银屑病与大肠（调研手稿四）

旧城等待， 2022-09-12 12:51 163阅读 0赞

肠胃相关的菌群名称：

<table style="width:500px;"> 
 <tbody> 
  <tr> 
   <td><strong>细菌名称</strong></td> 
   <td><strong>银屑病患者大肠菌群丰度</strong></td> 
   <td>作用</td> 
  </tr> 
  <tr> 
   <td>厚壁菌门(Phylum Firmicutes)【2】</td> 
   <td>增加</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>放线菌门(Actinomycetes)【2】</td> 
   <td>增加</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td> <p>Ruminoccocus gnavus【2】</p> </td> 
   <td>增加</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td> <p>Dorea formicigenerans【2】</p> </td> 
   <td>增加</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>Collinsella aerofaciens【2】</td> 
   <td>增加</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td> <p>Prevotella copri&nbsp;【2】</p> </td> 
   <td>降低</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>Parabacteroides distasonis【2】</td> 
   <td>降低</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>Akkermansia muciniphila【2】</td> 
   <td>降低</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>A. muciniphila【2】</td> 
   <td>降低</td> 
   <td>可以增强肠道上皮的完整性并能抵抗全身性炎性疾病。</td> 
  </tr> 
  <tr> 
   <td>Ruminococcus【2】</td> 
   <td>降低</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>Pseudobutyrivibrio【2】</td> 
   <td>降低</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>金黄色葡萄球菌（Staphylococcus aureus)【2】</td> 
   <td>增加</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>白色念珠菌（Candida albicans）【2】</td> 
   <td>增加</td> 
   <td></td> 
  </tr> 
  <tr> 
   <td>马拉色菌（Malassezia）【2】</td> 
   <td>增加</td> 
   <td></td> 
  </tr> 
 </tbody> 
</table>

有其他论文的表格中显示，目前存在，对上述结果互相矛盾的论文。

**促炎性细胞因子的分泌，上皮通透性增加和激活的效应T细胞之间的不平衡**

**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#毒素\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**

LPS(lipopolysaccharide)

**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#相关T淋巴细胞汇总\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**

<table style="width:285px;"> 
 <tbody> 
  <tr> 
   <td style="width:120px;"><strong>T淋巴细胞名称</strong></td> 
   <td style="width:163px;"><strong>备注</strong></td> 
  </tr> 
  <tr> 
   <td style="width:120px;">Treg</td> 
   <td style="width:163px;"></td> 
  </tr> 
  <tr> 
   <td style="width:120px;">T1</td> 
   <td style="width:163px;"></td> 
  </tr> 
  <tr> 
   <td style="width:120px;">T2</td> 
   <td style="width:163px;"></td> 
  </tr> 
  <tr> 
   <td style="width:120px;">T17</td> 
   <td style="width:163px;"></td> 
  </tr> 
 </tbody> 
</table>

**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#相关的白细胞介素\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**

<table style="width:234px;"> 
 <tbody> 
  <tr> 
   <td style="width:143px;"><strong>白细胞介素名称</strong></td> 
   <td style="width:87px;"><strong>备注</strong></td> 
  </tr> 
  <tr> 
   <td style="width:143px;">IL-17A[11]</td> 
   <td style="width:87px;"></td> 
  </tr> 
  <tr> 
   <td style="width:143px;">IL-12</td> 
   <td style="width:87px;"></td> 
  </tr> 
  <tr> 
   <td style="width:143px;">IL36R【10】</td> 
   <td style="width:87px;"></td> 
  </tr> 
 </tbody> 
</table>

** **

**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**脆弱拟杆菌**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**

【4】中的总结说的很到位：“同为脆弱拟杆菌，不同菌株间可存在巨大差异，有的促癌，有的则有潜在的益生作用”

<table style="width:500px;"> 
 <tbody> 
  <tr> 
   <td><strong>菌群名称</strong></td> 
   <td><strong>备注</strong></td> 
  </tr> 
  <tr> 
   <td>Enterotoxigenic Bacteroides fragilis(ETBF)</td> 
   <td>产生肠毒素致癌【6】【7】</td> 
  </tr> 
  <tr> 
   <td>BF839</td> 
   <td> <p>阻断致癌物</p> <p>[9]中被用来治疗银屑病</p> </td> 
  </tr> 
 </tbody> 
</table>

