克罗恩病的肠道菌群：发生机制、临床应用及不良反应

Title：
Update on intestinal microbiota in Crohn's disease 2017: Mechanisms, Clinical application, Adverse reactions and Outlook

DOI：
10.1111/jgh.13861

Abstract：
The pathogenesis of CD is complex and it is thought to be associated with the environment, immune, hereditary, microbe and other factors. If the balance between the host and the intestinal microbes in CD patients was broken, immune-inflammatory response of susceptible individuals might be triggered. Probiotics could improve the intestinal microbial flora balance and treat human effectively. There are several new mechanisms which might explain the role of probiotics. Fecal microbiota transplantation (FMT) is becoming more and more attractive in treating a large amount of digestive system diseases which are related to the dysbiosis of intestinal microbiota. FMT has been widely used in recurrent clostridium difficile infection (RCDI). More and more attention has been paid on the clinical application of FMT in CD.While the exact mechanism is still a mystery. So in this review, we explore the mechanism, clinical application and adverse reactions of intestinal microbiota in CD so that we can use the tool to cure more diseases. Enteric microbiota leads to new therapeutic strategies for CD.

All Authors：
Zhaohua Shen,Changxin Zhu,Yongsheng Quan,Wei Yuan,Shuai Wu,Zhenyu Yang,Weiwei Luo,Bei Tan,Xiaoyan Wang

First Authors：
Zhaohua Shen

Correspondence：
Xiaoyan Wang

内容要点：

1、克罗恩病患者的肠道菌群多样性降低，大肠杆菌及产生硫酸盐的细菌显著增加，F.prausnitzii、C.prausnitzii及产生短链脂肪酸的Roseburia显著减少；

2、短链脂肪酸可通过GPR43介导的通路诱导Treg而缓解炎症；

3、益生菌可能用于治疗克罗恩病的机制包括：抗氧化效应、改善肠道屏障功能以起到免疫调节效应、影响肠道菌群的分泌和代谢、与致癌性底物结合、产生短链脂肪酸；

4、2项meta分析表明，粪菌移植治疗克罗恩病的缓解率分别可达78%或60.5%。