Article(id=1242093864853504141, tenantId=1146029695717560320, journalId=1192105938417971205, issueId=1242093864144666765, articleNumber=null, orderNo=null, doi=10.13343/j.cnki.wsxb.20240209, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1711728000000, receivedDateStr=2024-03-30, revisedDate=null, revisedDateStr=null, acceptedDate=1716220800000, acceptedDateStr=2024-05-21, onlineDate=1774067854369, onlineDateStr=2026-03-21, pubDate=1716825600000, pubDateStr=2024-05-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1774067854369, onlineIssueDateStr=2026-03-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1774067854369, creator=13701087609, updateTime=1774067854369, updator=13701087609, issue=Issue{id=1242093864144666765, tenantId=1146029695717560320, journalId=1192105938417971205, year='2024', volume='64', issue='10', pageStart='3571', pageEnd='3997', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1774067854200, creator=13701087609, updateTime=1774067980255, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1242094392937353679, tenantId=1146029695717560320, journalId=1192105938417971205, issueId=1242093864144666765, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1242094392937353680, tenantId=1146029695717560320, journalId=1192105938417971205, issueId=1242093864144666765, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3610, endPage=3619, ext={EN=ArticleExt(id=1242093867378475159, articleId=1242093864853504141, tenantId=1146029695717560320, journalId=1192105938417971205, language=EN, title=Research progress in the relationship between gut microbiota and Parkinson's disease, columnId=1239895164987175635, journalTitle=Acta Microbiologica Sinica, columnName=Reviews, runingTitle=null, highlight=null, articleAbstract=

Parkinson's disease is a common neurodegenerative disorder that seriously threatens the health of middle-aged and elderly individuals. However, the pathogenesis of Parkinson's disease is not fully understood. Recent studies have shown that gut microbiota plays an important role in the occurrence and development of Parkinson's disease. Gut microbiota and its metabolites influence the intestinal mucosal barrier, neuroinflammation, endocrine system, and other aspects through the microbiota-gut-brain axis, thereby participating in the occurrence and development of Parkinson's disease. Gut microbiota can be regulated by various methods such as probiotic supplementation, fecal microbiota transplantation, dietary adjustments, and traditional Chinese medicine interventions, being an important target for the prevention and treatment of Parkinson's disease. This article reviews the possible mechanisms of gut microbiota being involved in the occurrence of Parkinson's disease and further discusses the current status of prevention and treatment of gut microbiota dysbiosis.

, correspAuthors=Yi QIAO, authorNote=null, correspAuthorsNote=
*QIAO Yi, E-mail:
, copyrightStatement=Copyright ©2024 Acta Microbiologica Sinica. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Yujing WANG, Ruining XIE, Shuangshuang JIA, Yaqing LI, Yi QIAO), CN=ArticleExt(id=1242093868431245487, articleId=1242093864853504141, tenantId=1146029695717560320, journalId=1192105938417971205, language=CN, title=肠道菌群与帕金森病关系的研究进展, columnId=1192149543882997826, journalTitle=微生物学报, columnName=综述, runingTitle=null, highlight=null, articleAbstract=

帕金森病是一种常见的神经退行性疾病,严重威胁着中老年人的健康,然而目前帕金森病的发病机制尚不完全明确。近年的研究显示,肠道菌群在帕金森病的发生发展中发挥重要角色,肠道菌群及其代谢物通过微生物-肠-脑轴影响机体的肠道黏膜屏障、神经炎症、内分泌等方面进而参与到帕金森病的发生发展中。肠道菌群可通过补充益生菌、粪菌移植、饮食调整、中医药干预等多种途径进行调控,是帕金森病防治的重要靶点。本文对肠道菌群在帕金森病中的可能发病机制进行综述,并进一步探讨肠道菌群失调的防治现状。

