肠道菌群及其代谢产物与T2DM发病机制及干预措施*

2型糖尿病(type 2 diabetes mellitus,T2DM)是一种因胰岛素分泌不足或胰岛素抵抗而引起的慢性代谢疾病,T2DM患病人数的快速增长使治疗和预防T2DM成为世界上亟待解决的医学问题。随着微生物组学技术的进步,肠道菌群及其代谢产物与T2DM的研究亦逐渐深入,肠道菌群可能成为治疗和预防T2DM的靶点。肠道菌群及其代谢产物作用于T2DM的潜在机制,主要是参与体内炎症反应、增加肠道短链脂肪酸产量、调节肠道胆汁酸的代谢、调节支链氨基酸的代谢等。目前,治疗T2DM的药物可能会产生一些副作用,而基于肠道菌群干预T2DM的措施相对安全无害。例如,可通过严格控制的特定结构饮食长期摄入或增加益生菌的长期摄取控制血糖,或通过口服可影响肠道菌群生态结构的降糖药物(二甲双胍、阿卡波糖)有效地调控血糖水平。综述基于肠道菌群及其代谢产物诱发T2DM的潜在机制,研讨基于肠道菌群干预T2DM的措施,从肠道菌群的新视角探索治疗T2DM的新方法,为彻底治疗T2DM提供一种新可能。

Intestinal Microflora and Its Metabolites in Relation to the Pathogenesis and Intervention of T2DM

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease caused by insufficient insulin secretion or insulin resistance. The rapid increase in the number of patients with T2DM makes the treatment and prevention of T2DM an urgent problem in the world. With the advancement of microbiome technology, the research on the intestinal flora, its metabolites and the T2DM has gradually deepened. Perhaps the intestinal flora can be used as a target for the treatment and prevention of T2DM. The potential mechanism of intestinal flora acting on T2DM is reviewed. It mainly participates in the inflammatory response in the body, increasing the production of intestinal short-chain fatty acids, regulating the metabolism of intestinal bile acids and their product distribution, and ajusting the metabolism of branched-chain amino acids. Currently, drugs for T2DM may have some side effects. Measures based on the intestinal flora to intervene in T2DM are relatively safe and harmless. Long-term intake of a strictly controlled diet with a specific structure can be used to control blood sugar or increase the long-term intake of probiotics. It can also affect the ecological structure of the intestinal flora through oral administration. Sugar drugs (metformin and acarbose) effectively regulate blood sugar levels. The potential mechanism of T2DM induced by the intestinal flora and its metabolites is reviewed, and measures for the intervention of T2DM based on the intestinal flora are also discussed. In addition, new methods for the treatment of T2DM from a new perspective of the intestinal flora are explored, which may provide a thorough treatment of T2DM in the future.