aCenter for Experimental and Molecular Medicine bDivision of Infectious Diseases, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Curr Opin Crit Care. 2017 Aug;23(4):257-263. doi: 10.1097/MCC.0000000000000424.
The review aims to discuss emerging evidence in the field of microbiome-dependent roles in host defense during critical illness with a focus on lung, kidney, and brain inflammation.
The gut microbiota of critical ill patients is characterized by lower diversity, lower abundances of key commensal genera, and in some cases overgrowth by one bacterial genera, a state otherwise known as dysbiosis. Increasing evidence suggests that microbiota-derived components can reach the circulatory system from the gut and modulate immune homeostasis. Dysbiosis might have greater consequences for the critically ill than previously imagined and could contribute to poor outcome. Preclinical studies suggest that impaired communication across the gut - organ axes is associated with brain, lung - and kidney failure.
In health, a diverse microbiome might enhance host defense, while during critical illness, the dysbiotic microbiome might contribute to comorbidity and organ dysfunction. Future research should be aimed at further establishing the causes and consequences of dysbiosis seen in the critically ill, which will provide perspective for developing new strategies of intervention.
本文旨在讨论微生物组在危重病宿主防御中的作用方面的新证据，重点关注肺部、肾脏和大脑炎症。
危重病患者的肠道微生物组具有较低的多样性、关键共生菌属的丰度较低、在某些情况下单一细菌属过度生长的特点，这种状态称为肠道菌群失调。越来越多的证据表明，微生物群衍生的成分可以从肠道进入循环系统，并调节免疫稳态。与之前的想象相比，菌群失调可能对危重病患者产生更大的影响，并可能导致不良结局。临床前研究表明，肠道-器官轴之间的通讯障碍与脑、肺和肾功能衰竭有关。
在健康状态下，多样化的微生物组可能增强宿主防御，而在危重病期间，失调的微生物组可能导致合并症和器官功能障碍。未来的研究应旨在进一步确定危重病患者中观察到的菌群失调的原因和后果，这将为开发新的干预策略提供视角。