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Modern Journal of Integrated Traditional Chinese and Western Medicine, 2022, 31 (10):1320-1327 (in Chinese)., articleTitle=Discussion on the intervention mechanism of Yipi Tongfu method on Parkinson's disease mice based on brain-intestine-microorganism axis, refAbstract=null)], funds=[Fund(id=1243285155381625168, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, awardId=JYHL2022MS10, language=EN, fundingSource=Jining Medical University Research Fund for Academician Lin He New Medicine(JYHL2022MS10), fundOrder=null, country=null), Fund(id=1243285155490677081, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, awardId=JYHL2022MS10, language=CN, fundingSource=济宁医学院贺林院士新医学临床转化工作站科研基金(JYHL2022MS10), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1243285151816466479, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, xref=null, ext=[AuthorCompanyExt(id=1243285151833243698, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, companyId=1243285151816466479, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1 School of Public Health, Shandong Second Medical University, Weifang 261053, Shandong, China), AuthorCompanyExt(id=1243285151845826611, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, companyId=1243285151816466479, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1 山东第二医科大学 公共卫生学院, 山东 潍坊 261053)]), AuthorCompany(id=1243285151904546873, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, xref=null, ext=[AuthorCompanyExt(id=1243285151908741178, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, companyId=1243285151904546873, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2 School of Public Health, Jining Medical University, Jining 272067, Shandong, China), AuthorCompanyExt(id=1243285151917129787, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, companyId=1243285151904546873, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2 济宁医学院 公共卫生学院, 山东 济宁 272067)])], figs=[ArticleFig(id=1243285154752479512, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, language=EN, label=Figure 1, caption=Possible mechanisms of intestinal flora and its metabolites in the pathogenesis of PD. The alteration in the composition of the gut microbiota and changes in the levels of their metabolic products, such as short-chain fatty acids (SCFAs), can lead to an increase in intestinal permeability. An increased abundance of pro-inflammatory metabolites from the gut microbiota, such as lipopolysaccharide (LPS), promotes the release of inflammatory cytokines and induce neuroinflammation. The gut microbiota influences the levels of neurotransmitters such as serotonin (5-HT) and gamma-aminobutyric acid (GABA) within the intestine, which in turn modulates brain function and cognition., figureFileSmall=7VTpzLGbbfXdSiWEzZE2oQ==, figureFileBig=xC32edHtLWJYGNa5+Hm62g==, tableContent=null), ArticleFig(id=1243285154836365606, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, language=CN, label=图1, caption=肠道菌群及其代谢产物在PD发病中的可能机制, figureFileSmall=7VTpzLGbbfXdSiWEzZE2oQ==, figureFileBig=xC32edHtLWJYGNa5+Hm62g==, tableContent=null), ArticleFig(id=1243285154999943477, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, language=EN, label=Table 1, caption=

Altered gut microbiota compositions in PD patients and animal models

, figureFileSmall=null, figureFileBig=null, tableContent=
Study objectNeurotoxinAltered microbiotaReferences
−: The population study; ↑: The increase in the abundance of gut microbiota in PD patients compared with healthy controls; ↓: The increase in the abundance of gut microbiota in PD patients compared with healthy controls.
PD patientVerrucomicrobiota ↑, Lactobacillaceae ↑, Akkermansiaceae ↑, Lactobacillus ↑, Firmicutes ↓, Coriobacteriales[11]
PD patientAlistipes ↑, Bifidobacterium ↑, ParaBacteroides ↑, Sphingomonas ↑, Faecalibacterium[12]
MiceMPTPBifidobacterium ↑, Proteus ↑, Akkermansia ↓, Firmicutes ↓, Prevotella ↓, Ruminococcus[13]
MiceRotenoneAlistipes ↑, Akkermansia ↑, Bilophila ↑, Bifidobacterium ↓, Faecalibaculum ↓, Turicibacter[14]
MiceMPTPActinobacteria ↑, Proteobacteria ↑, Erysipelotrichaceae ↑, Desulfovibrionaceae ↑, Ruminococcaceae ↑, Lactobacillaceae ↓, Lactobacillus[15]
), ArticleFig(id=1243285155125772607, tenantId=1146029695717560320, journalId=1192105938417971205, articleId=1242093864853504141, language=CN, label=表1, caption=

PD患者和动物模型肠道菌群组成的变化

, figureFileSmall=null, figureFileBig=null, tableContent=
Study objectNeurotoxinAltered microbiotaReferences
−: The population study; ↑: The increase in the abundance of gut microbiota in PD patients compared with healthy controls; ↓: The increase in the abundance of gut microbiota in PD patients compared with healthy controls.
