Article(id=1315688500033340393, tenantId=1146029695717560320, journalId=1315121837170065538, issueId=1315688435411694395, articleNumber=null, orderNo=null, doi=10.16368/j.issn.1674-8999.2025.12.406, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750089600000, receivedDateStr=2025-06-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1791614182714, onlineDateStr=2026-10-10, pubDate=1765296000000, pubDateStr=2025-12-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1791614182714, onlineIssueDateStr=2026-10-10, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1791614182714, creator=13701087609, updateTime=1791614182714, updator=13701087609, issue=Issue{id=1315688435411694395, tenantId=1146029695717560320, journalId=1315121837170065538, year='2025', volume='40', issue='12', pageStart='2487', pageEnd='2712', issueExtLink='null', onlineDate='null', pubDate='1765296000000', pubDateStr='2025-12-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1791614167309, creator='13701087609', updateTime=1791616084449, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1315696476567744680, tenantId=1146029695717560320, journalId=1315121837170065538, issueId=1315688435411694395, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1315696476571938985, tenantId=1146029695717560320, journalId=1315121837170065538, issueId=1315688435411694395, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2595, endPage=2601, ext={EN=ArticleExt(id=1315688500297581546, articleId=1315688500033340393, tenantId=1146029695717560320, journalId=1315121837170065538, language=EN, title=Research Progress on Traditional Chinese Medicine Regulating Microbiota-Gut-Brain Axis to Intervene Post-Stroke Depression, columnId=1315688445339612089, journalTitle=Acta Chinese Medicine, columnName=Commentary, runingTitle=null, highlight=null, articleAbstract=

The microbiota-gut-brain axis(MGBA)plays an important role in the pathogenesis and treatment of post-stroke depression(PSD).The gut microbiota,as a key regulatory factor of this pathway,participates in the onset of PSD through neural,endocrine,metabolic,and immune systems,and maintains bidirectional communication between the brain and the gut.Research indicates that traditional Chinese medicine(TCM)can act on the MGBA through multiple pathways.Single herbs such as Chaihu(Bupleurum),Roucongrong(Cistanches Herba)and Ciwujia(Acanthopanax root)can regulate the gut microbiota,inhibit inflammation,and modulate the HPA axis. Compound formulas,such as Xiaoyao Powder and Chaigui Granule,can increase short-chain fatty acids,regulate amino acid metabolism,and collaboratively restore neurotransmitter and neurotrophic factor levels.Animal experiments have confirmed that TCM monomers and compound preparations can regulate the overall function of the gut microbiota. Combined with dietary interventions and gut microbiota transplantation,they can regulate the proportion of beneficial and harmful bacteria,restoring microbial structure and metabolic balance.In the future,it is necessary to explore how traditional Chinese medicine can target the gut microbiota and transform its active components to exert biological effects,promote multidisciplinary and multi-target research,clarify the pathogenesis of PSD,enhance fecal microbiota transplantation and Chinese medicine-microbiota co-culture techniques,and systematically validate the value of the MGBA in individualized and precise treatment of PSD by integrating animal experiments with clinical practice.

