慢性阻塞性肺疾病(chronic obstructive pulmonary disease),简称“慢阻肺”,是最常见的慢性呼吸道疾病之一,临床特征主要包括气流受限和呼吸困难、咳嗽及咳痰等慢性呼吸道症状。慢阻肺已成为第三大死亡病因,在全球范围内呈现高患病率、高死亡率和高疾病负担的流行病学特征, 防控形式十分严峻。“肠-肺”轴概念的提出为慢阻肺等慢性呼吸道疾病发病机制研究及临床防治提供了新的方向。肠道菌群(gut microbiota)是寄居在机体肠道内微生物的统称,对宿主免疫、代谢等健康稳态具有重要作用。近年来的研究证实肠道菌群可能参与了慢阻肺的发生发展,一方面慢阻肺患者和动物的肠道微生物组成和功能异常,另一方面慢阻肺肠道菌群可诱发疾病样症状,而重塑肠道菌群至少部分可以延缓慢阻肺进程,减轻慢阻肺症状。本文旨在概述慢阻肺肠道微生物组最新发现,尤其是慢阻肺演进中的肠道菌群变化规律及其对慢阻肺发病的作用机制研究进展,为临床诊疗与研究提供新思路。

Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory diseases, clinically characterized by persistent airflow limitation and chronic respiratory symptoms such as dyspnea, cough, and sputum production. Currently, COPD has become the third leading cause of death worldwide, exhibiting high prevalence, high mortality, and a significant disease burden, making its prevention and control a critical public health challenge. The concept of the "gut-lung axis" provides novel insights into the pathogenesis of COPD, as well as its clinical prevention and treatment. The gut microbiota refers to the collective microorganisms residing in the intestinal tract, which play a vital role in maintaining host immunity and metabolic homeostasis. Recent studies have demonstrated the essential role of the gut microbiota in COPD pathogenesis. On one hand, the composition and functionality of the gut microbiota are perturbed in patients and rodents with COPD. On the other hand, gut microbiota derived from COPD patients can induce similar symptoms to those of the disease, whereas restoring the gut microbiota can at least partially delay the progression of COPD and alleviate its symptoms. This review summarizes the latest findings regarding the gut microbiota in COPD, particularly the role of gut microbiota in COPD pathogenesis and its underlying mechanisms, providing new insights into the future investigations, diagnosis and treatment of COPD.