PD patientVerrucomicrobiota ↑, Lactobacillaceae ↑, Akkermansiaceae ↑, Lactobacillus ↑, Firmicutes ↓, Coriobacteriales[11]
PD patientAlistipes ↑, Bifidobacterium ↑, ParaBacteroides ↑, Sphingomonas ↑, Faecalibacterium[12]
MiceMPTPBifidobacterium ↑, Proteus ↑, Akkermansia ↓, Firmicutes ↓, Prevotella ↓, Ruminococcus[13]
MiceRotenoneAlistipes ↑, Akkermansia ↑, Bilophila ↑, Bifidobacterium ↓, Faecalibaculum ↓, Turicibacter[14]
MiceMPTPActinobacteria ↑, Proteobacteria ↑, Erysipelotrichaceae ↑, Desulfovibrionaceae ↑, Ruminococcaceae ↑, Lactobacillaceae ↓, Lactobacillus[15]
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肠道菌群与帕金森病关系的研究进展
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王玉静 1, 2 , 解瑞宁 2 , 贾双双 2 , 李雅青 1, 2 , 乔艺 2, *
微生物学报 | 综述 2024,64(10): 3610-3619
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微生物学报 | 综述 2024, 64(10): 3610-3619
肠道菌群与帕金森病关系的研究进展
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王玉静1, 2, 解瑞宁2, 贾双双2, 李雅青1, 2, 乔艺2, *
作者信息
  • 1 山东第二医科大学 公共卫生学院, 山东 潍坊 261053
  • 2 济宁医学院 公共卫生学院, 山东 济宁 272067
Research progress in the relationship between gut microbiota and Parkinson's disease
Yujing WANG1, 2, Ruining XIE2, Shuangshuang JIA2, Yaqing LI1, 2, Yi QIAO2, *
Affiliations
  • 1 School of Public Health, Shandong Second Medical University, Weifang 261053, Shandong, China
  • 2 School of Public Health, Jining Medical University, Jining 272067, Shandong, China
出版时间: 2024-05-28 doi: 10.13343/j.cnki.wsxb.20240209
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帕金森病是一种常见的神经退行性疾病,严重威胁着中老年人的健康,然而目前帕金森病的发病机制尚不完全明确。近年的研究显示,肠道菌群在帕金森病的发生发展中发挥重要角色,肠道菌群及其代谢物通过微生物-肠-脑轴影响机体的肠道黏膜屏障、神经炎症、内分泌等方面进而参与到帕金森病的发生发展中。肠道菌群可通过补充益生菌、粪菌移植、饮食调整、中医药干预等多种途径进行调控,是帕金森病防治的重要靶点。本文对肠道菌群在帕金森病中的可能发病机制进行综述,并进一步探讨肠道菌群失调的防治现状。

帕金森病  /  肠道菌群  /  肠道菌群代谢产物

Parkinson's disease is a common neurodegenerative disorder that seriously threatens the health of middle-aged and elderly individuals. However, the pathogenesis of Parkinson's disease is not fully understood. Recent studies have shown that gut microbiota plays an important role in the occurrence and development of Parkinson's disease. Gut microbiota and its metabolites influence the intestinal mucosal barrier, neuroinflammation, endocrine system, and other aspects through the microbiota-gut-brain axis, thereby participating in the occurrence and development of Parkinson's disease. Gut microbiota can be regulated by various methods such as probiotic supplementation, fecal microbiota transplantation, dietary adjustments, and traditional Chinese medicine interventions, being an important target for the prevention and treatment of Parkinson's disease. This article reviews the possible mechanisms of gut microbiota being involved in the occurrence of Parkinson's disease and further discusses the current status of prevention and treatment of gut microbiota dysbiosis.