, authors=Jun YIN1, Yifan YANG2, Yedong YUN1, Zhouyuan HU1, Yongmei YAN2, authorsList=Jun YIN, Yifan YANG, Yedong YUN, Zhouyuan HU, Yongmei YAN, authorCompany=null, correspAuthors=Yongmei YAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, 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, fund=null), CN=ArticleExt(id=1315688500670874603, articleId=1315688500033340393, tenantId=1146029695717560320, journalId=1315121837170065538, language=CN, title=中医药调控微生物-肠-脑轴干预卒中后抑郁研究进展, columnId=1315688445511578555, journalTitle=中医学报, columnName=述评, runingTitle=null, highlight=null, articleAbstract=

微生物-肠-脑轴(microbiota-gut-brain Axis,MGBA)在卒中后抑郁的发病与治疗中具有重要作用。肠道菌群作为该通路的关键调控因子,通过神经、内分泌、代谢及免疫系统参与卒中后抑郁(post-stroke depression,PSD)发病,并维持大脑与肠道间的双向交流。中药可多途径作用于MGBA,如柴胡、肉苁蓉、刺五加等单味药可调节肠道菌群、抑制炎症并调节HPA轴;逍遥散、柴归颗粒等复方则能增加短链脂肪酸、调节氨基酸代谢,协同恢复神经递质与神经营养因子水平。动物实验证实,中药单体及复方制剂可调节肠道菌群整体功能,结合饮食干预与肠道菌群移植,调节有益菌与有害菌比例,恢复微生物结构及代谢平衡。未来需探索中药如何靶向肠道微生物,并转化其活性成分以发挥生物学效应,推动多学科、多靶点研究,明确PSD发病机制,提高粪菌移植与中药-菌群共培养技术,将动物实验与临床实践相结合,系统验证MGBA在PSD个体化、精准化治疗中的价值。

, authors=阴俊1, 杨一帆2, 云烨栋1, 胡周圆1, 闫咏梅2, authorsList=阴俊, 杨一帆, 云烨栋, 胡周圆, 闫咏梅, authorCompany=null, correspAuthors=闫咏梅, authorNote=

阴俊(1996 -),男,陕西商洛人,硕士研究生,研究方向:脑血管病的基础与临床研究。

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闫咏梅(1961 -),女,主任医师,教授,博士研究生导师,研究方向:脑血管病的基础与临床研究。E -mail:
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阴俊(1996 -),男,陕西商洛人,硕士研究生,研究方向:脑血管病的基础与临床研究。

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中医药调控微生物-肠-脑轴干预卒中后抑郁研究进展
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阴俊 1 , 杨一帆 2 , 云烨栋 1 , 胡周圆 1 , 闫咏梅 2
中医学报 | 述评 2025,40(12): 2595-2601
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中医学报 |述评 2025 , 40 (12) : 2595 -2601
中医药调控微生物-肠-脑轴干预卒中后抑郁研究进展
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阴俊1, 杨一帆2, 云烨栋1, 胡周圆1, 闫咏梅2
