a new intervention target for preventing and curing CRF progress. Based on the background of TCM discussion, this paper discussed the correlation between nephrology and intestinal microecology in TCM from many aspects, such as syndrome, medicine, treatment, a potential new therapy, etc. It provided a theoretical basis for revealing the bridge role of intestinal microecology and the essence of TCM and provided the necessary theoretical basis and ideas for the development of transformational medicine.
引文
[1]魏曦.微生态学刍议.中国微生态学杂志,1989,1(1):4-5
[2]严人,江慧勇,李兰娟.人体微生态与健康和疾病.微生物学报,2017,57(6):793-805
[3]Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:A cross-sectional survey.Lancet,2012,379(9818):815-822
[4]甄建华,于河,谷晓红.肠道微生态医学研究进展概述.中华中医药杂志,2017,32(7):3069-3075
[5]O’Hara A M,Shanahan F.The gut flora as a forgotten organ.Embo Reports,2006,7(7):688-693
[6]Eva Schepers,Griet Glorieux,Raymond Vanholder.The Gut:The Forgotten Organ in Uremia?.Blood Purif,2010,29:130-136
[7]Ramezani A,Raj D S.The gut microbiome,kidney disease,and targeted interventions.J Am Soc Nephrol,2014,25(4):657-670
[8]Meijers B K,Evenepoel P.The gut-kidney axis:indoxyl sulfate,pcresyl sulfate and CKD progression.Nephrol Dial Transplant,2011,26(3):759-761
[9]Pahl M V,Vaziri N D.The chronic kidney disease-colonic axis.Semin Dial,2015,28(5):459-463
[10]Sabatino A,Regolisti G,Brusasco I,et al.Alterations of intestinal barrier and microbiota in chronic kidney disease.Nephrol Dial Transplant,2015,30:924-933
[11]Mafra D,Lobo J C,Barros A F,et al.Role of altered intestinal microbiota in systemic inflammation and cardiovascular disease in chronic kidney disease.Future Microbiol,2014,9(3):399-410
[12]Nallu A,Sharma S,Ramezani A,et al.Gut microbiome in chronic kidney disease:Challenges and opportunities.Translational Research,2017,179:24-37
[13]Gao H,Liu S.Role of uremic toxin indoxyl sulfate in the progression of cardiovascular disease.Life Sci,2017,185:23-29
[14]Tessa Gryp,Raymond Vanholder,Mario Vaneechoutte,et al.p-Cresyl Sulfate.Toxins(Basel),2017,9(2):52
[15]Wong J,Piceno Y M,DeSantis T Z,et al.Expansion of urease-and uricase-containing,indole-and p-cresol-forming and contraction of short-chain fatty acid-producing intestinal microbiota in ESRD.Am J Nephrol,2014,39(3):230-237
[16]Tang W H,Wang Z,Kennedy D J,et al.Gut microbiota-dependent trimethylamine N-oxide(TMAO)pathway contributes to both development of renal insufficiency and mortality risk in chronic kidney disease.Circ Res,2015,116(3):448-455