Parkinson's disease  /  gut microbiota  /  metabolites of gut microbiota
王玉静, 解瑞宁, 贾双双, 李雅青, 乔艺. 肠道菌群与帕金森病关系的研究进展. 微生物学报, 2024 , 64 (10) : 3610 -3619 . DOI: 10.13343/j.cnki.wsxb.20240209
Yujing WANG, Ruining XIE, Shuangshuang JIA, Yaqing LI, Yi QIAO. Research progress in the relationship between gut microbiota and Parkinson's disease[J]. Acta Microbiologica Sinica, 2024 , 64 (10) : 3610 -3619 . DOI: 10.13343/j.cnki.wsxb.20240209
帕金森病(Parkinson’s disease, PD)是仅次于阿尔茨海默病的第二常见的神经退行性疾病,多发于65岁及以上人群,与衰老密切相关,流行病学研究数据表明我国此类人群的患病率达1.6%[1]。随着我国人口老龄化进程的加速,PD患者数量急剧增加,这将会带来严重的经济和医疗负担。PD的主要病理特征为α-突触核蛋白(α-synuclein, α-syn)的异常聚集以及中脑黑质多巴胺能神经元的丧失,以运动症状和非运动症状为主要特征,严重影响患者的生活质量;PD运动症状包括运动迟缓、僵硬、异常姿势和静息性震颤等;患者还经常出现非运动症状,如便秘、焦虑、睡眠障碍、自主神经障碍等[2]。研究发现,大多数的PD患者存在胃肠道症状,如恶心、便秘、胃排空延迟等,其中约80%的PD患者会出现便秘,而且便秘症状比PD运动症状平均早10年或者更久[3]。近年来越来越多的研究表明,肠道菌群与PD密切相关,因此明确肠道菌群在PD中的作用机制,可能为PD的干预与治疗提供新思路。
微生物-肠-脑轴(microbiome-gut-brain axis, MGBA)是将大脑与肠道功能整合的双向信息交流系统,其中微生物在系统中扮演重要角色。肠道微生物通过神经系统、免疫系统和神经递质等途径与大脑进行交流[4-5]。肠道微生物可以直接刺激肠神经(enteric nervous system, ENS)传入神经元,通过迷走神经(vagus nerve, VN)对脑发出信号。肠道微生物还可以通过免疫反应影响机体炎性因子水平进而影响中枢神经系统的功能。此外,肠道微生物能合成多巴胺(dopamine, DA)、5-羟色胺(5-hydroxytryptamine, 5-HT)、γ-氨基丁酸(γ-aminobutyric acid, GABA)等多种神经递质,通过ENS直接或间接地将信号发送给大脑。
Mao等研究发现,PD患者粪便样本中普雷沃氏菌属(Prevotella)的丰度降低,与疾病严重程度呈负相关关系[6]。此外,Nishiwaki等研究表明,PD患者肠道菌群内分解肠道黏蛋白的阿克曼氏菌属(Akkermansia)丰度升高,而产生短链脂肪酸的罗斯拜瑞氏菌属(Roseburia)和栖粪杆菌属(Faecalibacterium)丰度下降[7]
