Subramanian Sreedhar, Campbell Barry James, Rhodes Jonathan Michael
Division of Gastroenterology, School of Clinical Sciences, University of Liverpool, Liverpool, UK.
Curr Opin Infect Dis. 2006 Oct;19(5):475-84. doi: 10.1097/01.qco.0000244054.69253.f3.
Inflammatory bowel disease is thought to result from an abnormal response to the gut microbiota. This review discusses advances in knowledge of the changes in gut microbiota and host response in inflammatory bowel disease.
Approximately 15% of Crohn's disease cases in western populations result from mutations in NOD2/CARD15. This disease leads to defective intestinal defensin production and defective monocyte interleukin-8 response to bacterial peptidoglycan. A similar defective interleukin-8 response and consequent delayed neutrophil recruitment have also been shown in patients with Crohn's disease who do not have the NOD2 mutation. A consequence seems to be the accumulation in tissue of macrophages containing various bacteria, perhaps particularly Escherichia coli. In keeping with this patients with Crohn's disease have circulating antibodies against bacterial flagellar proteins of enterobacteria and clostridia. In ulcerative colitis, there is less evidence for invasion by or immune response to bacteria but changes in gut microbiota include a relative deficiency of bifidobacteria. There is considerable interest in probiotic or prebiotic therapies although so far little evidence for their efficacy.
Molecular techniques are giving us better insight into the gut microbiota in inflammatory bowel disease that should translate into improved therapies.
炎症性肠病被认为是对肠道微生物群异常反应的结果。本综述讨论了炎症性肠病中肠道微生物群变化及宿主反应的相关知识进展。
西方人群中约15%的克罗恩病病例是由NOD2/CARD15基因突变引起的。这种疾病导致肠道防御素产生缺陷以及单核细胞对细菌肽聚糖的白细胞介素-8反应缺陷。在没有NOD2突变的克罗恩病患者中也显示出类似的白细胞介素-8反应缺陷以及随之而来的中性粒细胞募集延迟。结果似乎是含有各种细菌（可能特别是大肠杆菌）的巨噬细胞在组织中积聚。与此一致的是，克罗恩病患者体内存在针对肠杆菌科细菌和梭菌细菌鞭毛蛋白的循环抗体。在溃疡性结肠炎中，细菌侵袭或免疫反应的证据较少，但肠道微生物群的变化包括双歧杆菌相对缺乏。尽管目前益生菌或益生元疗法疗效的证据很少，但人们对其相当感兴趣。
分子技术使我们对炎症性肠病中的肠道微生物群有了更好的了解，这有望转化为改进的治疗方法。
