Intestinal Flora: A New Target for the Treatment of Parkinson's Disease
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摘要: 帕金森病是一种受遗传和环境因素影响的神经退行性疾病，其发病机制尚不清晰。与健康人相比，帕金森患者的肠道菌群发生紊乱，具体表现为肠道微生物丰度的提高以及特定菌属的增加。益生菌可以通过调节肠道菌群有效改善帕金森患者的机体炎症、便秘和腹痛等症状，提高患者的生活质量。基于这些特性，益生菌有望成为帕金森病治疗的一种辅助手段应用到实际生活中。本文从帕金森患者的肠道菌群、病程和治疗方法等方面出发，根据近几年的研究报告进行综述，总结了帕金森患者的肠道菌群特点及二者间的联系，并对益生菌干预的新型治疗方法进行讨论，为帕金森病的治疗提供新的参考。Abstract: Parkinson's disease (PD) is a neurodegenerative disease influenced by genetic and environmental factors, and its pathogenesis is still unclear. Compared with healthy people, the intestinal flora of patients with PD is disturbed, which is manifested by an increase in the abundance of intestinal microbial and an increase in specific bacteria. Probiotics can effectively improve the quality of PD patients' life by regulating the intestinal flora and improving symptoms such as inflammation, constipation and abdominal pain. Based on these properties, probiotics are expected to become an adjunct to the treatment of Parkinson's disease in real life. Starting from the aspects of intestinal flora, disease course and treatment methods of Parkinson's patients, this paper reviews the research reports in recent years. Moreover, this paper summarizes the characteristics of intestinal flora of Parkinson's patients and the relationship between them, and discusses the new therapeutic methods of probiotic intervention, which provides a new reference for the treatment of Parkinson's disease.
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Key words:
- Parkinson's disease /
- intestinal flora /
- flora disorder /
- probiotics
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表 1 帕金森病与肠道菌群的关系
Table 1. Relationship between Parkinson's disease and intestinal flora
物种英文名称 物种中文名称 肠道菌群与帕金森病的关系 参考文献 Actinobacteria
Bifidobacteriales
Bifidobacteriaceae
Bifidobacterium
Firmicutes
Lactobacillaceae
Lactobacillus变形菌门
双歧杆菌目
双歧杆菌科
双歧杆菌属
厚壁菌门
乳杆菌科
乳杆菌属放线菌门和厚壁菌门中的一些特定菌与帕金森病患者的异常炎症指标（中性粒细胞百分比，单核细胞计数/百分比，白细胞计数）具有正相关性 [15] Proteus
Akkermansia变形杆菌属
嗜粘蛋白阿克曼菌变形杆菌属的增加和嗜粘蛋白阿克曼菌的减少与帕金森病小鼠炎症水平下降，肠道屏障完整性提升相关 [16] Enterococcus 肠球菌属 肠球菌含有酪氨酸羟化酶和多巴脱羧酶，可以通过增加小鼠脑多巴胺改善其帕金森病症状 [18] Clostridium coccoides
Clostridium leptum拟球梭菌
柔嫩梭菌帕金森病患者肠道中丁酸盐水平的降低与产丁酸菌（梭状芽孢杆菌与麻风梭菌）丰度的减少相关 [19] 
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表 2 益生菌辅助治疗帕金森病研究进展
Table 2. Research progress of probiotics in adjuvant treatment of Parkinson's disease
时间（年） 菌株 干预时间 受试者分布（人） 实验类型 实验效果 参考文献 2011 发酵乳饮料（Lactobacillus casei Shirota；6.5×109 CFU/d） 5周 实验组：40 改善Bristol评分，降低腹痛和腹胀的次数 [39] 2016 发酵乳（Enterococcus faecium，Lactobacillus rhamnosus GG, Bifidobacterium animalis subsp lactis等；2.5×109 CFU/d） 4周 益生菌发酵乳组：40；
益生菌益生元发酵乳组：40；
安慰剂组：40随机、双盲、
安慰剂对照试验增加自发排便次数 [40] 2018 益生菌胶囊（Lactobacillus acidophilus，Bifidobacterium bifidum，Lactobacillus reuteri，Lactobacillus fermentum； each 2×109 CFU/g） 12周 益生菌组：30；
安慰剂组：30随机、双盲、
安慰剂对照试验降低MDS-UPDRS评分，降低机体炎症，提高抗氧化水平，对少数代谢谱有有益影响 [41] 2020 多菌株益生菌胶囊（Lactobacillus reuteri，Enterococcus faecalis，Bifidobacterium longum等；
1010 CFU/d）4周 益生菌组：34；
安慰剂组：38随机、双盲、
安慰剂对照试验增加自发排便次数，改善Bristol评分和便秘相关生活质量 [42] 2016 片剂（Lactobacillus acidophilus，Bifidobacterium infantis；
120 mg/d，活菌数不明）3个月 益生菌组：20；
曲美布汀组：20随机、双盲、
安慰剂对照试验改善腹胀、腹痛 [43]
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