在PD动物模型中同样也存在着肠道菌群组成的改变。Gan等[8]对1-甲基-4-苯基-1, 2, 3, 6-四氢吡啶(1-methyl-4-phe⁃nyl-1, 2, 3, 6-tetrahydropyridine, MPTP)诱导的PD小鼠粪便研究显示,厚壁菌门(Firmicutes)和疣微菌门(Verrucomicrobia)丰度增加,而拟杆菌门(Bacteroidetes)丰度降低。王玉等[9]研究发现,PD小鼠粪便中出现菌群失调,菌群多样性升高且菌群组成发生明显变化,厚壁菌门/拟杆菌门的比值增加,而且变形菌门(Proteobacteria)和放线菌门(Actinobacteria)丰度升高。此外,Zhao等研究发现,鱼藤酮诱导的PD小鼠粪便中脱硫弧菌属(Desulfovibrio)和阿克曼氏菌属的相对丰度显著增加[10]。更多关于PD患者和动物模型肠道菌群组成变化的研究总结见表1。以上结果表明,PD患者及PD动物模型的肠道菌群与健康的肠道菌群相比,在组成上存在明显差异,而且菌群变化与PD的发病密切相关。
聚集性α-syn是神经元包涵体即路易小体(lewy bodies, LBs)和路易神经突(lewy neurites, LNs)的主要成分,是PD的病理标志[16]。α-syn的聚集可能始于肠道,经过迷走神经进入大脑,肠道菌群的改变是导致α-syn聚集的潜在因素[17]
在动物模型中,对过度表达α-syn的小鼠研究发现,具有正常肠道微生物菌群的小鼠脑内出现α-syn的异常聚集,而无菌小鼠并未出现以上改变;此外,将健康人群和PD患者的肠道微生物群分别移植到过表达α-syn的无菌小鼠肠道中,结果显示,接受PD患者肠道微生物群移植的小鼠出现明显的运动功能障碍,这表明PD患者肠道微生物的存在加剧了肠道中α-syn的病理变化[18]。以上研究表明,肠道菌群在α-syn的聚集中发挥重要作用。
SCFAs是肠道菌群的重要代谢产物之一,它的含量可以间接反映PD患者肠道菌群组成的变化。PD患者经常表现出胃肠功能障碍,而SCFAs可以调节肠神经系统活性,促进胃肠运动;与健康对照组相比,PD患者粪便中SCFAs含量以及产生SCFAs的细菌数量明显减少,因此SCFAs浓度的改变可能是引起胃肠功能障碍的原因[19]。一项临床研究表明,PD患者的低SCFAs与较差的认知能力和低身体质量指数(body mass index, BMI)显著相关,较低的丁酸水平与较差的姿势不稳定-步态障碍评分相关[20]。在鱼藤酮诱导的PD小鼠中,丁酸钠(sodium butyrate, NaB)的干预减少了多巴胺能神经元的丢失及α-syn的聚集,通过重塑肠道菌群的组成改善小鼠肠道功能障碍[21]
近年来,BAs成为微生物-肠-脑轴研究中的“明星分子”,它被证明是一种抗炎分子,在PD和阿尔茨海默病等神经退行性疾病中展现出治疗潜力[22]。Nie等研究表明,伴有认知障碍的PD患者血清BAs有明显改变,表现为鹅去氧胆酸(chenodeoxycholic acid, CDCA)、胆酸(cholic acid, CA)和熊脱氧胆酸(ursodeoxycholic acid, UDCA)水平的降低[23];在PD小鼠模型的血清中,牛磺熊脱氧胆酸(tauroursodeoxycholic acid, TUDCA)水平与对照组相比均显著降低[24]
LPS又称为内毒素,是革兰氏阴性菌外膜的主要成分,由脂质和多糖构成,被公认为是一种促炎因子,也可用来诱导PD动物模型。肠道菌群紊乱导致LPS增加,而LPS能够特异性识别并结合Toll样受体4 (Toll-like receptor 4, TLR4),释放促炎细胞因子引起全身炎症[25]。Gorecki等研究表明,PD患者粪便中产生LPS的革兰氏阴性菌γ-变形菌纲(Gammaproteobacteria)的丰度明显高于健康对照组[26]。Yan等[12]研究发现,PD患者肠道中革兰氏阴性菌与革兰氏阳性菌的比值升高。
