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摘要: 反流性食管炎(reflux esophagitis，RE)在未经临床干预的情况下存在向巴雷特食管(Barrett's esophagus，BE)发展的风险，而BE将进一步发展成为食管腺癌(esophageal adenocacinoma，EAC)。食管菌群的改变可介导食管炎症，影响RE的进展，促进“RE-BE”转变的进程。识别食管菌群的改变将进一步促进人类对RE和BE发病机制及进展的理解。本文主要综述了食管菌群对RE和BE影响，以及饮食、吸烟、药物、益生菌、抗生素或中药等对食管微生物群的调节作用，为临床RE和BE的诊断及个性化治疗提供新思路。Abstract: Reflux esophagitis (RE) is at risk of progressing to Barrett's esophagus (BE) without clinical intervention, which will further develop into esophageal adenocarcinoma (EAC).The esophageal microbiome is one of the hotspots in the research of esophageal diseases.It has been shown that the alteration of the esophageal microbiome can mediate esophageal inflammation and influence the progression of reflux esophagitis, promoting disease progression between RE-BE.Identifying the changes in esophageal flora will further promote our understanding of the pathogenesis and disease progression of RE and BE.This article mainly reviews the influence of esophageal flora on RE and BE, as well as the regulatory effect of diet, smoking, drugs, probiotics, synbiotics, antibiotics, or Traditional Chinese Medicine on esophageal flora, to provide new ideas for clinical diagnosis of RE and BE diseases and personalized treatment.
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Key words:
- reflux esophagitis /
- Barrett's esophagus /
- esophageal microbiome
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表 1 不同研究对象的食管菌群结构
作者 出版时间 研究方法 研究对象 食管菌群结构 Dong等[30] 2018 16S rRNA 健康人 门水平：主要为变形菌门、厚壁菌门、拟杆菌门、放线菌门、梭菌门和TM7；
属水平：以链球菌、奈瑟菌、普雷沃菌、放线菌和细孔菌的相对丰度较高。Yu等[37] 2019 16S rDNA 健康人 门水平：厚壁菌门36.9%、放线菌门34.6%、拟杆菌门16.5%、变形菌门10.6%；
属水平：双歧杆菌属32.5%、拟杆菌属7.0%、克雷伯菌属6.9%、链球菌属2.8%。Liu等[31] 2013 16S rDNA RE患者 门水平：主要为变形菌门43%、厚壁菌门33%、拟杆菌门10%、梭菌门10%；
属水平：链球菌20%、巴氏杆菌10%、克雷伯菌9%、梭杆菌9%、嗜血杆菌9%、普雷沃菌5%。Yu等[37] 2019 16S rDNA RE患者 轻度RE：门水平：厚壁菌门36.6%、放线菌门38.4%、拟杆菌门13.2%、变形菌门10.8%；属水平：双歧杆菌属32.3%，拟杆菌属6.3%，克雷伯菌属7.0%，链球菌属2.7%。
重度RE：门水平：厚壁菌门38.0%、放线菌门34.2%、拟杆菌门13.7%、变形菌门12.0%；属水平：双歧杆菌属31.5%，拟杆菌属6.8%，克雷伯菌属7.5%，链球菌属2.8%。Amir等[22] 2014 16S rRNA BE患者 发现胃液中肠杆菌科(主要是大肠杆菌属)与食管异常有关，可能通过反流进入食管。 Liu等[31] 2013 16S rDNA BE患者 门水平：厚壁菌门55%、变形菌门20%、拟杆菌门14%、梭菌门9%、放线菌门2%；
属水平：细孔菌19%、普雷沃菌12%、链球菌11%、梭杆菌9%、双歧杆菌4%、幽门螺杆菌4%、奈瑟菌4%、放线菌4%、乳酸杆菌4%、透析菌3%和无色杆菌3%。Blackett等[33] 2013 共培养实验 BE患者 BE患者较健康人的食管菌群弯曲杆菌增多。 Zaidi等[34] 2016 PCR-ESI-MS-TOF BE患者 食管菌群中大肠杆菌丰度较健康人及RE患者食管菌群高。 Okereke等[35] 2019 16S rDNA BE患者 嗜血杆菌在BE食管黏膜中富集。 Gall等[36] 2015 16S rRNA BE患者 BE危险因素与链球菌属和普雷沃菌属比例呈负相关。 高峰等[38] 2021 16S rDNA RE大鼠 有益菌减少；消化链球菌属(1.7±0.7)%，螺杆菌属(1.0±0.5)%，苏黎世杆菌属(0.5±0.2)%。 贾梦真等[39] 2019 16S rDNA RE大鼠 消化链球菌属增多，螺杆菌属、乳球菌属减少。 
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| 引用本文: |
郭政, 唐艳萍, 李明莉, 等. 从反流性食管炎到巴雷特食管：食管菌群扮演的角色[J]. 中国中西医结合消化杂志, 2023, 31(10): 810-815. doi: 10.3969/j.issn.1671-038X.2023.10.16
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| Citation: |
GUO Zheng, TANG Yanping, LI Mingli, et al. From reflux esophagitis to Barrett's esophagus: the role of esophageal microbiome[J]. Chin J Integr Tradit West Med Dig, 2023, 31(10): 810-815. doi: 10.3969/j.issn.1671-038X.2023.10.16
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