白术通过调节肠道菌群–代谢网络干预慢性 肾脏病的研究进展

Research Progress on Atractylodes macrocephala in Intervening Chronic Kidney Disease by Regulating the Gut Microbiota-Metabolic Network

摘要: 慢性肾脏病(chronic kidney disease, CKD)患病率高、病程迁延，已成为全球重要公共卫生问题。近年来，“肠–肾轴”理论不断受到关注，肠道菌群失衡及其代谢产物异常被认为参与CKD发生发展及相关并发症形成。肾功能减退可导致尿素及其他含氮代谢产物在肠腔蓄积，促进产脲酶菌、产酚菌及产吲哚菌增殖，增加对甲酚硫酸酯、吲哚硫酸酯、三甲胺氧化物等肠源性尿毒症毒素生成，并通过破坏肠屏障、诱导炎症反应和氧化应激进一步加重肾脏损伤。白术为健脾益气、燥湿利水之要药，传统上常用于脾虚湿盛、水湿内停等证候。现代研究表明，白术及其多糖成分可能具有调节肠道菌群、促进短链脂肪酸生成、改善肠黏膜屏障及调控免疫炎症等潜在作用。本文从中医“脾肾相关”理论、白术化学成分及药理作用、肠道菌群与尿毒症毒素、肠道菌群失衡相关并发症等方面进行综述，探讨白术通过“肠道菌群–代谢网络”干预CKD的潜在机制，以期为中医药防治CKD及开发以肠道微生态为靶点的干预策略提供参考。

Abstract: Chronic kidney disease (CKD) has a high prevalence and a protracted course, making it a major global public health issue. In recent years, the “gut-kidney axis” theory has gained increasing attention. Dysbiosis of the gut microbiota and abnormalities in its metabolites are considered to be involved in the development and progression of CKD and the formation of related complications. Reduced renal function leads to the accumulation of urea and other nitrogenous metabolites in the intestinal lumen, promoting the proliferation of urease-producing, phenol-producing, and indole-producing bacteria. This increases the production of gut-derived uremic toxins such as p-cresyl sulfate, indoxyl sulfate, and trimethylamine N-oxide (TMAO), which further exacerbate kidney injury by disrupting the intestinal barrier and inducing inflammatory responses and oxidative stress. Atractylodes macrocephala is a key herb for invigorating the spleen, benefiting qi, drying dampness, and promoting diuresis. Traditionally, it is commonly used for patterns of spleen deficiency with dampness abundance and internal retention of water-dampness. Modern studies have shown that A. macrocephala and its polysaccharide components can regulate the gut microbiota, promote the production of short-chain fatty acids (SCFAs), improve the intestinal mucosal barrier, and modulate immune inflammation. This review summarizes the traditional Chinese medicine theory of “spleen-kidney interconnection”, the chemical constituents and pharmacological actions of A. macrocephala, the relationship between gut microbiota and uremic toxins, and complications associated with gut dysbiosis. It explores the potential mechanisms by which A. macrocephala intervenes in CKD through the “gut microbiota-metabolic network”, aiming to provide a reference for the prevention and treatment of CKD with traditional Chinese medicine and for the development of intervention strategies targeting the gut microecology.