TMAO主要是通过肠道内的厚壁菌门和变形菌门等微生物对富含胆碱、甜菜碱、肉碱的食物进行代谢产生,它可以穿过血脑屏障,与神经炎症密切相关[27]。临床研究表明,PD患者血浆中TMAO水平明显下降,这种较低水平的TMAO可作为PD早期诊断的生物标志物[28];另一项研究则发现,PD患者血浆中TMAO水平升高,并与疾病的严重程度和运动症状进展呈显著正相关[29]。以上临床研究结果表明,TMAO与PD之间存在较强的相关性,但具体结论并不一致。
综上所述,肠道菌群代谢产物的含量变化与PD存在密切的相关性,它们通过调节肠道功能、影响神经炎症、参与神经保护机制等方式参与到PD的进程中。因此,调节肠道菌群结构影响其代谢产物可能成为防治PD的新策略。
肠道稳态的维持离不开完整的肠道屏障,肠道屏障的受损可能会导致有害物质(毒素、细菌)等进入体内,诱导肠道及全身炎症反应。研究表明,肠道菌群的失调会影响肠道屏障并增加肠道通透性。PD肠道菌群失调的主要特征之一是产生SCFAs的细菌数量减少,而SCFAs在维持肠道上皮组织的完整性方面发挥着重要作用,其数量的减少可能直接或间接地导致肠黏膜屏障的损伤和通透性的增加,使ENS更易受到病原体的侵害,引发炎症反应。李剑兰等[30]研究发现,PD患者肠道菌群结构发生变化,产生SCFAs的细菌数量减少,从而降低了SCFAs的含量;这一改变导致肠道屏障受损,肠神经更容易受到病原体的侵害,引发体内炎症,并通过肠脑轴影响CNS,进而促进PD的发生与发展。Hasegawa等[31]研究表明,PD患者粪便样本中乳杆菌属(Lactobacillus)数量相对增多,普雷沃氏菌属数量相对减少,而普雷沃氏菌属数量的减少可能会使PD患者肠道黏蛋白合成量下降,从而增加肠道的通透性,进而加速PD的发展进程。
此外,一些动物研究表明,肠道屏障的受损可能导致PD的发生与发展。研究发现,肠道通透性增加引发α-syn在肠道神经元及黑质多巴胺能神经元中的异常聚集,进而导致老年α-syn转基因小鼠出现神经元退行性改变[32]。肠道屏障的损伤与PD的发生密切相关,但确切的机制需要更多的研究来证实。
神经炎症是PD常见的发病机制之一,而神经炎症的重要特征之一是中枢内胶质细胞的激活。胶质细胞的激活会导致促炎因子和细胞毒性分子的增加,进而损害神经元活性并导致神经退行性病变。肠道菌群失调继而影响其代谢产物,如SCFAs、LPS、TMAO、BAs的含量,导致肠道炎症,随后代谢产物和促炎因子可进入循环系统并穿过血脑屏障,从而引起神经炎症。SCFAs的减少会上调辅助性T细胞17 (T helper cell 17, Th17)发挥促炎潜能,下调调节性T细胞,增加肠道屏障的通透性,引起神经元炎症,导致神经退行性变[33]。较高水平的肠源性LPS会破坏血脑屏障的完整性,从而引发神经炎症和损伤[34]。在动物模型中,TMAO加剧了PD小鼠的运动功能障碍并且显著激活了纹状体和海马中的胶质细胞,加重了PD小鼠的神经炎症[35]。研究表明,BAs可以减少PD样病理改变,牛磺熊去氧胆酸(tauroursodeoxycholic acid, TUDCA)预处理可以预防MPTP诱导的PD小鼠多巴胺能神经元损伤,抑制小胶质细胞和星形胶质细胞的激活,从而起到抗神经炎症的作用[36]
PD患者肠道菌群组成和肠道通透性改变,通过激活Toll样受体(Toll-like receptors, TLRs)和天然免疫应答反应,增强α-syn的炎症作用并导致α-syn的错误折叠[37]。随后错误折叠的α-syn与小胶质细胞上的TLR2结合,进而激活下游涉及髓样分化因子(myeloid differentiation factor 88, MyD88)和抑制核因子κB (nuclear factor kappa-B, NF-κB)的通路,触发肿瘤坏死因子α (tumor necrosis factor-α, TNF-α)和白细胞介素-1β (interleukin-1β, IL-1β)的产生,加重神经炎症损伤[38]。因此,肠道菌群的改变可能会导致神经炎症,而抑制伴随胶质细胞活化的神经炎症,是PD的潜在治疗靶点。
