Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada.
Curr Opin Rheumatol. 2021 Jan;33(1):15-23. doi: 10.1097/BOR.0000000000000758.
To summarize recent evidence regarding the presence and potential role of the microbiome in systemic vasculitides.
Microbiomic descriptions are now available in patients with small, medium and large vessel vasculitis. The majority of studies have evaluated gastrointestinal inhabitants, with a smaller number of studies describing the nasal, pulmonary or vascular microbiomes. Most published studies are observational and cross-sectional. Dysbiosis is seen frequently in vasculitis patients with reduced microbial diversity observed in nasal, fecal and vascular samples compared with disease and/or healthy controls. Predominant bacteria vary, but overall, patients with vasculitis tend to have more pathogenic and less commensal bacteria in active disease. In the few longitudinal studies available, improvement or resolution of dysbiosis has been observed following vasculitis treatment and improved disease activity.
Dysbiosis and reduced microbial diversity has been identified in patients with small, medium and large vessel vasculitis. Although limited data suggests microbiomes may 'normalize' following immunosuppression, cause or effect cannot be determined. It is hypothesized that microbial disruption in a genetically susceptible individual may trigger excessive host immune activation and vasculitis; however, larger studies with longitudinal and translational design are needed to further our current understanding.
总结微生物组在系统性血管炎中的存在及其潜在作用的最新证据。
现在已经可以在小、中、大血管血管炎患者中进行微生物组描述。大多数研究都评估了胃肠道居民，少数研究描述了鼻腔、肺部或血管微生物组。大多数已发表的研究都是观察性和横断面研究。血管炎患者中经常出现菌群失调，与疾病和/或健康对照组相比，鼻腔、粪便和血管样本中观察到的微生物多样性减少。优势细菌不同，但总的来说，血管炎患者在活动期的致病性细菌较多，共生性细菌较少。在少数可用的纵向研究中，血管炎治疗后观察到菌群失调的改善或缓解，同时疾病活动度也得到改善。
小、中、大血管血管炎患者中存在菌群失调和微生物多样性减少。虽然有限的数据表明微生物组可能在免疫抑制后“正常化”，但不能确定因果关系。有人假设，在遗传易感个体中，微生物的破坏可能会引发过度的宿主免疫激活和血管炎；然而，需要进行具有纵向和转化设计的更大规模研究，以进一步加深我们目前的认识。
