通过肠肺轴预防呼吸机相关性肺炎：神灵白术散假说
Preventing ventilator-associated pneumonia via the gut-lung axis: the Shenling Baizhu San hypothesis.
摘要(中文译文)
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）中常见的医院获得性感染，与高发病率和死亡率相关，而患者衰弱和疾病严重程度往往加重了这一负担。尽管遵循抗生素治疗指南，死亡率仍持续居高不下。危重症会破坏肠道功能并改变上皮细胞动力学，具体表现为细胞凋亡增加和增殖减少，从而损害上皮单层的稳态。肠道通透性增加促进了细菌及微生物产物的易位。此外，肠道免疫功能受损加剧了全身性炎症和器官功能障碍。既往研究表明，ICU患者早期出现的严重获得性免疫抑制显著增加了继发感染的风险。肠-肺轴涉及胃肠道与呼吸系统之间的双向交流，与免疫调节及肺部疾病的进展密切相关。我们假设，参苓白术散（SLBZS）——一种传统上用于胃肠道疾病、富含多糖的多味中药复方——可通过重塑肠道菌群、增强肠黏膜屏障，并通过微生物群衍生代谢物如短链脂肪酸（SCFAs）调节从全身性炎症向危重症诱导的免疫麻痹（CIIP）的转变，从而降低VAP的易感性。验证这一假设将为管理高危VAP患者提供一种新颖的综合治疗策略。
Abstract
Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in the intensive care unit (ICU). It is associated with high morbidity and mortality, which are often compounded by patient frailty and disease severity. Despite adherence to antibiotic treatment guidelines, mortality rates remain persistently high. Critical illness disrupts intestinal function and alters epithelial cell dynamics, specifically increasing apoptosis and decreasing proliferation, thereby compromising the homeostasis of the epithelial monolayer. This increased intestinal permeability facilitates the translocation of bacteria and microbial products. Furthermore, impaired intestinal immunity exacerbates systemic inflammation and organ dysfunction. Previous studies indicate that the early onset of severe acquired immunosuppression in ICU patients significantly increases the risk of secondary infections. The gut-lung axis, which involves bidirectional crosstalk between the gastrointestinal and respiratory systems, is closely linked to immune regulation and the progression of lung diseases. We hypothesize that Shenling Baizhu San (SLBZS), a polysaccharide-rich multi-herb formula traditionally used for gastrointestinal disorders, could reduce susceptibility to VAP by reshaping the gut microbiota, enhancing the intestinal mucosal barrier, and modulating the transition from systemic inflammation to critical illness-induced immunoparalysis (CIIP) through microbiota-derived metabolites such as short-chain fatty acids (SCFAs). Validating this hypothesis would provide a novel, integrative therapeutic strategy for managing high-risk VAP patients.
如何引用
AMA
Xinyu Zhang, Jiawen Li, Yujia Lai, Guanxi Ren, Saiyin Chaoketu, Guofeng Cai. Preventing ventilator-associated pneumonia via the gut-lung axis: the Shenling Baizhu San hypothesis.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1829153.
APA
Xinyu Zhang, Jiawen Li, Yujia Lai, Guanxi Ren, Saiyin Chaoketu, Guofeng Cai (2026). Preventing ventilator-associated pneumonia via the gut-lung axis: the Shenling Baizhu San hypothesis.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1829153
GB/T 7714
Xinyu Zhang, Jiawen Li, Yujia Lai, Guanxi Ren, Saiyin Chaoketu, Guofeng Cai. Preventing ventilator-associated pneumonia via the gut-lung axis: the Shenling Baizhu San hypothesis.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1829153.
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