膜性肾病与肠道菌群关联的研究进展：肠–肾轴视角
Research Progress on the Association between Membranous Nephropathy and Intestinal Microbiota: From the Perspective of the Gut-Kidney Axis
DOI: 10.12677/acm.2025.15123679, PDF,    科研立项经费支持
作者: 聂小敏, 沈 清*：重庆医科大学附属第一医院肾脏内科，重庆
关键词: 膜性肾病(R692.3)；肠道菌群(R378.99)；肠–肾轴(R363)；Membranous Nephropathy (R692.3)； Gut Microbiota (R378.99)； Gut-Kidney Axis (R363)
摘要: 膜性肾病(MN)作为成人肾病综合征的主要病因，其发病机制与自身免疫介导的肾小球损伤密切相关，但现有免疫抑制剂治疗存在应答率有限和不良反应等问题。近年来研究揭示，肠道菌群失调通过“肠–肾轴”参与MN的发生发展：MN患者肠道菌群呈现变形菌门富集、厚壁菌门(Firmicutes)减少的特征性改变，伴随短链脂肪酸(SCFAs)产生菌(如毛螺菌属)丰度降低及促炎菌属(如埃希菌–志贺菌属、链球菌属)升高。菌群代谢产物如脂多糖可激活TLR4/NF-κB炎症通路，而SCFAs缺乏则削弱肠屏障功能并影响调节性T细胞分化。临床干预研究显示，粪菌移植、益生菌及中药方剂等手段可通过重塑菌群结构改善MN病理进程，但机制复杂性和个体差异仍制约其临床转化。未来研究需聚焦菌群–免疫–肾脏互作的分子机制，结合宏基因组学开发个体化菌群干预策略，为MN的精准诊疗提供新方向。
Abstract: Membranous nephropathy (MN), a major cause of nephrotic syndrome in adults, is characterized by autoimmune-mediated glomerular injury. Current immunosuppressive therapies face limitations in response rate and safety, prompting exploration of novel pathogenetic mechanisms. Emerging evidence highlights the gut-kidney axis as a key mediator, where dysbiosis in MN patients is marked by enriched Proteobacteria, reduced Firmicutes, and depletion of short-chain fatty acid (SCFA)-producing bacteria (e.g., Lachnospira), alongside expansion of proinflammatory genera (e.g., Escherichia-Shigella, Streptococcus). Microbial metabolites like lipopolysaccharide (LPS) activate TLR4/NF-κB signaling, while SCFA deficiency impairs intestinal barrier function and Treg cell differentiation. Interventional studies show fecal microbiota transplantation, probiotics, and traditional Chinese medicine formulas may ameliorate MN by remodeling the microbiota, though mechanistic complexity and interindividual variability hinder clinical translation. Future research should focus on molecular mechanisms of microbiota-immune-kidney crosstalk, leveraging metagenomics for personalized microbiota-based therapies to advance precision medicine in MN.
文章引用：聂小敏, 沈清. 膜性肾病与肠道菌群关联的研究进展：肠–肾轴视角[J]. 临床医学进展, 2025, 15(12): 2470-2478. https://doi.org/10.12677/acm.2025.15123679

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