肠道菌群对炎症性肠病诊断的研究进展
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摘要
炎症性肠病(inflammatory bowel disease, IBD)是由免疫、遗传、环境三因素共同作用导致,由于它存在发病早期症状不典型及后期病变多样化的特点,因此在发病早期准确诊断IBD是一个难点,目前诊断依赖于内镜检查和影像学检查,但是患者缺乏依从性.肠道菌群在IBD中的特征性变化提示它可能成为一种新的生物标记物.近年来多项临床研究深入探讨肠道菌群在IBD鉴别诊断、疾病活动度、肠外表现等中的特征性变化,并建立肠道菌群诊断模型,获得了较高的敏感性和特异性,但由于该模型易受外界因素干扰,仍需进一步完善.本文拟将综述肠道菌群对IBD的诊断价值及临床意义.
Inflammatory bowel disease(IBD) is caused by immune, genetic, and environmental factors together. It is difficult to accurately diagnose IBD early because it is characterized by atypical symptoms at early stage and diverse lesions at late stage. The diagnosis is currently dependent on endoscopic and imaging examinations, but patients often have poor compliance. The characteristic change of gut microbiota in IBD suggests that it may become a new biomarker. In recent years, a number of clinical studies have focused on the role of characteristic changes of gut microbiota in the differential diagnosis, disease activity, and extra-intestinal manifestations of IBD. These studies have established a gut microbiota based diagnostic model with high sensitivity and specificity, but the model is susceptible to be influenced by external factors and needs to be further improved. This paper reviews the diagnostic value and clinical significance of gut microbiota in IBD.
Inflammatory bowel disease(IBD) is caused by immune, genetic, and environmental factors together. It is difficult to accurately diagnose IBD early because it is characterized by atypical symptoms at early stage and diverse lesions at late stage. The diagnosis is currently dependent on endoscopic and imaging examinations, but patients often have poor compliance. The characteristic change of gut microbiota in IBD suggests that it may become a new biomarker. In recent years, a number of clinical studies have focused on the role of characteristic changes of gut microbiota in the differential diagnosis, disease activity, and extra-intestinal manifestations of IBD. These studies have established a gut microbiota based diagnostic model with high sensitivity and specificity, but the model is susceptible to be influenced by external factors and needs to be further improved. This paper reviews the diagnostic value and clinical significance of gut microbiota in IBD.
引文
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2 Qin J,Li R,Raes J,Arumugam M,Burgdorf KS,Manichanh C,Nielsen T,Pons N,Levenez F,Yamada T,Mende DR,Li J,Xu J,Li S,Li D,Cao J,Wang B,Liang H,Zheng H,Xie Y,Tap J,Lepage P,Bertalan M,Batto JM,Hansen T,Le Paslier D,Linneberg A,Nielsen HB,Pelletier E,Renault P,SicheritzPonten T,Turner K,Zhu H,Yu C,Li S,Jian M,Zhou Y,Li Y,Zhang X,Li S,Qin N,Yang H,Wang J,Brunak S,DoréJ,Guarner F,Kristiansen K,Pedersen O,Parkhill J,Weissenbach J;MetaHIT Consortium,Bork P,Ehrlich SD,Wang J.A human gut microbial gene catalogue established by metagenomic sequencing.Nature 2010;464:59-65[PMID:20203603 DOI:10.1038/nature08821]
3 Hold GL,Smith M,Grange C,Watt ER,El-Omar EM,Mukhopadhya I.Role of the gut microbiota in inflammatory bowel disease pathogenesis:what have we learnt in the past10 years?World J Gastroenterol 2014;20:1192-1210[PMID:24574795 DOI:10.3748/wjg.v20.i5.1192]
