肠道菌群与脑出血：脑肠轴介导的病理机制及治疗策略研究进展

Gut Microbiota and Intracerebral Hemorrhage: Research Progress on Pathological Mechanisms and Therapeutic Strategies Mediated by the Gut-Brain Axis

摘要: 脑出血(intracerebral hemorrhage, ICH)是致死率和致残率最高的卒中亚型，目前仍缺乏有效的治疗手段。脑–肠轴作为中枢神经系统与肠道之间的双向通信通路，其中肠道菌群作为关键媒介，在ICH病理机制中的作用日益受到关注。本文系统总结了ICH后肠道菌群失调的主要特征及变化规律，并阐述了菌群代谢产物(如短链脂肪酸、三甲胺氧化物、胆汁酸)调控神经炎症、氧化应激及血脑屏障完整性的分子机制，进一步梳理了益生菌、粪菌移植及中医药等菌群干预策略的相关研究证据，并指出了当前研究在因果机制解析与临床转化方面面临的挑战，展望了多组学整合与精准菌群调控等未来发展方向，为ICH的机制研究和靶向治疗提供新的思路。

Abstract: Intracerebral hemorrhage (ICH) is the stroke subtype with the highest mortality and disability rates, yet effective therapeutic options remain limited. The brain-gut axis serves as a bidirectional communication pathway between the central nervous system and the intestine, in which the gut microbiota, as a key mediator, has attracted growing attention for its role in the pathogenesis of ICH. This review systematically summarizes the principal characteristics of and dynamic changes in gut microbiota dysbiosis following ICH, and elaborates on the molecular mechanisms by which microbial metabolites (e.g., short-chain fatty acids, trimethylamine N-oxide, and bile acids) modulate neuroinflammation, oxidative stress, and blood-brain barrier integrity. Furthermore, we discuss the current evidence for microbiota-targeted interventions, including probiotics, fecal microbiota transplantation, and traditional Chinese medicine. Finally, we highlight the challenges in elucidating causal mechanisms and in clinical translation, and propose future directions such as multi-omics integration and precision modulation of the gut microbiota, aiming to provide new insights into mechanistic research and targeted therapies for ICH.