童年不良经历、抑郁与消化系统疾病： 基于脑–肠–微生物轴的研究综述

Adverse Childhood Experiences, Depression, and Gastrointestinal Disorders: A Review Based on the Microbiota-Gut-Brain Axis

摘要: 本报告旨在系统性地剖析童年不良经历(Adverse Childhood Experiences, ACEs)、成年期抑郁障碍与消化系统疾病(涵盖功能性胃肠病与器质性肠病)之间错综复杂的病理生理联系。基于广泛的流行病学数据、神经生物学机制研究及临床干预试验，本文分析揭示了早期创伤如何通过“生物嵌入”(Biological Embedding)机制——特别是下丘脑–垂体–肾上腺(HPA)轴的长期异稳态(Allostasis)、肠道微生物群的生态失调(Dysbiosis)、肠道通透性改变(“肠漏”理论)以及表观遗传修饰——将心理创伤转化为持久的生理病理改变。研究表明，消化系统疾病不仅是ACEs的躯体化后果，更是抑郁症状持续与恶化的关键中介因素。本报告为理解身心共病的深层机制提供了整合性视角，并强调了在消化科与精神科临床实践中实施创伤知情护理(Trauma-Informed Care)的紧迫性与必要性。

Abstract: This report aims to systematically delineate the complex pathophysiological interplay among Adverse Childhood Experiences (ACEs), adult depressive disorders, and gastrointestinal disorders, encompassing both functional gastrointestinal disorders and organic intestinal diseases. Drawing on extensive epidemiological evidence, neurobiological mechanism studies, and clinical intervention trials, this analysis elucidates how early-life trauma can be biologically embedded through mechanisms such as long-term allostatic dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, gut microbiota dysbiosis, increased intestinal permeability (“leaky gut”), and epigenetic modifications, thereby translating psychological trauma into enduring physiological and pathophysiological alterations. Evidence indicates that gastrointestinal disorders are not merely somatic sequelae of ACEs but also serve as critical mediators in the persistence and exacerbation of depressive symptoms. This report provides an integrative perspective for understanding the underlying mechanisms of mind-body comorbidity and underscores the urgency and necessity of implementing trauma-informed care in both gastroenterological and psychiatric clinical practice.