Department of General Surgery, Eash Lancashire NHS Hospital, Burnley, UK.
Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
Ann Noninvasive Electrocardiol. 2023 Jul;28(4):e13059. doi: 10.1111/anec.13059. Epub 2023 Mar 20.
Many clinical and preclinical studies have implicated an association between atrial fibrillation (AF) and its progression to imbalances in the gut microbiome composition. The gut microbiome is a diverse and complex ecosystem containing billions of microorganisms that produce biologically active metabolites influencing the host disease development.
For this review, a literature search was conducted using digital databases to systematically identify the studies reporting the association of gut microbiota with AF progression.
In a total of 14 studies, 2479 patients were recruited for the final analysis. More than half (n = 8) of the studies reported alterations in alpha diversity in atrial fibrillation. As for the beta diversity, 10 studies showed significant alterations. Almost all studies that assessed gut microbiota alterations reported major taxa associated with atrial fibrillation. Most studies focused on short-chain fatty acids (SCFAs), whereas three studies evaluated TMAO levels in the blood, which is the breakdown product of dietary l-carnitine, choline, and lecithin. Moreover, an independent cohort study assessed the relationship between phenylacetylglutamine (PAGIn) and AF.
Intestinal dysbiosis is a modifiable risk factor that might provide newer treatment strategies for AF prevention. Well-designed research and prospective randomized interventional studies are required to target the gut dysbiotic mechanisms and determine the gut dysbiotic-AF relationship.
许多临床前和临床研究表明，心房颤动（AF）与其肠道微生物组组成失衡之间存在关联。肠道微生物组是一个多样化且复杂的生态系统，其中包含数十亿种产生影响宿主疾病发展的生物活性代谢物的微生物。
为了进行本次综述，使用数字数据库进行了文献检索，以系统地确定报告肠道微生物群与 AF 进展之间关联的研究。
在总共 14 项研究中，共有 2479 名患者被纳入最终分析。超过一半（n=8）的研究报告了 AF 中 alpha 多样性的改变。至于 beta 多样性，有 10 项研究显示出明显的改变。几乎所有评估肠道微生物群改变的研究都报告了与心房颤动相关的主要分类群。大多数研究集中在短链脂肪酸（SCFAs）上，而三项研究评估了血液中的 TMAO 水平，TMAO 是膳食肉碱、胆碱和卵磷脂的分解产物。此外，一项独立的队列研究评估了苯乙酰谷氨酰胺（PAGIn）与 AF 的关系。
肠道菌群失调是一种可改变的危险因素，可能为 AF 的预防提供新的治疗策略。需要进行精心设计的研究和前瞻性随机干预研究，以针对肠道菌群失调机制，并确定肠道菌群失调与 AF 的关系。