作者信息
  • 1陕西中医药大学,陕西 咸阳 712046
  • 2陕西中医药大学附属医院,陕西 咸阳 712000
通讯作者:
闫咏梅(1961 -),女,主任医师,教授,博士研究生导师,研究方向:脑血管病的基础与临床研究。E -mail:
作者简介:

阴俊(1996 -),男,陕西商洛人,硕士研究生,研究方向:脑血管病的基础与临床研究。

Research Progress on Traditional Chinese Medicine Regulating Microbiota-Gut-Brain Axis to Intervene Post-Stroke Depression
Jun YIN1, Yifan YANG2, Yedong YUN1, Zhouyuan HU1, Yongmei YAN2
Affiliations
  • 1Shaanxi University of Chinese Medicine, Xianyang Shaanxi China 712046
  • 2The Affiliated Hospital to Shaanxi University of Chinese Medicine, Xianyang Shaanxi China 712000
出版时间: 2025-12-10 doi: 10.16368/j.issn.1674-8999.2025.12.406
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微生物-肠-脑轴(microbiota-gut-brain Axis,MGBA)在卒中后抑郁的发病与治疗中具有重要作用。肠道菌群作为该通路的关键调控因子,通过神经、内分泌、代谢及免疫系统参与卒中后抑郁(post-stroke depression,PSD)发病,并维持大脑与肠道间的双向交流。中药可多途径作用于MGBA,如柴胡、肉苁蓉、刺五加等单味药可调节肠道菌群、抑制炎症并调节HPA轴;逍遥散、柴归颗粒等复方则能增加短链脂肪酸、调节氨基酸代谢,协同恢复神经递质与神经营养因子水平。动物实验证实,中药单体及复方制剂可调节肠道菌群整体功能,结合饮食干预与肠道菌群移植,调节有益菌与有害菌比例,恢复微生物结构及代谢平衡。未来需探索中药如何靶向肠道微生物,并转化其活性成分以发挥生物学效应,推动多学科、多靶点研究,明确PSD发病机制,提高粪菌移植与中药-菌群共培养技术,将动物实验与临床实践相结合,系统验证MGBA在PSD个体化、精准化治疗中的价值。

卒中后抑郁  /  微生物-肠-脑轴  /  发病机制  /  肠道菌群  /  中医药

The microbiota-gut-brain axis(MGBA)plays an important role in the pathogenesis and treatment of post-stroke depression(PSD).The gut microbiota,as a key regulatory factor of this pathway,participates in the onset of PSD through neural,endocrine,metabolic,and immune systems,and maintains bidirectional communication between the brain and the gut.Research indicates that traditional Chinese medicine(TCM)can act on the MGBA through multiple pathways.Single herbs such as Chaihu(Bupleurum),Roucongrong(Cistanches Herba)and Ciwujia(Acanthopanax root)can regulate the gut microbiota,inhibit inflammation,and modulate the HPA axis. Compound formulas,such as Xiaoyao