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肝移植术后免疫抑制剂治疗与肠道微生态的相互作用及机制
DOI: 10.12449/JCH260430
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作者贡献声明：王岩负责文章构思和撰写；刘玉凤负责查阅文献并修改文章；张海洋、张志伟对文章知识性内容进行补充；莱智勇负责文章审阅工作；徐钧指导撰写文章并最终定稿。
Mechanism of the interaction between immunosuppressive therapy and intestinal microflora after liver transplantation
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摘要: 免疫抑制药物的应用显著降低了肝移植术后的排斥反应发生率，然而受患者个体差异影响，其临床疗效仍存在较大波动。本文系统综述了近年来免疫抑制剂与肠道微生态相互作用的研究进展，重点探讨了肠道微生物群落对免疫抑制剂疗效的调控作用及其机制。研究表明，肠道微生物组是维持肝移植术后免疫抑制治疗效果稳定的关键因素之一。本综述旨在为该领域的深入探索提供理论依据，并为开发基于肠道微生态调控的个体化免疫抑制治疗方案提供新思路。Abstract: The application of immunosuppressants has significantly reduced the incidence rate of rejection reaction after liver transplantation， but the clinical efficacy of immunosuppressants is greatly affected by individual differences between patients. This article systematically reviews the recent research advances in the interaction between immunosuppressants and gut microbiota， with a focus on the regulatory role and mechanism of intestinal microflora communities on the efficacy of immunosuppressants. Studies have shown that intestinal microbiome is one of the key factors influencing the efficacy of immunosuppressive therapy after liver transplantation. This review aims to provide a theoretical basis for in-depth research in this field and provide new insights for developing individualized immunosuppressive treatment regimens based on the regulation of intestinal microflora.
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注： a，肠道微生物代谢物通过肠-肝轴进入肝脏与体循环；b，Tac与肠道微生物群之间的相互作用；c，肠道微生物群通过调节蛋白质功能影响免疫抑制剂的药物代谢动力学；d，MMF与肠道微生物群之间的相互作用；e，GC与肠道微生物群之间的相互作用及其对肠道免疫功能的调节作用。PRR，模式识别受体；Tac，他克莫司；M1，Tac代谢物；CsA，环孢素A；ABCB1，三磷酸腺苷结合盒亚家族B成员1；UGT1A1，UDP-葡萄糖醛酸转移酶1家族多肽A1；CYP3A1，细胞色素P450 3A1；SCFA，短链脂肪酸；MMF，吗替麦考酚酯；MPA，霉酚酸；MPAG，霉酚酸葡萄糖醛酸苷；GC，糖皮质激素；Reg3γ，再生胰岛衍生蛋白3γ；Reg3β，再生胰岛衍生蛋白3β；IL-22，白细胞介素22。
图 1 肠道微生物与免疫抑制剂之间的关系
Figure 1. The relationship between gut microbes and immunosuppressants
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