肠道菌群可以通过其代谢产物及神经递质等多种因素调节内分泌紊乱,如SCFAs、GABA、5-HT等。
SCFAs可以通过内分泌途径对PD发挥保护作用。在MPTP诱导的PD小鼠中,NaB通过刺激肠道胰高血糖素样肽-1 (glucagon-like peptide-1, GLP-1)的分泌,激活GLP-1受体在脑内发挥神经保护作用,减轻小鼠的多巴胺能变性[39]。在鱼藤酮诱导的PD小鼠中,结肠、血清和黑质中GLP-1水平降低,经NaB干预后恢复,GLP-1可通过抑制神经炎症在PD中发挥保护作用[21]
5-HT是一种单胺类神经递质,绝大多数的5-HT合成和分布于肠内分泌细胞中的肠嗜铬细胞,在调节认知功能和脑功能中发挥重要作用。PD患者5-HT的水平较对照组降低,与抑郁和疼痛的严重程度相关[40]。5-HT类药物对PD患者的抑郁症状有显著改善[41]。GABA是一种抑制性神经递质,可由乳酸杆菌和双歧杆菌(Bifidobacterium)产生,对于维持肠道稳定和参与微生物-肠-脑轴调节具有重要作用。研究发现,PD患者基底神经节GABA水平明显升高,而且与步态障碍程度相关,提示GABA参与PD的发病机制[42]。综上所述,肠道菌群的改变通过调控免疫系统中的神经递质来介导PD的发生发展。
以上关于肠道菌群及其代谢产物在PD发病中的可能机制或许会相互作用,共同介导PD的发生发展。简而言之,肠道菌群及其代谢物通过影响机体的肠道黏膜屏障、神经炎症、内分泌等方面参与到PD的发生发展中,相关机制图解见图1,具体机制有待进一步研究。
通常情况下,肠道菌群的构成及数量保持着一种动态平衡,维持宿主的体内稳态。然而饮食习惯、药物滥用和感染等会破坏这种平衡,进而影响宿主的肠道免疫及内分泌调节等功能,导致疾病的发生。近年来的研究表明,肠道菌群失调与PD的发生发展密切相关。目前,PD尚未找到理想的治愈手段,治疗仍以药物为主,主要是通过左旋多巴来缓解,但这些药物主要针对PD患者的运动症状,对非运动症状的疗效较为有限,甚至会加重PD患者的胃肠功能紊乱。随着近年来对肠道菌群与PD之间关系的认识,通过调节肠道菌群的结构组成来治疗PD成为热点。将失调的肠道菌群转化为健康的肠道菌群是当前肠道菌群治疗的原则。
研究表明,益生菌对PD患者的胃肠道症状,如便秘、腹痛腹胀等具有缓解作用。在临床试验中发现,多菌株益生菌胶囊可以帮助缓解PD患者的胃肠功能障碍,如缓解便秘和改善排便习惯,提高患者的生活质量[43]。此外,益生菌在改善PD的神经系统功能中发挥重要作用。研究发现,益生菌干预能够缓解小鼠运动功能障碍,减轻氧化应激水平,对PD小鼠的多巴胺能神经元起到保护作用[44]。以上研究表明,补充益生菌可能是PD潜在的治疗方法,但益生菌治疗PD的安全性、长期有效性及作用机制有待进一步研究。
在临床研究中,经FMT后PD患者的便秘和四肢震颤情况得到缓解[45]。在动物实验中,FMT可显著缓解PD小鼠肠道菌群失调,并通过抑制神经炎症和减少TLR4/MyD88/TNF-a信号转导,对PD小鼠起到保护作用[10]。另一项研究表明,与来自健康人类供体的粪便菌群移植相比,来自PD患者的粪便菌群移植到小鼠体内会加重小鼠的运动功能障碍,并增加小胶质细胞的激活,促进神经炎症[18]。综上所述,FMT可以改善PD肠道菌群失调,调节神经炎症,进而发挥神经保护作用,但由于临床试验较少,数据有限,迫切需要更多高质量的研究数据来进一步确定FMT的安全性和有效性。
