肠道菌群与慢性便秘相关性及干预机制研究 进展

Research Progress on the Correlation between Gut Microbiota and Chronic Constipation and Its Intervention Mechanisms

摘要: 慢性便秘是一类由多种因素引发的消化系统常见疾病，以排便频率减少、粪便干结坚硬、排便费力、排便不尽感为主要临床表现，病程至少持续6个月。近年来，随着肠道微生态学的快速发展，肠道菌群结构失衡与慢性便秘发生、发展的密切关联得到广泛证实。慢性便秘患者普遍存在肠道菌群多样性降低、有益菌丰度减少、有害菌过度增殖、短链脂肪酸生成不足、5‑羟色胺代谢紊乱、肠黏膜屏障受损、低度炎症激活及胆汁酸代谢异常等特征，通过调控胃肠动力、肠道水分分泌、肠神经传导及肠‑脑轴信号通路，直接参与便秘病理生理过程。以益生菌、益生元、粪菌移植、中医药干预为代表的微生态调节策略，可有效重建肠道菌群稳态、改善肠道蠕动与分泌功能，为慢性便秘提供了超越传统泻药的长效、安全、标本兼顾的治疗新路径。本文系统梳理肠道菌群与慢性便秘的相关性、关键致病机制及各类微生态干预手段的最新研究进展，总结当前研究存在的问题与不足，并对未来精准化、标准化、个体化诊疗方向进行展望，以期为慢性便秘的微生态靶向治疗提供坚实理论依据与临床参考。

Abstract: Chronic constipation is a common digestive system disorder caused by multiple factors, characterized primarily by decreased frequency of bowel movements, dry and hard stools, difficulty in defecation, and a feeling of incomplete evacuation, with a course lasting at least six months. In recent years, with the rapid development of gut microbiology, the close association between imbalances in gut microbiota structure and the occurrence and progression of chronic constipation has been widely confirmed. Patients with chronic constipation generally exhibit characteristics such as reduced gut microbiota diversity, decreased abundance of beneficial bacteria, excessive proliferation of harmful bacteria, insufficient production of short-chain fatty acids, disordered serotonin metabolism, impaired intestinal mucosal barrier, low-grade inflammation activation, and abnormal bile acid metabolism. These factors directly participate in the pathophysiological process of constipation by regulating gastrointestinal motility, intestinal water secretion, enteric nervous conduction, and gut-brain axis signaling pathways. Microecological regulation strategies, represented by probiotics, prebiotics, fecal microbiota transplantation, and traditional Chinese medicine interventions, can effectively restore gut microbiota homeostasis and improve intestinal motility and secretory function, providing a long-lasting, safe, and comprehensive treatment approach for chronic constipation that goes beyond traditional laxatives. This article systematically reviews the relationship between gut microbiota and chronic constipation, key pathogenic mechanisms, and the latest research progress on various microecological interventions, summarizes existing issues and deficiencies in current research, and explores future directions for precise, standardized, and individualized diagnosis and treatment, aiming to provide a solid theoretical basis and clinical reference for microecological targeted therapy of chronic constipation.