肝硬化门静脉血栓形成与肠道菌群及其代谢物的关系
The Relationship between Gut Microbiota, Gut Microbiota Metabolites, and Portal Vein Thrombosis in Cirrhosis
DOI: 10.12677/acm.2026.161177, PDF,   
作者: 盛江涛, 张月荣*：重庆医科大学附属大学城医院消化内科，重庆
关键词: 肝硬化；门静脉血栓；肠道菌群；肠道菌群代谢产物；Cirrhosis； Portal Vein Thrombosis； Gut Microbiota； Gut Microbiota Metabolites
摘要: 肝硬化是各种慢性肝病进展至晚期的常见结局，其并发症门静脉血栓形成(PVT)显著增加患者病死率。本综述系统探讨了肠道菌群及其代谢产物在PVT发生发展中的作用机制。肝硬化状态下，门脉高压导致肠道屏障功能受损，菌群失调促使细菌脂多糖等病原相关分子模式易位，通过激活TLR4/NF-κB等信号通路诱发肝脏炎症与高凝状态，进而促进PVT形成。此外，肠道菌群代谢产物如短链脂肪酸(SCFAs)的减少、胆汁酸代谢紊乱、三甲胺-N-氧化物(TMAO)及硫酸吲哚酚等促血栓物质的增多，共同调控凝血功能与内皮稳定性。当前PVT治疗以抗凝和经颈静脉肝内门体分流术(TIPS)为主，而针对肠道微生态的干预策略(如益生菌、粪菌移植等)展现出通过恢复肠肝轴平衡以防治PVT的潜力。未来应进一步明确肠道菌群影响PVT的分子机制，推动微生态治疗在临床中的应用。
Abstract: Cirrhosis represents the advanced stage of various chronic liver diseases, with portal vein thrombosis (PVT) as a serious complication that significantly increases mortality. This review systematically examines the role of gut microbiota and their metabolites in the pathogenesis of PVT. In cirrhosis, portal hypertension impairs intestinal barrier function, leading to gut dysbiosis and translocation of bacterial pathogen-associated molecular patterns such as lipopolysaccharide. These activate signaling pathways including TLR4/NF-κB, inducing hepatic inflammation and a hypercoagulable state that promotes PVT development. Furthermore, gut microbiota-derived metabolites—including reduced levels of anti-inflammatory short-chain fatty acids (SCFAs), dysregulated bile acid metabolism, and elevated pro-thrombotic molecules such as trimethylamine N-oxide (TMAO) and indoxyl sulfate—collectively modulate coagulation and endothelial integrity. Current PVT management primarily involves anticoagulation and transjugular intrahepatic portosystemic shunt (TIPS), while interventions targeting the gut microbiome (e.g., probiotics, fecal microbiota transplantation) show promise in rebalancing the gut-liver axis for PVT prevention and treatment. Future studies should further elucidate the molecular mechanisms linking gut microbiota to PVT and advance microbiome-based therapies into clinical practice.
文章引用：盛江涛, 张月荣. 肝硬化门静脉血栓形成与肠道菌群及其代谢物的关系[J]. 临床医学进展, 2026, 16(1): 1375-1382. https://doi.org/10.12677/acm.2026.161177

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