人体不同部位菌群与慢性肾脏病研究现状

Research Progress on Microbiota in Different Human Body Sites and Chronic Kidney Disease

摘要: 目的：本综述旨在探讨慢性肾脏病(Chronic Kidney Disease, CKD)与人体不同部位菌群(包括肠道菌群和口腔菌群)之间的关系，总结当前研究现状，并探讨菌群在CKD发生发展中的作用机制、作为诊断生物标志物的潜力以及基于菌群的治疗策略。方法：通过文献综述，总结了CKD患者肠道菌群和口腔菌群的变化特征，分析了这些变化与CKD病理生理过程的潜在联系，并探讨了菌群失调对CKD进展的影响。结果：1) 肠道菌群与CKD：CKD患者肠道菌群多样性增加，但物种丰度降低。特定菌属(如厚壁菌门、拟杆菌门)的相对丰度显著增加，而有益菌属(如双歧杆菌属、乳杆菌属)的相对丰度减少。透析(尤其是长期血液透析)加剧菌群失衡，导致尿毒症毒素积累，这些变化与患者的炎症状态和肾功能损害程度相关。2) 口腔菌群与CKD：CKD患者的口腔菌群也发生显著变化，包括唾液和舌苔菌群的多样性增加。特定菌属(如链球菌属、放线菌属)的相对丰度增加，而普雷沃菌属和嗜血杆菌属的相对丰度减少。且牙周致病菌(如牙龈卟啉单胞菌)与肾功能下降相关。这些变化可能与CKD的炎症反应和疾病进展有关。结论：CKD与人体菌群的分布和数量密切相关。肠道菌群和口腔菌群的失调不仅反映了CKD的病理状态，还可能通过多种机制影响CKD的进展。未来的研究应进一步探索菌群在CKD中的具体作用机制，并开发基于菌群的诊断和治疗策略。

Abstract: Objective: This review aims to explore the relationship between chronic kidney disease (CKD) and microbiota in different human body sites (including gut microbiota and oral microbiota), summarize current research progress, and investigate the mechanisms by which microbiota influence the onset and progression of CKD, their potential as diagnostic biomarkers, and microbiota-based therapeutic strategies. Methods: Through a literature review, we summarized the characteristics of gut and oral microbiota changes in CKD patients, analyzed the potential links between these changes and CKD pathophysiology, and discussed the impact of dysbiosis on CKD progression. Results: 1) Gut microbiota and CKD: CKD patients exhibit increased gut microbiota diversity but reduced species abundance. The relative abundance of specific bacterial phyla (e.g., Firmicutes, Bacteroidetes) significantly increases, while beneficial genera (e.g., Bifidobacterium, Lactobacillus) decrease. Dialysis (especially long-term hemodialysis) exacerbates microbiota imbalance, leading to uremic toxin accumulation, which correlates with patients’ inflammatory status and renal function impairment. 2) Oral microbiota and CKD: Significant alterations are observed in the oral microbiota of CKD patients, including increased diversity in salivary and tongue coating microbiota. The relative abundance of specific genera (e.g., Streptococcus, Actinomyces) rises, while Prevotella and Haemophilus decrease. Periodontal pathogens (e.g., Porphyromonas gingivalis) are associated with declining renal function. These changes may contribute to CKD-related inflammation and disease progression. Conclusion: CKD is closely associated with the composition and abundance of human microbiota. Dysbiosis in gut and oral microbiota not only reflects the pathological state of CKD but may also influence its progression through various mechanisms. Future research should further elucidate the specific roles of microbiota in CKD and develop microbiota-based diagnostic and therapeutic strategies.