肠道微生物与风湿免疫性疾病的研究进展

doi:10.16138/j.1673-6087.2025.05.11

摘要/Abstract

摘要：

肠道微生物对维持人体健康至关重要，其本身及其代谢产物可通过调节炎症因子和免疫细胞功能，参与风湿免疫性疾病的发生和发展。多项研究表明，肠道微生物失调与类风湿关节炎、系统性红斑狼疮和强直性脊柱炎等风湿免疫性疾病发病机制密切相关。近年来，益生菌和粪菌移植等新兴干预方式已显示出初步疗效。随着宏基因组学的快速发展，对肠道微生物的深入研究有望为风湿免疫性疾病的诊断和防治提供新视角和潜在干预策略。本文旨在综述肠道微生物在风湿免疫性疾病中的作用机制及其治疗潜力。

关键词: 肠道微生物, 风湿免疫性疾病, 益生菌, 粪菌移植

Abstract:

The gut microbes are crucial for maintaining human health. Intestinal microorganisms and their metabolites participate in the occurrence and development of rheumatic immune diseases by regulating inflammatory factors and immune cells. More studies show that intestinal microbial imbalance is closely related to the pathogenesis of rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and other rheumatic immune diseases. Recently, transplantation of probiotics and fecal microbiota as emerging therapeutic approaches has shown preliminary efficacy. With the rapid development of metagenomics, in-depth study on gut microbes will provide new perspective and potential intervention strategies for the diagnosis, treatment and prevention of rheumatic immune diseases. This article reviews the role and potential therapeutic effects of gut microbes in rheumatic immune diseases.

Key words: Gut microbiota, Autoimmune rheumatic diseases, Probiotics, Fecal microbiota transplantation

中图分类号:

R593.2

刘齐龙, 靳正逸, 胡佳琪, 闵杜牧, 马泰彦, 高洁. 肠道微生物与风湿免疫性疾病的研究进展[J]. 内科理论与实践, 2025, 20(05): 405-409.

LIU Qilong, JIN Zhengyi, HU Jiaqi, MIN Dumu, MA Taiyan, GAO Jie. Advances in the study of intestinal microbes and rheumatic immune diseases[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(05): 405-409.

图/表 1

参考文献 34

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疾病	肠道微生物变化	关键代谢产物异常	免疫调控机制
↑：升高，↓:减少。pSS：原发性干燥综合征（primary Sjögren syndrome）；SSc：系统性硬化症（systemic sclerosis）；CCP：环瓜氨酸肽（cyclic citrullinated peptide）；dsDNA：双链DNA（double-stranded DNA）；HLA：人类白细胞抗原（human leucocyte antigen）；TGF：转化生长因子（transforming growth factor）
RA	厚壁菌门↓，拟杆菌门↓，放线菌门↑，变形菌门↑，普雷沃氏菌属↑	SCFA↓	Th17/Treg失衡，促炎细胞因子（IL-17、TNF-α）↑，自身抗体（抗CCP抗体、RF）产生↑
SLE	厚壁菌门↓，拟杆菌门失衡，噬菌体多样性改变	SCFA↓，色氨酸代谢紊乱	Treg功能受损，抗炎因子（IL-10）↓，B细胞过度活化→自身抗体（抗dsDNA）产生↑
AS	巨单胞菌属↑，Dorea↑，布劳特氏菌属↑，毛螺菌↓，瘤胃球菌↓，梭菌属Clostridium_XlVb↓	SCFAs↓，次级胆汁酸↓	肠道通透性↑→细菌易位，IL-23/IL-17轴活化↑，HLA-B27与微生物交叉反应
pSS	肠道/口腔/阴道菌群α多样性↓，链球菌属↑，乳杆菌属↓	未明确报道	黏膜屏障破坏→自身抗原暴露，B细胞异常活化→抗SSA/SSB抗体↑
SSc	厚壁菌门↑，放线菌门↑，拟杆菌门↓	SCFA↓	纤维化相关通路（TGF-β、Wnt）激活，Th2细胞优势→促纤维化因子（IL-4、IL-13）↑