[17]Vaziri N D,Zhao Y Y,Pahl M V.Altered intestinal microbial flora and impaired epithelial barrier structure and function in CKD:The nature,mechanisms,consequences and potential treatment.Nephrol Dial Transplant,2016,31(5):737-746
[18]Anders H J,Andersen K,Stecher B.The intestinal microbiota,a leaky gut,and abnormal immunity in kidney disease.Kidney Int,2013,83(6):1010-1016
[19]Gansevoort R T,Correa-Rotter R,Hemmelgarn B R,et al.Chronic kidney disease and cardiovascular risk:Epidemiology,mechanisms,and prevention.Lancet,2013,382:339-352
[20]王占国.中医“脾”与消化道正常菌群.中国微生态学杂志,1991,3(2):65-68
[21]吉春兰,卓若君,吴禹池,等.基于肠道微生态探索“补脾益肾”法治疗慢性肾脏病的新思路.世界科学技术——中医药现代化,2018,33(3):819-822
[22]王世东,赵国屏,张庆华.系统生物学在中医“证”本质研究中的作用.中国中西医结合杂志,2013,33(1):131-134
[23]吴佳佳,李晓娟,陈家旭.肠道微生态与中医证候的相关性研究概况.中医杂志,2018,59(14):1247-1251
[24]丁维俊,杨红亚,杨杰.肾阳虚证患者唾液菌群初步研究.上海中医药大学学报,2007,21(1):43-46
[25]杨化冰,邹小娟,孔明望,等.肠道微生态与传统中医思想内涵.中医杂志,2017,58(12):1070-1072
[26]张玉,张军峰,杨亚平.近十五年来肠道微生态的中医药研究概况.辽宁中医杂志,2016,43(11):2442-2445
[27]丁维俊,高峰,杨杰.肾阳虚证患者肠道菌群失调状况的临床研究.新中医,2017,32(7):3069-3075
[28]Xu J,Chen H B,Li S L.Understanding the molecular mechanisms of the interplay between herbal medicines and gut microbiota.Med Res Rev,2017,37(5):1140-1185
[29]韩文贝,刘莹露,万毅刚,等.慢性肾脏病肠道菌群失调的病理机制、治疗策略及中药的干预作用.中国中药杂志,2017,42(13):2426-2432
[30]祖先鹏,林璋,谢海胜,等.中药有效成分与肠道菌群相互作用的研究进展.中国中药杂志,2016,41(10):1766
[31]邹川,吴禹池,罗丽,等.中药大黄复方灌肠对慢性肾脏病5期(非透析)肠道菌群和肠道屏障功能影响的临床研究.辽宁中医杂志,2012,39(7):1309-1311
[32]Fournier-Larente J,Azelmat J,Yoshioka M,et al.The Daiokanzoto(TJ-84)Kampo Formulation reduces virulence factor gene expression in porphyromonas gingivalis and possesses anti-inflammatory and anti-protease activities.PLoS One,2016,11(2):e0148860
[33]Steed A L,Chiristophi G P,Kaiko G E,et al,The microbial metabolite desaminotyrosine protects from influenza through type I interferon.Science,2017,357:498-502
[34]黄生辉,李妍怡,金华,等.中药有效成分皂苷对肠道微生态免疫相关作用研究进展.中华中医药杂志,2017,32(8):3606-3609
[35]葛金玲.捏脊疗法治疗小儿外感发热的免疫和肠道微生态机制研究.广州:广州中医药大学,2007
[36]程偲婧.汗法调节肠道微生态治疗慢性肾脏病的研究.泸州:西南医科大学,2017
[37]侯天舒,韩晓霞,杨阳,等.电针对溃疡性结肠炎大鼠肠道微生态的保护作用.针刺研究,2014,39(1):27-34
[38]郑海生,贺敏,蒋健,等.中药复方为主的灌肠法治疗慢性肾功能衰竭的meta分析.辽宁中医杂志,2008,35(11):1650-1651
[39]罗学文.健脾益肾泄浊法对慢性肾脏病5期代谢毒素和肠道菌群的影晌.广州:广州中医药大学,2015
[40]曹利华,白明,苗明三,等.中药外治的“双微调平衡”机制探析.中华中医药杂志,2018,33(3):819-822
[41]张成岗.人体微生态尤其是肠道微生态为新药研发提供前所未有的机遇和挑战.中国药理学与毒理学杂志,2016,30(7):703-712
[42]Borody T J,Khoruts A.Fecal microbiota transplantation and emerging applications.Nat Rev Gastroenterol Hepatol,2012,9:88-96
[43]Brandt L J.American Journal of Gastroenterology Lecture:Intestinal Microbiota and the Role of Fecal Microbiota Transplant(FMT)in Treatment of C.difficile Infection.Am J Gastroenterol,2013,108(2):177-185
