肺部、肠道菌群及其相互作用与慢性阻塞性肺疾病发生发展的研究进展

doi:10.12114/j.issn.1007-9572.2022.0539

摘要/Abstract

摘要： 慢性阻塞性肺疾病（COPD）是一种常见的慢性呼吸系统疾病，对人类健康造成极大威胁。研究发现，COPD患者与健康人群相比，肺部菌群及肠道菌群的组成结构发生了显著改变，导致黏膜屏障功能及机体免疫稳态被破坏，进而加重病情。积极调节肺部、肠道菌群平衡对于干预COPD的发生、发展有着至关重要的作用，但目前关于肺部、肠道菌群及其相互作用机制在COPD中作用的总结和认识还有待进一步阐明。本文就健康人群以及COPD患者肺部、肠道菌群的组成特点及可能的相互作用机制，以及现阶段基于肺部、肠道菌群及其相互作用防治COPD的最新研究成果进行综述，以期为COPD的发病机制、早期诊断、预防与治疗研究提供新思路。

关键词: 肺疾病，慢性阻塞性, 肺-肠轴, 肺部菌群, 肠道菌群, 微生物相互作用, 诊断, 预防, 综述

Abstract:

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease that greatly threatens human health. Studies have found that compared with the healthy population, the mucosal barrier function and immune homeostasis in COPD patients are impaired due to significantly changed composition and structure of both lung and gut microbiota, which further aggravate the disease progression. Taking measures to actively improve the microbial balance in lung and gut microbiota is very important for the prevention and delaying of the development of COPD. However, the summary and understanding of the role of lung and gut microbiota and their cross-talk mechanism in COPD still have much room for development. We reviewed the latest developments in the composition characteristics of lung and gut microbiota and the possible cross-talk mechanism between them in healthy people and COPD patients, as well as the prevention and treatment of COPD based on lung and gut microbiota and their cross-talk, providing new ideas for pathogenesis exploration, early diagnosis, prevention and treatment of COPD.

Key words: Pulmonary disease, chronic obstructive, Lung-gut axis, Lung microbiota, Gut microbiota, Microbial interactions, Diagnosis, Prevention, Review

沈俊希,朱星,陈云志,等. 肺部、肠道菌群及其相互作用与慢性阻塞性肺疾病发生发展的研究进展[J]. 中国全科医学, 2023, 26(20): 2548-2554. DOI: 10.12114/j.issn.1007-9572.2022.0539.
SHEN Junxi,ZHU Xing,CHEN Yunzhi, et al. Novel Developments in Lung and Gut Microbiota and Their Cross-talk with the Development of Chronic Obstructive Pulmonary Disease[J]. Chinese General Practice, 2023, 26(20): 2548-2554. DOI: 10.12114/j.issn.1007-9572.2022.0539.

图/表 1

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菌群部位	健康人群	COPD患者
肺部菌群	门水平：以厚壁菌门、拟杆菌门和变形菌门等为主^[12,13]	门水平：以厚壁菌门、拟杆菌门和变形菌门等为主，但变形菌门丰度增加^[15]
	属水平：以拟杆菌属、普雷沃菌属、假单胞菌属、韦荣球菌属、链球菌属、奈瑟菌属、嗜血杆菌属和梭杆菌属等为主^[12,13]	属水平：链球菌属、罗斯菌属、韦荣球菌属、普雷沃菌属和嗜血杆菌属丰度增加^[14,15]，乳酸杆菌属丰度减少^[18]。随着疾病严重程度增加普雷沃菌属、韦荣球菌属逐渐减少^[18]
肠道菌群	门水平：以厚壁菌门、拟杆菌门、放线菌门、变形菌门、疣微菌门和梭杆菌门为主^[21]	门水平：以厚壁菌门、拟杆菌门、变形菌门、放线菌门和疣微菌门为主^[26]。Ⅲ~Ⅳ期患者出现拟杆菌门减少^[28]
	属水平：以粪杆菌属、双歧杆菌属、拟杆菌属、布劳菌属等为主^[22,23]	属水平：Ⅰ期患者以Tyzzerella 4和戴阿利斯特杆菌属减少；Ⅱ~Ⅳ期以蓝绿藻菌属减少；Ⅲ~Ⅳ期患者梭杆菌属和气球菌属增加^[28]

菌群部位	健康人群	COPD患者
肺部菌群	门水平：以厚壁菌门、拟杆菌门和变形菌门等为主^[12,13]	门水平：以厚壁菌门、拟杆菌门和变形菌门等为主，但变形菌门丰度增加^[15]
	属水平：以拟杆菌属、普雷沃菌属、假单胞菌属、韦荣球菌属、链球菌属、奈瑟菌属、嗜血杆菌属和梭杆菌属等为主^[12,13]	属水平：链球菌属、罗斯菌属、韦荣球菌属、普雷沃菌属和嗜血杆菌属丰度增加^[14,15]，乳酸杆菌属丰度减少^[18]。随着疾病严重程度增加普雷沃菌属、韦荣球菌属逐渐减少^[18]
肠道菌群	门水平：以厚壁菌门、拟杆菌门、放线菌门、变形菌门、疣微菌门和梭杆菌门为主^[21]	门水平：以厚壁菌门、拟杆菌门、变形菌门、放线菌门和疣微菌门为主^[26]。Ⅲ~Ⅳ期患者出现拟杆菌门减少^[28]
	属水平：以粪杆菌属、双歧杆菌属、拟杆菌属、布劳菌属等为主^[22,23]	属水平：Ⅰ期患者以Tyzzerella 4和戴阿利斯特杆菌属减少；Ⅱ~Ⅳ期以蓝绿藻菌属减少；Ⅲ~Ⅳ期患者梭杆菌属和气球菌属增加^[28]