Akobeng Anthony K, Singh Parul, Kumar Manoj, Al Khodor Souhaila
Division of Gastroenterology, Hepatology, and Nutrition, Sidra Medicine, Doha, Qatar.
Weill Cornell Medicine, Cornell University, Doha, Qatar.
Eur J Nutr. 2020 Dec;59(8):3369-3390. doi: 10.1007/s00394-020-02324-y. Epub 2020 Jul 10.
Although genetic predisposition and exposure to dietary gluten are considered necessary triggers for the development of coeliac disease, alterations in the gut microbial composition may also contribute towards the pathogenesis of coeliac disease. This review aims to provide an overview of the available data on the potential mechanisms through which the gut microbiota plays a role in the causation of coeliac disease and to discuss the potential therapeutic strategies that could diminish the consequences of microbial dysbiosis.
A search of the literature was performed using the PubMed, Embase, and JSTOR databases; relevant articles were included.
Recent studies in patients with coeliac disease have reported an increase in the relative amounts of gram negative bacterial genera such as Bacteroides, Prevotella, and Escherichia, and reduced amounts of protective anti-inflammatory bacteria such as Bifidobacteria and Lactobacilli. Dysbiotic microbiota may lead to a dysregulated immune response that may contribute to the pathogenesis of coeliac disease. In infancy, antibiotic use and certain infant feeding practices may lead to alterations in the developing gut microbiota to influence the immune maturation process and predispose to coeliac disease.
The induction of the intestinal immune system and gluten intolerance may be influenced by the relative abundance of certain microbiota. Factors such as infant feeding practices, diet, antibiotics, and infections, may be involved in the development of coeliac disease due to their influence on gut microbial composition. The efficacy of potential modulators of the gut microbiota such as probiotics, prebiotics, and fecal microbial transplant as adjunctive treatments to gluten-free diet in coeliac disease is unproven and requires further investigation.
尽管遗传易感性和饮食中麸质的暴露被认为是乳糜泻发生的必要触发因素，但肠道微生物组成的改变也可能在乳糜泻的发病机制中起作用。本综述旨在概述现有数据，说明肠道微生物群在乳糜泻病因中发挥作用的潜在机制，并讨论可能减轻微生物失调后果的潜在治疗策略。
使用PubMed、Embase和JSTOR数据库进行文献检索；纳入相关文章。
最近对乳糜泻患者的研究报告称，革兰氏阴性菌属（如拟杆菌属、普雷沃菌属和大肠杆菌属）的相对数量增加，而保护性抗炎细菌（如双歧杆菌和乳杆菌）的数量减少。微生物群失调可能导致免疫反应失调，这可能在乳糜泻的发病机制中起作用。在婴儿期，使用抗生素和某些婴儿喂养方式可能会导致发育中的肠道微生物群发生改变，从而影响免疫成熟过程并易患乳糜泻。
肠道免疫系统的诱导和麸质不耐受可能受某些微生物群相对丰度的影响。婴儿喂养方式、饮食、抗生素和感染等因素可能因其对肠道微生物组成的影响而参与乳糜泻的发生。肠道微生物群的潜在调节剂（如益生菌、益生元和粪便微生物移植）作为乳糜泻无麸质饮食辅助治疗的疗效尚未得到证实，需要进一步研究。