Powder and Chaigui Granule,can increase short-chain fatty acids,regulate amino acid metabolism,and collaboratively restore neurotransmitter and neurotrophic factor levels.Animal experiments have confirmed that TCM monomers and compound preparations can regulate the overall function of the gut microbiota. Combined with dietary interventions and gut microbiota transplantation,they can regulate the proportion of beneficial and harmful bacteria,restoring microbial structure and metabolic balance.In the future,it is necessary to explore how traditional Chinese medicine can target the gut microbiota and transform its active components to exert biological effects,promote multidisciplinary and multi-target research,clarify the pathogenesis of PSD,enhance fecal microbiota transplantation and Chinese medicine-microbiota co-culture techniques,and systematically validate the value of the MGBA in individualized and precise treatment of PSD by integrating animal experiments with clinical practice.

post-stroke depression  /  microbiota-gut-brain axis  /  pathogenesis  /  gut microbiota  /  traditional Chinese medicine
阴俊, 杨一帆, 云烨栋, 胡周圆, 闫咏梅. 中医药调控微生物-肠-脑轴干预卒中后抑郁研究进展. 中医学报, 2025 , 40 (12) : 2595 -2601 . DOI: 10.16368/j.issn.1674-8999.2025.12.406
Jun YIN, Yifan YANG, Yedong YUN, Zhouyuan HU, Yongmei YAN. Research Progress on Traditional Chinese Medicine Regulating Microbiota-Gut-Brain Axis to Intervene Post-Stroke Depression[J]. Acta Chinese Medicine, 2025 , 40 (12) : 2595 -2601 . DOI: 10.16368/j.issn.1674-8999.2025.12.406
卒中后抑郁(post-stroke depression,PSD)是卒中后最常见的、最严重的神经精神并发症,表现为情绪低落、思维迟缓、反应迟钝,甚则有自杀倾向,常伴有睡眠不佳、眩晕、排便障碍、身体困乏等一系列躯体化症状。流行病学数据显示,PSD在卒中后5年内发病率达31%,1月内发病率为33%,1年内发病率为34%,病死率高于非PSD患者数倍[1]。PSD对卒中后患者神经功能损害极大[2],会延长治疗及康复时间,降低患者生活质量,因此对其早期诊断及干预具有重要临床意义。现阶段PSD的治疗以抗抑郁药物为主[3],如三环抗抑郁药、选择性血清素再摄取抑制剂、血清素和去甲肾上腺素再摄取抑制剂及单胺氧化酶抑制剂等,但其存在心脏和神经毒性,治疗成本高,副作用大。研究还表明,长期使用抗抑郁药可能增加继发性脑缺血或脑出血的风险,严重者甚至诱发上消化道出血及自残行为[4]。此外,PSD患者服用多种药物间的相互作用也可能会降低抗抑郁疗效。
