肠道菌群–免疫轴在阻塞性睡眠呼吸暂停相关 高血压中的桥梁作用：综述

The Bridging Role of the Gut Microbiota-Immune Axis in Obstructive Sleep Apnea-Associated Hypertension: Review

摘要: 阻塞性睡眠呼吸暂停(Obstructive Sleep Apnea, OSA)是一种以反复上气道塌陷和间歇性低氧(Intermittent Hypoxia, IH)为特征的常见睡眠障碍，近年来被认为是继发性高血压的重要危险因素。最新研究表明，肠道菌群–免疫轴(Gut Microbiota-Immune Axis)在OSA与高血压的关联中发挥关键桥梁作用。OSA诱导的肠道菌群失调可损害肠屏障功能，促进脂多糖(LPS)等微生物成分入血，激活Toll样受体4 (TLR4)/NF-κB等免疫通路，诱发系统性炎症反应、血管内皮功能障碍与血管重构，最终导致血压升高。同时，T细胞亚群平衡失调，尤其是Th17/Treg比例升高，进一步加剧免疫介导的血管损伤。菌群与免疫系统之间的双向调节形成恶性循环，促进疾病进展。益生菌、合生元、膳食干预及粪菌移植等靶向菌群的干预策略在动物模型与临床研究中显示出降压潜力。本文综述了肠道菌群–免疫轴在OSA相关高血压中的关键作用机制与干预前景，旨在为该疾病的精准防控提供理论依据与研究方向。

Abstract: Obstructive Sleep Apnoea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway collapse and intermittent hypoxia (IH), which has been increasingly recognized as a significant risk factor for secondary hypertension in recent years. Accumulating evidence suggests that the gut microbiota-immune axis plays a pivotal bridging role in the pathogenic association between OSA and hypertension. OSA-induced gut dysbiosis impairs intestinal barrier integrity, thereby facilitating the translocation of microbial components (e.g., lipopolysaccharide, LPS) into the systemic circulation. This translocation activates key immune signaling pathways, including the Toll-like receptor 4 (TLR4)/nuclear factor-κB (NF-κB) pathway, which in turn triggers systemic low-grade inflammation, vascular endothelial dysfunction, and vascular remodeling, ultimately contributing to the elevation of blood pressure. Concomitantly, dysregulation of T-cell subsets, particularly the imbalance of T helper 17 (Th17)/regulatory T (Treg) cells with an elevated ratio, further exacerbates immune-mediated vascular injury. The bidirectional regulatory interaction between the gut microbiota and the immune system forms a vicious cycle that accelerates the progression of both OSA and hypertension. Targeted gut microbiota intervention strategies, including probiotic supplementation, synbiotic administration, dietary adjustments, and faecal microbiota transplantation (FMT), have exhibited promising antihypertensive effects in both preclinical animal models and clinical trials. This review summarizes the key mechanisms underlying the involvement of the gut microbiota-immune axis in OSA-associated hypertension and discusses its intervention prospects, aiming to provide a theoretical basis and research direction for the precise prevention and management of this comorbidity.