[44]Shimizu H,Arai K,Abe J,et al.Repeated fecal microbiota transplantation in a child with ulcerative colitis.Pediatr Int,2016,58(8):781-785
[45]东晋·葛洪.肘后备急方(第2卷).天津:天津科技出版社,2000:36
[46]Zhang F,Luo W,Shi Y,et al.Should We Standardize the 1,700Year-old Fecal Microbiota Transplantation?.Am J Gastroenterol,2012,107:1755
[2]严人,江慧勇,李兰娟.人体微生态与健康和疾病.微生物学报,2017,57(6):793-805
[3]Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:A cross-sectional survey.Lancet,2012,379(9818):815-822
[4]甄建华,于河,谷晓红.肠道微生态医学研究进展概述.中华中医药杂志,2017,32(7):3069-3075
[5]O’Hara A M,Shanahan F.The gut flora as a forgotten organ.Embo Reports,2006,7(7):688-693
[6]Eva Schepers,Griet Glorieux,Raymond Vanholder.The Gut:The Forgotten Organ in Uremia?.Blood Purif,2010,29:130-136
[7]Ramezani A,Raj D S.The gut microbiome,kidney disease,and targeted interventions.J Am Soc Nephrol,2014,25(4):657-670
[8]Meijers B K,Evenepoel P.The gut-kidney axis:indoxyl sulfate,pcresyl sulfate and CKD progression.Nephrol Dial Transplant,2011,26(3):759-761
[9]Pahl M V,Vaziri N D.The chronic kidney disease-colonic axis.Semin Dial,2015,28(5):459-463
[10]Sabatino A,Regolisti G,Brusasco I,et al.Alterations of intestinal barrier and microbiota in chronic kidney disease.Nephrol Dial Transplant,2015,30:924-933
[11]Mafra D,Lobo J C,Barros A F,et al.Role of altered intestinal microbiota in systemic inflammation and cardiovascular disease in chronic kidney disease.Future Microbiol,2014,9(3):399-410
[12]Nallu A,Sharma S,Ramezani A,et al.Gut microbiome in chronic kidney disease:Challenges and opportunities.Translational Research,2017,179:24-37
[13]Gao H,Liu S.Role of uremic toxin indoxyl sulfate in the progression of cardiovascular disease.Life Sci,2017,185:23-29
[14]Tessa Gryp,Raymond Vanholder,Mario Vaneechoutte,et al.p-Cresyl Sulfate.Toxins(Basel),2017,9(2):52
[15]Wong J,Piceno Y M,DeSantis T Z,et al.Expansion of urease-and uricase-containing,indole-and p-cresol-forming and contraction of short-chain fatty acid-producing intestinal microbiota in ESRD.Am J Nephrol,2014,39(3):230-237
[16]Tang W H,Wang Z,Kennedy D J,et al.Gut microbiota-dependent trimethylamine N-oxide(TMAO)pathway contributes to both development of renal insufficiency and mortality risk in chronic kidney disease.Circ Res,2015,116(3):448-455
[17]Vaziri N D,Zhao Y Y,Pahl M V.Altered intestinal microbial flora and impaired epithelial barrier structure and function in CKD:The nature,mechanisms,consequences and potential treatment.Nephrol Dial Transplant,2016,31(5):737-746
[18]Anders H J,Andersen K,Stecher B.The intestinal microbiota,a leaky gut,and abnormal immunity in kidney disease.Kidney Int,2013,83(6):1010-1016