近年来,微生物-肠-脑轴(microbiota-gut-brain axis,MGBA)成为研究热点,通过调节肠道微生物平衡治疗PSD展现出广阔前景。本文通过梳理相关文献,总结MGBA的中西医研究进展,并结合PSD的发病机制,概述中医药通过调控肠道微生物菌群在治疗中发挥的作用,以期为临床实践提供新的理念与方法。
中医整体观念认为,人体各脏腑密切相关,脾胃、脑、大小肠生理及病理上相互协调。脑于人体之最上,肠居于腹位于下。于经络循行看,诸经汇于头面,《针灸大成》载:“百会,手足三阳、督脉之会。”大肠经、小肠经与脑相关联,小肠经百会,大肠经大椎;胃经于目系与脑相关,故经络为脑-各脏腑器官的纽带,大小肠经、胃经经过头面及腹部,脾胃经络循行与脑相通[5]。经络循行关系可证实肠与脑的紧密联系,经络周流全身沟通上下物质信息。人体气血津液等精微与脑肠也存在联系,《灵枢经》载:“精成脑髓生”“五谷津液补益脑髓,下流于阴股”。于生理结构而言,脑由先天精髓所化,受后天胃肠供养营养;小肠主津,大肠主液,肠腑精微周流布达全身,充养脑髓[6]。脑主宰机体思维、意识、神志、语言等精神活动,脏腑四肢的感知及运动与脑密切相关,大脑调控脾胃肠生理功能,可从胃肠角度治疗神经系统疾患。多数患者郁而忧思,思则气结,卒中症状本身对气机影响,脾胃功能失调,使得其他脏腑濡润失常,心神失养,反向影响情志。
脑肠轴是神经系统和肠道之间的调节通路[7],包括中枢神经系统、内分泌系统、肠神经及自主神经系统,某些胃肠道信号可通过脑-肠通路影响大脑的认知功能,包括情感、学习等。在这个通路中,肠道微生物可调控脑-肠轴,在稳态或病理状态下,肠道微生物群释放、调节代谢物和神经递质,菌群失调或生态失衡会进一步加重中枢神经系统疾病,故脑-肠轴重新定义为微生物-肠-脑轴[8]。诸多研究证明,肠道微生物群是脑-肠轴中不可或缺的一员,肠道微生物群可经神经元、免疫信号通路与神经系统沟通,降低脑损伤后炎症反应,提高机体免疫力,调节下丘脑-垂体-肾上腺轴(hypothalamic-pituitary-adrenal axis,HPA),增强神经递质分泌功能[9]。血脑屏障能够阻止脑内单胺类、神经肽、氨基酸类神经递质在外周合成直接入脑,肠道菌群仍能通过多种途径调控大脑内神经递质[10]。儿茶酚胺类递质多巴胺参与神经功能调节,肠道菌群变化可影响多巴胺的合成代谢,显著改变脑内多巴胺含量。定植于肠黏膜的微生物可产生免疫炎症信号[11],激活并刺激中枢免疫,刺激HPA亢进,促进皮质醇释放,增加肠道促炎因子,参与调控大脑神经免疫炎症;肠壁分布大量肠神经,肠道信息借此上行大脑,调节大脑功能。
现阶段对PSD的具体病理过程及发病原因尚不明确,较为公认的发病机制包括神经递质、免疫、内分泌机制及神经营养机制等[12]。
脑内参与情感调节的诸多区域,如额叶前皮质、杏仁核等,通过释放去甲肾上腺素和5-HT等神经递质调节神经递质,脑内神经递质失衡可能导致抑郁[13]。额叶前皮质是调控情感认知活动的关键,在缺血缺氧损伤脑区域内发生抑郁的概率较高。卒中后抑郁患者前扣带回皮质激活较正常人升高,双侧杏仁核及背侧前扣带回皮质激活降低。此外,效应细胞和神经细胞间信息传递因子单胺类神经递质,经过基底神经节、丘脑放射到海马区及额叶区,调控机体认知、情感及生理活动[14]。卒中后产生的神经细胞坏死,可降低卒中患者的神经递质水平及外周交感神经兴奋性。单胺类神经递质假说理论在PSD发病机制中备受认可,多个研究指出,大鼠抑郁模型脑组织中存在异常表达因子,如NE、5-HT、DA等,其含量直接影响抑郁病情[15],三者在神经间隙的作用下,可增加降解或减少摄取,造成抑郁样行为,早期抗抑郁药物治疗手段主要当调节突触间隙,降解其单胺类神经递质。
