肠道菌群在糖尿病膀胱功能障碍中的作用新机制及研究进展

Novel mechanisms and research progress on the role of gut microbiota in diabetic bladder dysfunction

摘要

糖尿病膀胱功能障碍（DBD）是糖尿病常见的慢性并发症之一，其临床表型表征了从早期的膀胱过度活动症（OAB）样高敏状态向晚期逼尿肌收缩乏力的动态演变过程。传统机制研究多聚焦于神经-肌源性损伤，而近年来的研究发现“肠-膀胱轴”在DBD的发生中扮演了重要角色。在糖尿病状态下，肠道菌群的改变可能通过促进系统性炎症反应、加重代谢紊乱与胰岛素抵抗、诱导氧化应激和影响神经调控机制等途径，对膀胱储尿或排尿功能产生影响，参与DBD的发生与发展。老龄化可进一步诱导菌群结构重塑、线粒体功能障碍、多重药物-菌群互作及神经内分泌调节受损，从而放大“肠-膀胱轴”异常并促进DBD进展。本文围绕肠道菌群及相关微生态改变在DBD中的潜在作用进行综述，希望为其发病机制研究提供新的思路，并为未来干预策略提供理论依据。

Abstract

Diabetic bladder dysfunction（DBD）is one of the common chronic complications of diabetes，and its clinical phenotypes represent a dynamic progression from an early overactive bladder（OAB）-like hypersensitive state to late-stage detrusor underactivity. Traditional mechanistic studies have mainly focused on neurogenic and myogenic injury，whereas recent research has revealed that the“gut-bladder axis”plays an important role in the development of DBD. Under diabetic conditions，alterations in the gut microbiota may affect bladder storage or voiding function and participate in the onset and progression of DBD by promoting systemic inflammatory responses，aggravating metabolic disturbances and insulin resistance，inducing oxidative stress，and influencing neural regulatory mechanisms. Aging may further induce remodeling of the microbial community structure，mitochondrial dysfunction，multidrug-microbiota interactions，and impaired neuroendocrine regulation，thereby amplifying abnormalities of the gut-bladder axis and promoting DBD progression. This article reviews the potential role of gut microbiota and related microecological alterations in DBD，with the aim of providing new perspectives for research into its pathogenesis and a theoretical basis for future intervention strategies.

关键词

糖尿病 / 糖尿病膀胱功能障碍 / 肠道菌群 / 肠-膀胱轴 / 衰老

Key words

diabetes mellitus / diabetic bladder dysfunction / gut microbiota / gut-bladder axis / aging

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基金资助

空军航空医学重点专项项目(HKYXZDZKKT01)

空军军医大学临床研究项目(2023LC2301)