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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 207 -213. doi: 10.3877/cma.j.issn.1674-0785.2024.02.016

综述

肾移植与人体微生态的相关性研究进展
张秋玥1, 程羽1, 牛雨田1, 唐茂芝2, 张克勤2, 张懿1, 郭亚楠1, 涂增3,()   
  1. 1. 401331 重庆,重庆医科大学国际医学院
    2. 400010 重庆,重庆医科大学附属第二医院泌尿肾病中心
    3. 400016 重庆,重庆医科大学基础医学院
  • 收稿日期:2023-10-19 出版日期:2024-02-15
  • 通信作者: 涂增
  • 基金资助:
    重庆市自然科学基金(cstc2021jcyj-msxmX0158); 重庆市高等教育教学改革研究项目(223115); 重庆医科大学2021年校级教育教学研究项目(JY210336)

Progress in understanding of correlation between kidney transplantation and human microecology

Qiuyue Zhang1, Yu Cheng1, Yutian Niu1, Maozhi Tang2, Keqin Zhang2, Yi Zhang1, Yanan Guo1, Zeng Tu3,()   

  1. 1. International Medical College, Chongqing Medical University, Chongqing 401331, China
    2. Urinary Nephropathy Center, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
    3. College of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China
  • Received:2023-10-19 Published:2024-02-15
  • Corresponding author: Zeng Tu
引用本文:

张秋玥, 程羽, 牛雨田, 唐茂芝, 张克勤, 张懿, 郭亚楠, 涂增. 肾移植与人体微生态的相关性研究进展[J]. 中华临床医师杂志(电子版), 2024, 18(02): 207-213.

Qiuyue Zhang, Yu Cheng, Yutian Niu, Maozhi Tang, Keqin Zhang, Yi Zhang, Yanan Guo, Zeng Tu. Progress in understanding of correlation between kidney transplantation and human microecology[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(02): 207-213.

肾移植是终末期肾病或终末期肾衰竭患者的首选治疗方式。防治肾移植术后并发症,提高移植肾存活率是值得持续关注的话题。近年来,研究人员对肾移植与人体微生态的相关性进行了大量研究。肾移植会导致人体微生物群构成和丰度的改变,进而对肾移植结局产生影响。该影响涉及术后免疫排斥、感染、腹泻和移植肾功能变化等。研究肾移植后人体微生物群的变化,针对特定微生物群的处理,可有效预测肾移植结局,并有效预防肾移植术后并发症,维护好移植肾功能。本文系统性的总结了目前肾移植和人体微生物群的相关研究,以期为改善肾移植结局提供新的方向和参考。

Kidney transplantation is the optimal treatment for patients with end-stage renal failure. Preventing complications and improving the survival of the transplanted kidney are important issues which deserve constant attention. In recent years, researchers have conducted numerous studies on the correlation between kidney transplantation and human microecology. Kidney transplantation can lead to the change of the human microbiota, which may in turn affect the renal transplantation outcome, including postoperative allograft rejection, infection, diarrhea, and delayed graft function. Studying the alteration of human microbiota composition may effectively predict the outcome of kidney transplantation. And the intervention of a specific microbiota can help to prevent the post-transplanting complication and maintain the graft function. This article systematically summarizes current studies on kidney transplantation and human microbiota, with an aim to provide a new direction and reference for improving the outcome of kidney transplantation.