免疫系统是卒中后中枢和外周间的双向交流通路,促炎因子和抗炎因子间失衡致神经系统恶化。细胞因子是先天免疫和适应性免疫的体液介质,也是重要的情绪调节因子[16]。缺血性卒中后,其分泌量明显增多,导致胶质细胞中的吲哚胺2,3 -双加氧酶激活,降低色氨酸的生物利用度,血清素能传递受到阻碍,产生神经活性色氨酸代谢物,最终引起抑郁。最新研究表明,在小胶质细胞介导的神经炎症病理过程中[17],促炎因子的分泌进一步引起或加重神经损伤或脑部实质损伤;小胶质细胞含大量IDO,共同参与炎症因子调节抑郁样行为的过程。缺血性卒中脑损伤后,在极短时间内,小胶质细胞激活并集中于损伤病变部位,释放细胞因子,如白细胞介素-1β和肿瘤坏死因子,这些因子可能引起神经兴奋,加重神经炎症。尽管抑郁的完整生理病理机制尚未明确,炎症仍是其发生发展的驱动因素,是增加抑郁发作风险的重要生物学因素。
HPA轴是调节情绪的主要神经内分泌系统,脑中海马组织或其他信号传到下丘脑时,室旁核组织释放促肾上腺皮质激素,进一步合成并释放促肾上腺皮质激素和糖皮质激素[18]。研究表明,HPA轴功能亢进是卒中后抑郁发生的主要原因,调节5 -HT可改善抑郁状态;HPA轴激活后负反馈机制受损,激素稳态失衡,抑郁症患者的唾液、血液中皮质醇浓度均可见升高。发病早期患者血清中白细胞介素-6及皮质醇水平显著高于非PSD患者[19],证实皮质醇含量浓度与PSD相关,但具体关系有待进一步研究。5-HT基因多态性与皮质醇增高相关,使得卒中后患者在面对低质量生活压力时更易抑郁。临床与动物实验研究表明,下丘脑内源性大麻素受体与HPA轴相互作用,在抑郁症发病机制发挥重要作用[20]。内源性大麻素存在于几个大脑区域和中枢神经系统中,主要参与神经和免疫调节,在大脑损伤急性期可避免神经元受兴奋性毒性损伤,还能保护血脑屏障完整性和功能,其体内水平变化与抑郁症调控方式密切相关。PSD动物模型表明,内源性大麻素可能具有抗抑郁活性,上调其水平可发挥治疗作用。
神经营养因子负责神经元生长发育、轴向突触及突触可塑性,对于缺血性卒中恢复和神经康复尤为重要。脑源性神经营养因子(brain derived neurotrophic factor,BDNF)由谷氨酸和神经胶质细胞产生,在海马、脑皮质、基底节等多处脑区显著表达,具有调节神经元分化、发育作用,能够改善机体学习、认知功能,与抑郁、抗抑郁密切相关[21]。BDNF作为突触前后分泌因子,可影响血清素能和多巴胺传递,通过调节神经元活动对突触可逆性及记忆转化至关重要[22],在哺乳类动物中分布最广、研究最广泛。在啮齿类抑郁动物模型中,海马神经元增殖和分化减少可引起抑郁样行为,直接影响单胺水平和行为功能。陈燕等[23]探讨miR-98-5p对小鼠抑郁病理机制,通过靶向BDNF改善小鼠抑郁行为,可在小鼠海马中明显观察到神经增加。PSD患者血清BDNF浓度较正常人群低,患者体内CRP水平亦可对BDNF造成影响,且NLR升高会加剧PSD严重程度。体内BDNF可调节细胞因子和转录因子,控制局部炎症,保护大脑损伤部位,而卒中所诱导的缺血缺氧环境可直接降低脑内BDNF表达。实验观察发现,大鼠的海马体体积减小,其脑内受络氨酸激酶2的水平也会下降,抗抑郁药治疗可增加海马体和皮质中BDNF表达,保护神经元,改善抑郁样行为[24]。
肠道菌群微生物种类聚集,能够维持肠道平衡、机体营养及代谢水平。通过检测12种肠道菌群发现,单纯卒中患者与PSD患者的菌群存在差异,后者主要表现为克雷伯菌属、肠杆菌属等潜在致病菌构成比增加,有益抗炎菌含量降低[25]。PSD患者肠道菌群种类多样性,但菌群丰度降低,大多数种属杆菌属、乳杆菌数量减少,可能为脂质、氨基酸等代谢紊乱;卒中后肠道免疫机制与菌群代谢共同产生神经递质,参与PSD进展;粪菌移植动物实验及临床研究则证明肠道菌群紊乱会加重抑郁样症状[26]。将PSD患者肠道菌群移植于大鼠肠道内[27],大鼠运动水平、糖水消耗量均降低,血清中NE等较空白组和假手术组显著降低,证明肠道菌群分布改变会影响大鼠精神类行为及相关神经递质。肠道有害菌增加可诱发精神障碍疾病,激活HPA轴及免疫功能反应性,引起肠道炎症,自下而上导致神经功能受损。