\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#

青黛、姜黄素、膳食调节剂、鱼油、，

冥想和针灸

上述内容来自【8】

**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#肠黏膜通透\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**

**肠黏膜通透检测**【3】**：**

乳果糖(L)

甘露醇(M)

口服测试液50ml(乳果糖10g，甘露醇5g)

**测量方法：**

高效液相色谱法

**检测结果：**

<table style="width:500px;"> 
 <tbody> 
  <tr> 
   <td style="width:127px;"></td> 
   <td style="width:95px;"><strong>数量</strong></td> 
   <td style="width:326px;"><strong>L/M</strong></td> 
  </tr> 
  <tr> 
   <td style="width:127px;"><strong>银屑病患者</strong></td> 
   <td style="width:95px;">40人</td> 
   <td style="width:326px;">0.070±0.026</td> 
  </tr> 
  <tr> 
   <td style="width:127px;"><strong>健康群体</strong></td> 
   <td style="width:95px;">20人</td> 
   <td style="width:326px;">0.029±0.006</td> 
  </tr> 
 </tbody> 
</table>

**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#产生神经递质的菌株\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**

![16784c7b6866d9f8382f573344303b98.png][]

\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#一些重要的学术结论\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#

Given all the above findings, it can be speculated that gut dysbiosis in psoriasis may be a result of differential abundance of bacteria instead of the quantity of bacterial species.【13】

（鉴于上述所有发现，可以推测银屑病患者的肠道生态失调可能是细菌数量差异而不是细菌种类数量差异的结果）  
**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#大肠杆菌\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**

**大肠杆菌属于变形菌门**

**根据【1】，大肠杆菌分为：**

即能够致使胃肠道感染的肠道致病性的大肠杆菌（EPEC）

肠道产毒素性的大肠杆菌 (ETEC)、

肠道侵袭性的大肠杆菌(EIEC)、

肠道出血性的大肠杆菌 (EHEC)、

肠集聚性的大肠杆菌（EAEC） 以及近年来发现的肠产志贺样毒素同时具有一定侵袭力的大肠杆菌（ESIES）

能够致使尿道感染的尿道致病性的大肠杆菌 (UPEC)，

最新命名的肠道集聚性的黏附大肠杆菌（EAggEC）

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现已证实益生菌可以抑制特应性，皮炎的炎症反应，有明确的治疗效果\[4\]，对益生菌治  
疗银屑病起到启示作用

人类肠道菌群中最主要的菌群包括厚壁菌门、拟杆菌门、放线菌门和变形菌门

银屑病的基本发病机制是免疫系统的异常，免疫失衡核心机制在于白介素-23/白介素-17 (inter⁃  
leukin-23/interleukin-17，IL-23/IL-17）轴，肿瘤坏死因子-ɑ (tumor necrosis factor-ɑ，TNF-ɑ）和特定的皮肤细胞树突细胞和角化细胞等\[19\]。有研究\[18\]显示，银屑病患者肠道中参与短链脂肪酸代谢（short-chain fatty acids，SCFA）的粪球菌属、布劳特氏菌属、双岐杆菌属丰度较健康人降低。短链脂肪酸可通过G蛋白偶联受体43(G protein-coupled receptor，GPR43）上调调节性T细胞（Treg细胞）\[20\]。对调控辅助性T细胞Th1/Th2、Th17/Treg等免疫平衡的功能起到重要促进  
作用\[21\]。

普拉梭菌属  
是产生丁酸盐主要来源，丁酸盐可以稳定参与屏障保护的缺氧诱导因子(hypoxia inducible factor，HIF)，诱导增强屏障功能的HIF靶基因表达，并通过抑制NF-κB通路，从而抑制炎症反应的，减少氧化应激。

然而，银屑病患者肠道中的拟杆菌门的副拟杆菌属和厚壁菌门的普拉梭菌属显著降低\[22-25\]。所以，肠道细菌的失调和相关代谢产物降低对银屑病患者的慢性炎症影响显著。