流行病调查结果显示,饮食对于包括PD在内的神经退行性疾病的发生发展具有重要作用。研究表明,饮食可能是决定肠道菌群结构和代谢功能最主要的因素[46]。地中海饮食被认为在改善肠道菌群与减轻炎症方面具有积极作用。在一项队列研究中发现,中年时期坚持地中海饮食习惯的女性,其晚年患PD的风险显著降低,呈负相关关系[47]。地中海饮食强调摄入大量的植物性食物,摄入适量的鱼类和葡萄酒,以及富含抗炎、抗氧化作用的食物,有助于维持肠道菌群的平衡与健康。此外,饮食中大量摄入不饱和脂肪酸也会影响肠道菌群的组成,减弱炎症反应,减少氧化应激,从而减轻α-syn的聚集[48]。综上所述,通过饮食调整来改善肠道菌群可能对PD的防治具有一定潜力,但仍需要更多的研究来验证,并进一步探索更佳的饮食策略与治疗方案。
近年来研究表明,中医药在PD的治疗中发挥重要作用。范建虎等[49]研究发现,PD患者经过柔肝通络汤治疗后,肠道菌群中双歧杆菌、乳酸杆菌含量明显增高,其作用机制可能与调节肠道菌群及脑-肠轴功能有关,并使患者血清5-HT水平明显升高和α-syn水平降低。刘畅等[50]研究发现,经术虎合剂干预后,PD小鼠运动功能得到改善,小鼠黑质神经元尼氏小体量明显增加,肠道菌群的丰富度及多样性有所提高。中医药干预可以通过靶向肠道菌群参与PD的发病进程,为PD的治疗策略提供新思路。
综上所述,肠道菌群的失调与PD的发生发展密切相关。肠道菌群失调可能通过影响肠道屏障的通透性、神经炎症及内分泌紊乱等途径,并通过微生物-肠-脑轴介导PD的发生发展。因此,加强对肠道菌群的研究对PD的防治具有重要意义。利用补充益生菌、粪菌移植、进行饮食调整和中医药干预等策略旨在恢复肠道菌群正常构成,改善PD症状,但其潜在的理论机制与临床疗效需进一步研究。
  • 济宁医学院贺林院士新医学临床转化工作站科研基金(JYHL2022MS10)
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2024年第64卷第10期
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doi: 10.13343/j.cnki.wsxb.20240209
  • 接收时间:2024-03-30
  • 首发时间:2026-03-21
  • 出版时间:2024-05-28
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  • 收稿日期:2024-03-30
  • 录用日期:2024-05-21
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Jining Medical University Research Fund for Academician Lin He New Medicine(JYHL2022MS10)
济宁医学院贺林院士新医学临床转化工作站科研基金(JYHL2022MS10)
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    1 山东第二医科大学 公共卫生学院, 山东 潍坊 261053
    2 济宁医学院 公共卫生学院, 山东 济宁 272067

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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