PSD发病与5-HT失衡密切相关[28]。肠道菌群与机体互利共存,影响着肠神经系统的发育成熟,维持机体健康。肠道菌群的数量及构成及其代谢物会影响大脑认知情感功能。大脑也可调节肠道菌群的分布及代谢。PSD患者的肠道微生物失衡较正常人更为显著,可通过神经免疫途径导致肠道菌群紊乱,继而降低5 -HT代谢及合成,加重患者抑郁状态。突变体小鼠CNS中5 -HT水平减少60%~80%时即表现出抑郁样行为[29],肠道菌群能够调节机体内5 -HT代谢,影响微生物的组成及功能,提示5-HT是脑-肠菌轴的共同节点。
短链脂肪酸(SCFAs)是菌群主要代谢物之一[30],由肠道微生物在结肠中吸收乙酸、丁酸等产生,可维持机体代谢及神经免疫系统。SCFAs可穿透血脑屏障与游离脂肪酸结合,调节神经可塑性及基因表达,从而影响神经功能。慢性应激、神经炎症在抑郁表型可发挥重要作用,可共同调节海马神经元再生[31]。SCFAs能够调节神经免疫系统、HPA轴和色氨酸代谢等,介导具有神经活性的神经递质代谢物合成,参与大量基本行为和神经过程[32]。SCFAs代谢影响神经炎症的发生和稳态,SCFAs肠道微生物相对丰度和血清水平在具有抑郁样行为的大鼠中显著降低,证明SCFAs介导的MG和神经炎症相互作用,参与PSD病理过程[33]。SCFAs可维持肠-脑通透性及小胶质细胞稳态,促进中枢神经系统抵抗外周炎症细胞因子与有毒物质;丁酸盐、丙酸盐等可保护肠道屏障,下调小胶质细胞促炎酶和促炎细胞因子,增加抗炎标志物IL -10和CD26表达[34]。
随着宏基因组学、代谢组学逐渐明确PSD患者LPS合成基因表达增加,血浆LPS明显增多,导致肠道菌群失调及肠道屏障通透性增高[35]。LPS进一步激活小胶质细胞,增加海马NF-κB蛋白表达,激活NF-κB/MAPK通路;经多糖与肠道菌群协同治疗后,血清LPS含量减少,厚壁菌门丰度提高,肠道屏障得以修复,可缓解LPS诱导的肠道损伤,抑制促炎因子表达。LPS预处理可抑制小胶质细胞过度激活及严重神经炎症,转化小胶质细胞表型以保护神经;腹腔注射LPS(10 μg·kg-1)可显著缓解小鼠神经炎症及抑郁样行为[36]。
目前PSD的临床治疗主要依赖抗抑郁药物、心理疗法及中西医结合等方案,但长期服用药物易引起嗜睡、全身乏力、胃肠道不适等不良反应,多数患者病情易反复、依从性差,且药物禁忌证未明确[37]。因此,应进一步寻找安全、有效、稳定、副作用小的治疗模式。
健康饮食模式对维持正常肠道微生物组成和功能至关重要,有利于共生微生物群的生长和病原菌的减少[38]。现阶段已证明饮食改善能够保护肠道屏障并抑制炎症[39],在日常饮食中补充必需营养物质是缓解抑郁症状行之有效的方法。据报道,增加碳水化合物摄入可能降低抑郁风险;“地中海饮食”富含膳食纤维,可保护肠道并具有抗炎特性[40]。在动物模型中,口服或腹腔注射SCFAs可发挥抗炎和保护神经作用,显著缓解抑郁样行为。口服丁酸钠可影响微生物组成,修复肠道屏障损伤,减少抑郁、焦虑行为[41]。食用丁酸盐可通过抗炎、调节MG神经递质及BDNF表达缓解PSD症状进展。高脂高糖类饮食(high fat and high fructose diet,HFFD)易诱发机体胰岛素抵抗,引发糖脂代谢紊乱,介导炎症反应,导致肠道菌群和代谢物失衡;在饮食中添加油橄榄多酚羟基酪醇(hydroxytyrosol,HT)一方面能够显著改善学习记忆能力,激活ERK/CREB/BDNF通路调节BDNF蛋白表达,改变小鼠海马神经元缺失和损伤,抑制海马小胶质细胞激活及促炎因子TNF-α、IL-1β mRNA表达,减轻脑部神经炎症;另一方面,调节5-HT能够恢复肠道微生物丰度和多样性,降低厚壁菌门/拟杆菌门比值,增加放线菌门和变形菌门丰度,上调SCFAs菌属,改善认知功能障碍[42]。
中药柴胡属理气类疏肝解郁代表药物,临床抗抑郁效果显著,其活性成分皂苷和黄酮可抑制细胞凋亡、调节HPA轴、抑制炎症反应及改善肠道菌群,已在动物模型中证实[43]。肉苁蓉能够重塑肠道拟杆菌属结构和组成,提高肠道内SCFAs含量及脑内BDNF含量,发挥抗抑郁作用[44]。刺五加可以降低小鼠放线菌属丰度,逆转菌群多样性,不同程度改善甘氨酸、丝氨酸代谢水平;其皂苷成分可减少乳酸菌属、链球菌属等炎症致病菌含量,从而维持肠道微生物平衡,改善疾病状态[45]。黄连广泛用于抑郁治疗[46],其活性成分小檗碱可显著提高抑郁大鼠脑内神经递质表达,降低大鼠海马体内NLRP3蛋白表达,有效抑制抑郁状态下NOD样受体信号,改善炎症反应。