[19]Gansevoort R T,Correa-Rotter R,Hemmelgarn B R,et al.Chronic kidney disease and cardiovascular risk:Epidemiology,mechanisms,and prevention.Lancet,2013,382:339-352
[20]王占国.中医“脾”与消化道正常菌群.中国微生态学杂志,1991,3(2):65-68
[21]吉春兰,卓若君,吴禹池,等.基于肠道微生态探索“补脾益肾”法治疗慢性肾脏病的新思路.世界科学技术——中医药现代化,2018,33(3):819-822
[22]王世东,赵国屏,张庆华.系统生物学在中医“证”本质研究中的作用.中国中西医结合杂志,2013,33(1):131-134
[23]吴佳佳,李晓娟,陈家旭.肠道微生态与中医证候的相关性研究概况.中医杂志,2018,59(14):1247-1251
[24]丁维俊,杨红亚,杨杰.肾阳虚证患者唾液菌群初步研究.上海中医药大学学报,2007,21(1):43-46
[25]杨化冰,邹小娟,孔明望,等.肠道微生态与传统中医思想内涵.中医杂志,2017,58(12):1070-1072
[26]张玉,张军峰,杨亚平.近十五年来肠道微生态的中医药研究概况.辽宁中医杂志,2016,43(11):2442-2445
[27]丁维俊,高峰,杨杰.肾阳虚证患者肠道菌群失调状况的临床研究.新中医,2017,32(7):3069-3075
[28]Xu J,Chen H B,Li S L.Understanding the molecular mechanisms of the interplay between herbal medicines and gut microbiota.Med Res Rev,2017,37(5):1140-1185
[29]韩文贝,刘莹露,万毅刚,等.慢性肾脏病肠道菌群失调的病理机制、治疗策略及中药的干预作用.中国中药杂志,2017,42(13):2426-2432
[30]祖先鹏,林璋,谢海胜,等.中药有效成分与肠道菌群相互作用的研究进展.中国中药杂志,2016,41(10):1766
[31]邹川,吴禹池,罗丽,等.中药大黄复方灌肠对慢性肾脏病5期(非透析)肠道菌群和肠道屏障功能影响的临床研究.辽宁中医杂志,2012,39(7):1309-1311
[32]Fournier-Larente J,Azelmat J,Yoshioka M,et al.The Daiokanzoto(TJ-84)Kampo Formulation reduces virulence factor gene expression in porphyromonas gingivalis and possesses anti-inflammatory and anti-protease activities.PLoS One,2016,11(2):e0148860
[33]Steed A L,Chiristophi G P,Kaiko G E,et al,The microbial metabolite desaminotyrosine protects from influenza through type I interferon.Science,2017,357:498-502
[34]黄生辉,李妍怡,金华,等.中药有效成分皂苷对肠道微生态免疫相关作用研究进展.中华中医药杂志,2017,32(8):3606-3609
[35]葛金玲.捏脊疗法治疗小儿外感发热的免疫和肠道微生态机制研究.广州:广州中医药大学,2007
[36]程偲婧.汗法调节肠道微生态治疗慢性肾脏病的研究.泸州:西南医科大学,2017
[37]侯天舒,韩晓霞,杨阳,等.电针对溃疡性结肠炎大鼠肠道微生态的保护作用.针刺研究,2014,39(1):27-34
[38]郑海生,贺敏,蒋健,等.中药复方为主的灌肠法治疗慢性肾功能衰竭的meta分析.辽宁中医杂志,2008,35(11):1650-1651
[39]罗学文.健脾益肾泄浊法对慢性肾脏病5期代谢毒素和肠道菌群的影晌.广州:广州中医药大学,2015
[40]曹利华,白明,苗明三,等.中药外治的“双微调平衡”机制探析.中华中医药杂志,2018,33(3):819-822
[41]张成岗.人体微生态尤其是肠道微生态为新药研发提供前所未有的机遇和挑战.中国药理学与毒理学杂志,2016,30(7):703-712
[42]Borody T J,Khoruts A.Fecal microbiota transplantation and emerging applications.Nat Rev Gastroenterol Hepatol,2012,9:88-96
[43]Brandt L J.American Journal of Gastroenterology Lecture:Intestinal Microbiota and the Role of Fecal Microbiota Transplant(FMT)in Treatment of C.difficile Infection.Am J Gastroenterol,2013,108(2):177-185
[44]Shimizu H,Arai K,Abe J,et al.Repeated fecal microbiota transplantation in a child with ulcerative colitis.Pediatr Int,2016,58(8):781-785
[45]东晋·葛洪.肘后备急方(第2卷).天津:天津科技出版社,2000:36
[46]Zhang F,Luo W,Shi Y,et al.Should We Standardize the 1,700Year-old Fecal Microbiota Transplantation?.Am J Gastroenterol,2012,107:1755