表1 肾移植导致人体微生物群改变
作者,发表时间 受试者特征 样本 变量监测 结果(移植后菌群相较移植前/健康受试者菌群)
Swarte等,2020[2] RTRs(N=139)
HCs(N=105)
粪便 16S rRNA测序 -肠杆菌目↑
-产丁酸细菌↓↓(普拉梭菌属、直肠真杆菌、灵巧粪球菌、陪伴粪球菌、罗斯氏菌、Gemmiger formicilis等)
Fricke等,2013[3] RTRs(N=60) 粪便唾液 16S rRNA测序 -肠道:厚壁菌门↓↓(厌氧菌属、粪杆菌属、粪球菌属和一未知消化链球菌科成员)
-口腔:属γ-变形菌门的潜在机会致病菌↑
马驰宇,2021[9] RTRs(N=28)
HCs(N=30)
粪便 16S rRNA测序描述肠道菌群结构LC-MS分析肠道菌群代谢物 -毛螺菌科、瘤胃菌科、粪杆菌科丰度↓
-变形菌门、肠杆菌科增加↑
Lee等,2019[14] RTRs(N=26) 粪便 16 SrRNA测序 -门水平,变形菌门相对丰度↑
-目水平,丹毒丝菌目,肠杆菌相对丰度↑
Yu等,2021[18] RTRs(N=10) 粪便 16 SrRNA深度测序描述菌群结构LC-MS分析肠道菌群代谢物 -柔壁菌门↓↓
-杆菌属,梭菌属,瘤胃球菌科,粪杆菌属,韦荣氏菌科↑↑
-厚壁菌门芽孢杆菌纲(包括肠球菌)↑↑
-术后一周丹毒菌丰度↑,一月后↓
Souai等,2020[19] RTRs(N=40)
HCs(N=18)
粪便 16SrRNA测序 -变形菌门↑,放线菌门↓,疣微菌门理研菌科
-拟杆菌属↑,粪杆菌属↑,埃希氏菌属/志贺杆菌属↑
Chan等,2021[20] RTRs(N=15)
供者(N=15)
粪便 宏基因组测序 -厚壁菌门↑,另枝菌属↓,理研菌科↓
Modena等,2017[21] IFTA(N=25)
TXs(N=23)
HCs(N=20)
尿液 16S rDNA测序 术后1月:
-女性IFTAs及TXs无明显变化
-男性IFTAs及TXs链球菌明显低于HCs术后6~8月:
-女性IFTAs乳酸菌↓
-男性TXs链球菌↑恢复正常水平,IFTAs链球菌↓丰度低于TXs组
Colas等,2020[2] RTRs(N=86)
HCs(N=27)
尿液 16S rRNA测序 -变形菌门(草酸杆菌科,柄杆菌科,丛毛单胞菌科,莫拉氏菌科,黄单胞菌科,无色杆菌属,假结核耶尔森菌)↑
de Santana Sarmento等,2018[22] RTRs(N=50)
HCs(N=50)
唾液 PCR筛查唾液疱疹病毒 -疱疹病毒脱落↑
表2 肠道菌群改变与肾移植术后并发症的关联
作者发表时间 受试者特征 肾移植后并发 样本 菌群/代谢产物改变(发生不良反应组相比未发生不良反应组)
Fricke等,2013[3] RTRs(N=60)
-感染(N=4)
-未感染(N=14)
-排斥(N=4)
-未排斥(N=14)
排斥 肠道 拟杆菌门↓
口腔 纤毛菌属、奈瑟菌属、放线菌门的两种不明菌属↓
腹泻 肠道 拟杆菌属,瘤胃球菌属和粪球菌属↓
UTI 肠道 肠球菌属↑
Lee等,2014[26] RTRs(N=26) 排斥 肠道 -乳杆菌目,肠球菌,厌氧细杆菌属和第三梭状芽胞杆菌↑
-梭菌目,拟杆菌目,毛螺菌科↓
口腔 纤毛菌属,奈瑟氏菌属,红蝽菌亚目和棒杆菌亚目的一未知成员↓
腹泻 肠道 -肠球菌,埃希菌,蓝绿藻菌属↑
-拟杆菌属,瘤胃球菌,粪球菌属和多尔氏菌属↓
UTI 肠道 -肠球菌属↑
Modena等,2017[21] IFTA(N=25) IFTA 尿道 -男性:链球菌↓
-女性:乳杆菌↓
Colas等2020[2] RTRs(N=71) UTI 尿道 -变形菌门↑
排斥
Li等,2022[7] RTRs(N=60)
-排斥(N=28)
-未排斥(N=32)
排斥 肠道 -发酵乳杆菌,约氏乳杆菌和嗜酸乳杆菌↑
-普拉梭菌,直肠真杆菌,扭链瘤胃球菌,灵巧粪球菌和假小链双歧杆菌↓
-牛磺胆酸盐,苯酚,L-谷氨酰胺,α-酮戊二酸和N1-甲基-2-吡啶酮-5-甲酰胺(2Py)↑
-N-乙酰-L-组氨酸,阿魏酸,3β-羟基-5-胆稀酸,2-异丙基苹酸,N6,N6,N6-三甲基-L-赖氨酸↓
Wang等,2021[8] RTRs(N=53)
-排斥(N=24)
-未排斥(N=29)
排斥 肠道 -梭状芽孢杆菌属,梭状芽孢杆菌目↓
Magruder等,2020[27]
Lee等,2019[10]
RTRs(N=168) 菌尿症 肠道 -埃希氏杆菌属,肠球菌属,粪杆菌属,罗斯氏菌属↑—菌尿症风险↑
-乳杆菌属↑—菌尿症风险↓
感染 肠道 -产丁酸盐细菌—丰度大于1%时,呼吸道病毒、巨细胞病毒感染↓
Zhang等,2021[28] RTRs(N=168)
-腹泻(N=22)
-无腹泻(N=57)
腹泻 肠道 真杆菌属,厌氧棒杆菌,瘤胃球菌属,多尔氏菌属,梭形杆菌属(瘤胃梭菌属V),双歧杆菌属↓
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