陆军军医大学(第三军医大学)大坪医院消化内科,重庆
WEI Yanling, E-mail: lingzi016@126.com
Received:20 May 2026,
Revised:2026-06-05,
Accepted:06 June 2026,
Published:15 July 2026
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魏艳玲,王尧.“菌群-屏障-免疫-信号”交互网络:溃疡性结肠炎的发病机制新论与精准干预新策[J].陆军军医大学学报,2026,48(13):1809-1817.DOI:10.16016/j.2097-0927.202605057.
WEI Y L,WANG Y.The “microbiota-barrier-immunity-signaling” interaction network: novel insights into the pathogenesis of ulcerative colitis and strategies for precision intervention[J].J Army Med Univ,2026,48(13):1809-1817.DOI:10.16016/j.2097-0927.202605057.
魏艳玲,王尧.“菌群-屏障-免疫-信号”交互网络:溃疡性结肠炎的发病机制新论与精准干预新策[J].陆军军医大学学报,2026,48(13):1809-1817.DOI:10.16016/j.2097-0927.202605057. DOI:
WEI Y L,WANG Y.The “microbiota-barrier-immunity-signaling” interaction network: novel insights into the pathogenesis of ulcerative colitis and strategies for precision intervention[J].J Army Med Univ,2026,48(13):1809-1817.DOI:10.16016/j.2097-0927.202605057. DOI:
溃疡性结肠炎(ulcerative colitis,UC)是一种以结肠黏膜连续性炎症损伤为特征的慢性非特异性肠道炎症性疾病,病程迁延、反复发作,全球疾病负担持续加重,我国发病率亦呈上升趋势,已成为消化系统重要的公共卫生问题。新近研究提出了UC发病的四大核心机制:①肠道菌群失衡通过“菌群结构改变-代谢功能紊乱-屏障损伤-免疫异常激活”多环节参与疾病进程,产短链脂肪酸(short-chain fatty acids,SCFAs)菌群减少削弱抗炎代谢物生成,条件致病菌增多促进炎症刺激;②肠道屏障功能障碍作为连接微生态与免疫的关键枢纽,紧密连接蛋白表达下调、黏液层变薄等改变使肠腔抗原更易进入黏膜固有层,触发免疫级联;③固有免疫与适应性免疫双重失衡构成炎症持续放大的基础,巨噬细胞M1型极化、中性粒细胞胞外陷阱形成、Th17/Treg平衡失调等共同推动慢性炎症;④Toll样受体(Toll-like receptors,TLRs)/NF-κB、JAK/STAT及自噬等多条信号通路异常激活并相互串扰,形成“炎症-损伤-再炎症”的病理循环。目前,UC的治疗策略正从传统5-氨基水杨酸、糖皮质激素向精准靶向干预转变:生物制剂与小分子药物[抗TNF-α制剂、抗整合素制剂、JAK抑制剂、鞘氨醇-1-磷酸受体(sphingosine-1-phosphate receptor,S1PR)调节剂等]通过阻断关键炎症因子或调控免疫细胞迁移实现精准免疫调控;微生态干预(肠菌移植、噬菌体疗法)为菌群重塑提供新路径;中药(白头翁汤、葛根芩连汤等)通过多靶点调控作为补充策略;外科治疗仍是药物难治性UC的重要保障。未来,对于UC防治的研究应从单一靶点干预转向系统解析“菌群-屏障-免疫-信号”交互网络的核心调控节点,并依托内科、外科、营养及心理等多学科协作模式,推动诊疗策略从症状控制向精准免疫调节、微生态重塑、屏障修复及全病程管理的纵深转型,从而为提升UC治疗的个体化水平与长期获益奠定坚实的理论与实践基础。
Ulcerative colitis (UC) is a chronic
nonspecific inflammatory bowel disease characterized by continuous mucosal inflammation of the colon
with a protracted course and recurrent episodes. The global disease burden continues to increase
and its incidence in China has also shown an upward trend
making it a significant public health concern in gastroenterology. Recent studies have proposed 4 core mechanisms underlying the pathogenesis of UC: ① Gut microbiota dysbiosis participates in disease progression through multiple steps of “structural alteration of microbiota-metabolic dysfunction-barrier impairment-aberrant immune activation”. Reduced short-chain fatty acids (SCFAs)-producing bacteria weaken the production of anti-inflammatory metabolites
and expansion of opportunistic pathogens promotes inflammatory stimula
tion; ② Intestinal barrier dysfunction serves as critical hub connecting the microbiota and the immune system. Downregulation of tight junction proteins and thinning of the mucus layer allow luminal antigens to more easily penetrate into the lamina propria
triggering an immune cascade; ③ Dual imbalance of innate and adaptive immunity constitutes the foundation for sustained amplification of inflammation. Macrophage M1 polarization
neutrophil extracellular trap (NET) formation
and Th17/Treg imbalance collectively drive chronic inflammation; ④ Aberrant activation and cross-talk among multiple signaling pathways
including TLR/NF-κB
JAK/STAT
and autophagy
create a pathological cycle of “initial inflammation-tissue injury-secondary inflammation”. Currently
the therapeutic strategy for UC is shifting from traditional 5-aminosalicylates and corticosteroids toward precision-targeted interventions: biologics and small-molecule drugs [
e.g
.
anti-TNF-α preparation
anti-integrin preparation
JAK inhibitors
sphingosine-1-phosphate receptor (S1PR) modulators
]
achieve precise immune regulation by blocking key inflammatory cytokines or modulating immune cell migration. Microecological interventions (fecal microbiota transplantation
phage therapy) provide new approaches for microbiota remodeling. Traditional Chinese medicine (
e.g.
Baitouweng Decoction
Gegen Qinlian Decoction) serves as a complementary strategy through multi-target regulation. Surgical treatment remains an important backup for medically refractory UC. In the future
research on UC prevention and treatment should shift from single-target intervention toward systematic dissection of the core regulatory nodes within the “microbiota-barrier-immunity-signaling” interaction network. Moreover
relying on a multidisciplinary team (MDT) model encompassing internal medicine
surgery
nutrition
and psychology
diagnostic and therapeutic strategies should be advanced from symptom control to precision immunomodulation
microbiota
remodeling
barrier repair
and whole-disease-course management
thereby laying a solid theoretical and practical foundation for improving individualized treatment and long-term benefits for UC patients.
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