有实验表明，益生菌可以抑制皮肤炎症。在诱发慢性皮肤炎症小鼠中，经益生菌混合物治疗后，在宏观和微观水平上均显著限制了其慢性皮肤炎症。这与促炎细胞因子IL-1β、IL-6、TNF-ɑ、IL-17和IL-22的下调水平以及抗炎细胞因子IL-10和IL-4的上调水平一致\[27\]。在另一个实验中\[28\]也发现唾液乳杆菌LA307和鼠李糖乳杆菌LA305也有显著抑制银屑病炎症效果，可能是通过调节肠道菌群来保持体内稳态。

在用咪喹莫特诱导的表皮增生和的银屑病样皮肤炎症小鼠中\[29\]发现，用戊糖乳杆菌GMNL-77治疗可显著减少红斑鳞屑病变，降低TNF-ɑ、IL6 和IL-23/IL-17A轴等促炎细胞因子的mRNA水平和病变小鼠皮肤中的相关细胞因子（IL-23，IL-17A/F，IL-22）。并且可以降低脾脏重量，减少其产生IL-17和IL-22的CD4+ T细胞的数量。有研究\[30\]表明，大肠杆菌也可改善咪喹莫特诱导的银屑病小鼠炎症情况。益生菌通过调节银屑病样皮损小鼠的炎症因子来起到明确的治疗作用。

口服益生菌可以对肠道的细菌进行调节，通过下调银屑病的促炎因子，上调抑炎因子，降低脾脏重  
量等方式来抑制银屑病的炎症反应

银屑病患者的血清存在大量失调的细胞因子和炎症标志物

上述结论来自【14】

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探讨了银屑病疾病状态下肠道  
菌群的多样性特征，发现银屑病患者较健康人的肠道  
菌群多样性显著降低。亦有研究发现，银屑病患者肠  
道菌群多样性和相对丰度明显减少，其中双歧杆菌  
属、布劳特氏菌属、粪球菌属等在银屑病患者肠道中  
显著降低\[15\]。孙超楠\[16\]认为银屑病患者发生反酸、背  
痛、恶心或呕吐、排气增多、排便紧迫感和排便不尽  
感等症状显著高于大众人群，并通过16SrRNA高通量  
测序分析了银屑病患者治疗前后的肠道菌群特征，  
结果发现瘤胃菌科（Ruminococcaceae）、粪球菌属  
（Coprococcus）和劳特氏菌属（Blautia）在患者治  
疗后和正常对照肠道中均显著降低，该研究证实了胃  
肠道与银屑病的密切关系。王群等\[17\]提出寻常型银屑  
病患者对人体皮肤正常菌群的嗜脂性马拉色菌存在免  
疫应答异常，斑块状寻常型银屑病的发病和（或）病  
情加重可能与嗜脂性马拉色菌有关。

且有研究采用四君子汤复  
方剂灌喂脾虚型小鼠，发现小鼠胃肠道中乳杆菌、双  
歧杆菌数量明显增加，而肠球菌数量明显减少，表明  
肠道菌群恢复正常\[28-30\]。

从肺、肠论治 临床众多医者提出“从肺论治”  
银屑病，李淑华等\[31\]提出宣畅肺气的治疗原则，并重  
用桔梗，治疗效果显著。邢锦秀等\[32\]以宣肺润燥，滋  
阴清热为大法论治银屑病，自拟宣肺润燥汤加减治  
疗，临床效果良好。顾敏婕等\[33\]从肺论治银屑病，临  
床上将其分为6个证型，分别为风寒袭表证、风热犯  
肺证、湿热蕴肺证、热邪壅肺证、肺热毒盛证、肺胃  
津伤证，辨证施治，其总有效率为92%。范叔弟等\[34\]  
治疗银屑病常用银翘散、麻黄汤、桑白皮汤合五味消  
毒饮、自拟银五号方加减，效果较好。张楚翘等\[35-36\]  
从肺论治银屑病，注重清热肺，清热解毒药物也多选  
用轻灵透达、清解发散的药物，如金银花、连翘、野  
菊花等，同时强调在运用苦寒药物的同时注重宣肺  
气，通阳气，如加用麻黄、细辛等。

