肠道屏障功能障碍在肝肾综合征-急性肾损伤发病中的串扰机制

孙文; 陈晓; 张鑫; 于博睿; 杨波; 邢海涛

doi:10.12449/JCH250833

肠道屏障功能障碍在肝肾综合征-急性肾损伤发病中的串扰机制

DOI: 10.12449/JCH250833

孙文^{1, 2},
陈晓^{1, 2},
张鑫^{1, 2},
于博睿^{1, 2},
杨波^{1, 2},
邢海涛^{1, 2, , ,}

1.
天津中医药大学第一附属医院肾病科，天津 300193
2.
国家中医针灸临床医学研究中心，天津 300193

基金项目:

国家自然科学基金 (81973799);

天津市教委科研计划 (2023KJ154)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：孙文、邢海涛、张鑫负责设计论文框架；孙文、陈晓、张鑫负责论文参考文献收集；孙文、陈晓负责起草论文；邢海涛、于博睿负责论文修改；邢海涛、杨波负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
邢海涛， haitxing@126.com （ORCID： 0009-0004-0382-7553）

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出版历程
- 收稿日期: 2024-12-09
- 录用日期: 2025-02-11
- 出版日期: 2025-08-25

The crosstalk mechanism of intestinal barrier dysfunction in the pathogenesis of hepatorenal syndrome-acute kidney injury

Wen SUN^{1, 2},
Xiao CHEN^{1, 2},
Xin ZHANG^{1, 2},
Borui YU^{1, 2},
Bo YANG^{1, 2},
Haitao XING^{1, 2
, ,
,}

1.
Department of Nephrology，The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine，Tianjin 300193，China
2.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion，Tianjin 300193，China

Research funding:

National Natural Science Foundation of China (81973799);

Tianjin Municipal Education Commission Scientific Research Project (2023KJ154)

More Information

Corresponding author: XING Haitao， haitxing@126.com （ORCID： 0009-0004-0382-7553）

摘要

摘要: 2015年国际腹水俱乐部就肝肾综合征的进展提出了肝肾综合征-急性肾损伤的新定义，目前其确切发病机制仍在探索中。肠道屏障在肝肾连接中发挥重要桥梁作用，肠道菌群紊乱，细菌易位发生，内毒素入血，通过释放促炎细胞因子、激活免疫相关细胞对肾脏造成损害，胆汁酸进入循环系统也直接或间接导致肝肾综合征-急性肾损伤的发生与进展。本文以肠道屏障为切入点对肝肾综合征-急性肾损伤的串扰机制进行综述，进一步阐明肝-肠-肾轴在其发病中的关键作用，以期提供新的治疗思路。
- 肠道屏障 /
- 肝硬化 /
- 肝肾综合征 /
- 急性肾损伤 /
- 细菌易位
Abstract: In 2015， the International Ascites Club proposed a new definition of hepatorenal syndrome-acute kidney injury based on the progression of hepatorenal syndrome， and studies are still being conducted to explore the exact pathogenesis of hepatorenal syndrome-acute kidney injury. Intestinal barrier plays an important bridging role in liver-kidney connection， and intestinal flora disturbance， bacterial translocation， and endotoxins entering the blood cause damage to the kidneys by releasing proinflammatory cytokines and activating immune-related cells. The entrance of bile acid into the circulation system also directly or indirectly lead to the development and progression of hepatorenal syndrome-acute kidney injury. This article reviews the crosstalk mechanism of hepatorenal syndrome-acute kidney injury from the perspective of the intestinal barrier and further clarifies the key role of the liver-gut-kidney axis in the pathogenesis of this disease， in order to provide new treatment ideas.
- Intestinal Barrier /
- Liver Cirrhosis /
- Hepatorenal Syndrome /
- Acute Kidney Injury /
- Bacterial Translocation

HTML全文

注： Claudin，紧密连接蛋白；Occludin，闭合蛋白；Weibel-Palade小体，怀布尔-帕拉德小体；VWF，血管性血友病因子；NF-κB，核因子κB；CXCL5，C-X-C基序趋化因子5。

图 1 肝硬化中的病理性细菌易位

Figure 1. Pathologic bacterial translocation in cirrhosis

下载: 全尺寸图片幻灯片

注： CYP7A1，胆固醇7-羟化酶；CYP8B1，细胞色素P450家族8亚家族B成员1；TGR5，胆汁酸G蛋白偶联受体5；ASBT，顶端膜钠依赖性胆汁酸转运蛋白；OSTα/β，有机溶质转运蛋白α/β。

图 2 肝硬化下肠黏液和胆汁酸的病理变化

Figure 2. Pathological changes in intestinal mucus and bile acids in cirrhosis

下载: 全尺寸图片幻灯片

注： ICAM-1，细胞间黏附分子1；MCP-1，单核细胞趋化蛋白-1；MIP-2，CXC趋化因子配体2；CCL2，趋化因子2；HLA-DR，人类白细胞抗原-DR；mtROS，线粒体活性氧；HSC，肝星状细胞；IEC，小肠上皮细胞。JAK2/STAT，Janus激酶2/信号转导与转录激活子。；AngⅡ，血管紧张素Ⅱ；ATIR，血管紧张素1型受体。

图 3 肝硬化后的免疫系统异常与氧化应激

Figure 3. Immune system abnormalities and oxidative stress after cirrhosis

下载: 全尺寸图片幻灯片

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