中药复方或制剂广泛应用于临床中。现代药理学发现,逍遥散加减可调节大鼠菌群 α和 β多样性,降低棒杆有害菌属丰度,提高乳杆有益菌属丰度及盲肠代谢物,缓解大鼠抑郁样行为;逍遥散多糖为菌群提供营养,丰富肠道内优势菌群丰度,增加丁酸等SCFAs含量,达到抗抑郁作用[47]。一项采用16SrRNA高通量测序技术的研究发现,柴归颗粒对不同肠段调节作用不同,空肠段菌群丰度改善显著,能够调节精氨酸代谢途径,提高不动杆菌属水平,继而改善抑郁症状。醒脾解郁汤常用于治疗卒中后认知障碍,能够降低大鼠体内毒性产物,改善肠道和脑内IDO酶表达,降低色氨酸过度代谢,具有抗炎和免疫调节作用[48]。柴胡疏肝散能够促使大鼠海马体内5-HT、NE、多巴胺等恢复正常水平[49]。将经灌胃处理小鼠的粪菌植入PSD小鼠体内,可显著提升血清猪胆酸及7 -酮脱氧胆酸水平,缓解小鼠抑郁症状,降低海马中胆汁酸运转基因表达,增加BDNF表达。
肠道菌群移植是近年研究热点,通过移植健康供者菌群,可重建患者肠道微生态,研究证实其操作简捷、副作用少。婴儿菌株CCFM687治疗PSD小鼠,能够平衡肠道内微生物群分布及功能,主要通过肠神经支配迷走神经产生局部信号,参与反馈认知、情绪的大脑区域,大脑前额叶皮质BDNF水平与5-HT合成增加,减轻HPA轴过度激活导致的抑郁症状[50]。丁酸梭菌属治疗PSD小鼠不可预知应激样抑郁症状[51],小鼠探索活动、饮食、体重明显较前恢复,神经活性物质纹状体血清素及多巴胺水平升高,证实注射丁酸菌属具有显著的抗抑郁效果。小鼠糖水偏好及强迫游泳实验证实,复合乳酸菌能够改善小鼠抑郁样行为,血清中皮质酮及大脑前额叶皮质促炎因子表达水平明显降低;可调节小鼠肠道色氨酸与脑中色氨酸代谢,缓解小鼠抑郁及便秘症状[52]。Su等[53]给予PSD小鼠肠道菌群移植和SCFAs干预,一方面能够改变粪菌群微生物群落结构和组成,逆转小鼠粪便中乙酸和丙酸水平的降低;另一方面可抑制神经胶质细胞活化,促进小胶质细胞由M1转向M2,发挥抗神经炎症作用,减轻神经元损伤和小胶质细胞介导的突触损伤,维持突触可塑性,保护线粒体功能,缓解抑郁样症状。
通过调节肠道微生物及其代谢水平治疗卒中后抑郁是现阶段研究的热点及难点。现有研究多从PSD发病机制入手,以改善或降低脑内与抑郁相关的神经系统损伤为目标,通过多项动物实验验证中药单药或方剂制剂作用肠道菌群的总体效果。饮食干预调控及肠道菌群移植也被用于改变肠道有益菌及有害菌含量,恢复肠道微生物结构及代谢水平。未来仍需继续研究中药如何靶向肠道微生物,转化其活性成分以发挥生物学作用,同时应推动多学科、多靶点研究,阐明PSD病理机制,提高粪菌移植及中药共孵育肠道菌群技术,通过动物实验结合临床应用,反复验证基于MGBA的PSD个性化、精准化治疗。

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doi: 10.16368/j.issn.1674-8999.2025.12.406
  • 接收时间:2025-06-17
  • 首发时间:2026-10-10
  • 出版时间:2025-12-10
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  • 收稿日期:2025-06-17
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    1陕西中医药大学,陕西 咸阳 712046
    2陕西中医药大学附属医院,陕西 咸阳 712000

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闫咏梅(1961 -),女,主任医师,教授,博士研究生导师,研究方向:脑血管病的基础与临床研究。E -mail:
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
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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