益生菌、益生元对  
皮肤具有免疫调节作用，通过降低皮肤细菌负荷和拮抗侵袭性共生，增强皮肤屏障修复功能\[38\]。Rather等\[39\]在一项为期6 d的动物试验中，发现乳酸杆菌益  
生菌-65改善了咪喹莫特诱导的小鼠银屑病皮损严重  
程度，还降低了银屑病相关的促炎细胞因子。Chen  
等\[13\]也证实了这一观点，经过益生菌处理的小鼠明显  
较少出现红斑、鳞屑和表皮增厚。国外研究证实，使  
用嗜酸乳酸杆菌（Lactobacillus acidophilus）CBT LA1  
（KCTC 11906BP）等七株双歧杆菌和乳酸菌组成的  
核心菌群可显著改善二硝基氯苯诱发的皮炎小鼠模型  
的皮损严重程度，包括Th1/Th2平衡和皮肤屏障指标  
恢复，以及Treg细胞的上调\[40\]。也有研究证实，银屑  
病患者口服8周双歧杆菌（Bifidobacterium infantis）  
35624后，与对照组比较，IL-6和TNF-α等细胞因子  
显著下降\[41

上述结论来自【15】

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普拉梭菌属是大  
肠中最常见的微生物之一，它是丁酸盐的重要来源，  
可以为结肠细胞提供能量，减少氧化应激，并通过触  
发调节性T细胞赋予短链脂肪酸(short chain fatty  
acid，scFA)抗炎作用¨㈣1|。sCFA对Treg细胞发挥  
调控Thl／Th2、卟17／Treg等若干免疫平衡的功能起  
到不可替代的促进作用，scFA缺乏或缺陷与物理屏  
障、细胞能量、营养代谢、免疫炎性反应等相关¨2I。  
厚壁菌门的某些属种可通过SCFA的G蛋白偶联受  
体43(G protein\_coupled receptor，GPR43)上调rI'reg细  
胞H 3I。此外，sCFA—GPR43受体轴可抑制中性粒细胞  
的炎性反应作用¨4|。研究者在一项随机、双盲、安慰  
剂对照的I临床试验。1纠中发现，基线时炎性标志物升  
高的银屑病患者口服婴儿双歧杆菌35624治疗6～8  
周可降低银屑病患者的血浆c一反应蛋白(c—reactive  
protein，CRP)和肿瘤坏死因子．仅(tumor necmsis fac．  
tor，TNF一仅)水平。研究者评估戊糖乳杆菌GMNL-77  
对咪喹莫特诱导的银屑病小鼠模型的影响，发现与未  
处理的对照小鼠相比，益生菌处理的小鼠表现更轻度  
的红斑、鳞屑和表皮增厚¨6|。

有学者口副通过研究慢性腹泻患者  
的肠道菌群特征，发现：与脾虚证组比较，脾胃湿热证  
组肠道需氧菌肠杆菌、肠球菌、双歧杆菌和肠杆菌比  
值及厌氧菌双歧杆菌、乳杆菌均升高，二证型之间存  
在不同程度的肠道菌群失调。不同证型的中重度痤  
疮患者具有不同的肠道菌群特征，与正常对照人群比  
较，痰湿证患者产碱杆菌科(属变形菌门)和苏特拉菌  
属(属变形菌门)丰度高，无柏科一普雷沃菌属∞9|。  
消化性溃疡不同中医分型的肠道菌群的物种构成之  
间存在部分门水平和种属水平上的差异，门水平上的  
中医分型可从放线菌门区分脾气虚弱证㈣J。以上报

道为从肠道微生态开展银屑病症候研究提供了参考。

证候分类是中医疾病诊断和治疗的基础和依据，  
银屑病临床多分为血热证、血燥证、血瘀证三证型进  
行辨证论治H1|，三种不同中医证型表现出的皮损特  
点、症状、体征复杂且多变，有些尚无量化性标准。有  
研究者m o选取52名银屑病患者，分析其肠道菌群组  
成，首次鉴定出“银屑病相关的核心肠道菌群”，可明  
确区分银屑病患者与健康人群；并将银屑病患者的肠  
型归类为2型，相比于其他肠型(1型及3型)，2型肠  
型的个体倾向于表现出更频繁的细菌易位，以及更高  
的炎性反应状态

