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中华危重症医学杂志(电子版) ›› 2026, Vol. 19 ›› Issue (01) : 85 -89. doi: 10.3877/cma.j.issn.1674-6880.2026.01.014

综述

肠道菌群失调在农药中毒导致急性肾损伤中的研究进展
罗欣, 许佳琦, 汤庆, 陈超, 张跃, 王力军()   
  1. 300052 天津,天津医科大学总医院急诊医学科
  • 收稿日期:2025-04-25 出版日期:2026-02-28
  • 通信作者: 王力军
  • 基金资助:
    天津市卫生健康科技项目(TJWJ2025XK001)
  • Received:2025-04-25 Published:2026-02-28
引用本文:

罗欣, 许佳琦, 汤庆, 陈超, 张跃, 王力军. 肠道菌群失调在农药中毒导致急性肾损伤中的研究进展[J/OL]. 中华危重症医学杂志(电子版), 2026, 19(01): 85-89.

表1 导致AKI的常见农药及其毒性机制
图1 农药中毒与肠-肾轴注:TNF-α.肿瘤坏死因子α;IL-1β.白细胞介素1β;ROS.活性氧;NF-κB.核因子κB;NLRP3.核苷酸结合寡聚化结构域样受体蛋白3;ZO-1.闭锁小带蛋白1;F/B.厚壁菌门/拟杆菌门;TMAO.三甲胺氧化物;IS.硫酸吲哚酚;p-CS.硫酸对甲酚;SCFAs.短链脂肪酸;Scr.血肌酐;BUN.血尿素氮;GFR.肾小球滤过率;AKI.急性肾损伤。农药通过两条途径损伤肾脏:直接肾毒性以及肠-肾轴。在肠-肾轴通路中:①农药破坏肠道上皮屏障:激活NF-κB/NLRP3炎症信号,上调促炎因子(TNF-α、IL-1β、IL-6),下调紧密连接蛋白(Occludin、ZO-1),导致肠道屏障完整性受损。②肠道菌群失调与代谢紊乱:有益菌减少、有害菌增多、微生物多样性下降及F/B比例失衡;菌群失调进而改变代谢产物谱:保护性SCFAs生成减少,而肾毒性代谢物(TMAO、IS、p-CS)积累增加。③肠源性有害物质入血:这些肠道来源的炎症介质和毒性代谢物经门静脉进入体循环,作用于肾脏,通过加剧氧化应激、激活肾内炎症信号、诱导细胞死亡等多种机制,最终导致AKI。值得注意的是,肾功能下降可致尿毒症毒素反流至肠道,进一步破坏肠道微环境,形成恶性循环
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