4 Dubinsky M,Braun J.Diagnostic and Prognostic Microbial Biomarkers in Inflammatory Bowel Diseases.Gastroenterology2015;149:1265-1274.e3[PMID:26284597 DOI:10.1053/j.gastro.2015.08.006]
5 Lobatón T,Domènech E.Bacterial Intestinal Superinfections in Inflammatory Bowel Diseases Beyond Clostridum difficile.Inflamm Bowel Dis 2016;22:1755-1762[PMID:27104824 DOI:10.1097/MIB.0000000000000788]
6李亚周,江慧琴,秦阳华.肠道真菌菌群和炎症性肠病.世界华人消化杂志2017;25:1528-1535[DOI:10.11569/wcjd.v25.i17.1528]
7 Sokol H,Leducq V,Aschard H,Pham HP,Jegou S,Landman C,Cohen D,Liguori G,Bourrier A,Nion-Larmurier I,Cosnes J,Seksik P,Langella P,Skurnik D,Richard ML,Beaugerie L.Fungal microbiota dysbiosis in IBD.Gut 2017;66:1039-1048[PMID:26843508 DOI:10.1136/gutjnl-2015-310746]
8 Mokili JL,Rohwer F,Dutilh BE.Metagenomics and future perspectives in virus discovery.Curr Opin Virol 2012;2:63-77[PMID:22440968 DOI:10.1016/j.coviro.2011.12.004]
9 Norman JM,Handley SA,Baldridge MT,Droit L,Liu CY,Keller BC,Kambal A,Monaco CL,Zhao G,Fleshner P,Stappenbeck TS,McGovern DP,Keshavarzian A,Mutlu EA,Sauk J,Gevers D,Xavier RJ,Wang D,Parkes M,Virgin HW.Disease-specific alterations in the enteric virome in inflammatory bowel disease.Cell 2015;160:447-460[PMID:25619688 DOI:10.1016/j.cell.2015.01.002]
10 Cornuault JK,Petit MA,Mariadassou M,Benevides L,Moncaut E,Langella P,Sokol H,De Paepe M.Phages infecting Faecalibacterium prausnitzii belong to novel viral genera that help to decipher intestinal viromes.Microbiome 2018;6:65[PMID:29615108 DOI:10.1186/s40168-018-0452-1]
11 Card TR,Siffledeen J,Fleming KM.Are IBD patients more likely to have a prior diagnosis of irritable bowel syndrome?Report of a case-control study in the General Practice Research Database.United European Gastroenterol J 2014;2:505-512[PMID:25452846 DOI:10.1177/2050640614554217]
12 Keohane J,O’Mahony C,O’Mahony L,O’Mahony S,Quigley EM,Shanahan F.Irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease:a real association or reflection of occult inflammation?Am J Gastroenterol 2010;105:1788,1789-1794;quiz 1795[PMID:20389294 DOI:10.1038/ajg.2010.156]
13 Zhuang X,Tian Z,Li L,Zeng Z,Chen M,Xiong L.Fecal Microbiota Alterations Associated With Diarrhea-Predominant Irritable Bowel Syndrome.Front Microbiol 2018;9:1600[PMID:30090090 DOI:10.3389/fmicb.2018.01600]
14 Zhong W,Lu X,Shi H,Zhao G,Song Y,Wang Y,Zhang J,Jin Y,Wang S.Distinct Microbial Populations Exist in the Mucosaassociated Microbiota of Diarrhea Predominant Irritable Bowel Syndrome and Ulcerative Colitis.J Clin Gastroenterol 2017[PMID:29210899 DOI:10.1097/MCG.0000000000000961]
15 Dai Z,Coker OO,Nakatsu G,Wu WKK,Zhao L,Chen Z,Chan FKL,Kristiansen K,Sung JJY,Wong SH,Yu J.Multicohort analysis of colorectal cancer metagenome identified altered bacteria across populations and universal bacterial markers.Microbiome 2018;6:70[PMID:29642940 DOI:10.1186/s40168-018-0451-2]
16 Xie YH,Gao QY,Cai GX,Sun XM,Zou TH,Chen HM,Yu SY,Qiu YW,Gu WQ,Chen XY,Cui Y,Sun D,Liu ZJ,Cai SJ,Xu J,Chen YX,Fang JY.Fecal Clostridium symbiosum for Noninvasive Detection of Early and Advanced Colorectal Cancer:Test and Validation Studies.EBio Medicine 2017;25:32-40[PMID:29033369 DOI:10.1016/j.ebiom.2017.10.005]
17胡品津.我们能解决克罗恩病与肠结核鉴别诊断的难题吗?中华消化杂志2011;31:192-194[DOI:10.3760/cma.j.issn.0254-1432.2011.03.014]
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