上述结论来自【16】

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部分益生菌会分泌葡萄糖醛酸酶，一旦益生菌数量降低、葡萄糖醛酸酶分泌减少，会造成蛋白消化酶在肠道中保留，并对肠黏膜产生消化破坏的作用。

由于益生菌紧贴肠黏膜，起到贴身保卫的作用，如果肠黏膜得不到有益菌的保护，肠黏膜的保护屏障就会受损，通透性增加，容易诱发局部的免疫反应或炎症反应；当肠内黏膜受损，过敏物质、毒素及细菌就可能进入受损的肠黏膜到达血液等其它器官，诱发炎症性或过敏性皮肤病如银屑病等。利用益生菌，可调节患者肠道功能，有助于免疫力的逐渐提高，使过敏物质、毒素等难以进入血液中，因此炎性因子水平也会下降。

上述结论来自【17】

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**目前已知的肠道微生物  
群落可分为三大部分:**

**①与宿主共生的生理性细菌，为专性厌氧菌，如双歧杆菌、类杆菌、优杆菌和消化球菌等，是肠道的优势菌群，具有营养及免疫调节作用;**

**②与宿主共栖的条  
件致病菌，以兼性需氧菌为主，为肠道非优势菌群，如肠球菌、肠杆菌，肠道微生态平衡时无害，在特定的条件下对人体有害;**

**③病原菌，大多为过路菌，长期定植的机会少，肠道微生态平衡时无害，若数量超出正常水平，则可引起人体发病，如变形杆菌、假单胞菌和韦氏梭菌等［6］。消化道正常菌群的种类、数量和分布受多种因素影响，诸如宿主与微生物、微生物及微生物之间的互相作用以及宿主的年龄、饮食  
习惯等。**

**肠道正常微生物群与宿主的消化、营养、代谢、免疫等密切相关，相当于人体后天获得的一个重要“器官”，对人体生理活动具有重要的作用:**

**①营养作用:**

**肠道内一些正常微生物，如双歧杆菌、乳杆菌等能合成多种蛋白质和维生素供宿主利用。**

**②防御作用:**

**正常微生物群定植在胃肠道黏膜和胃肠道内容物中，形成胃肠道的动态微生态平衡，能阻止外籍致病微生物的入侵和繁殖。**

**③免疫调节作用:**

**胃肠道的微生物能剌激宿主建立完备的免疫系统。正常微生物不仅能刺激机体免疫器官的发育，而且对增强机体特异性细胞和体液免疫是不可缺少的。**

**我国赵立平［11］对一个四世同堂中国家庭成员3 年跟踪研究，初步鉴定出肠道内参与人体代谢过程的一些重要的功能细菌元基因组，提示微生态的稳定遗传很可能是人类与遗传相关性疾病的重要物质基础。国外学者的研究［12］，将肥胖小鼠的肠道菌群移植至野生型无菌小鼠体内，导致后者摄食能量的能力明显提高而引起肥胖，更证实了疾病表型可以受肠道微生态调控，  
并随微生物群落在不同个体间发生转移**

**应激反应肠道菌群易位与银屑病  
临床上长期或突然的过度紧张、抑郁、劳累等神经、精神因素是银屑病诱发和复发的重要原因。一方面，机体在一定条件下分泌神经激素及其受体介导皮肤的功能活动，皮肤细胞、免疫细胞、神经细胞所形成皮肤免疫神经系统可诱导和维持皮肤的炎症过程［13］。另一方面，长期或突然的  
精神和神经刺激可引起机体的应激反应。  
应激反应也称为狩猎式反应，在突然受到外界刺激( 如创伤、手术、感染、饥饿等) 时，机体为保证心、脑组织的血液供氧，在肠绒毛的血管袢处发生血流“短路”。动脉血不经肠绒毛的毛细血管网直接进入肠绒毛静脉，引发肠黏膜缺氧、坏死脱落、毛细血管网失去屏障，肠道正常细菌易位入血［6， 14］，破坏肠道微生态平衡。长期累积形成体内慢性感染源［14 － 15］，刺激机体产生多种细胞因子［16］，并导致天然免疫功能失调［17］，形成了皮肤炎症( 表皮细胞角化过度  
和角化不全等) 。  
应激状态下，肠道正常菌群由原籍菌变为血液中的外籍菌，初始细菌入血无明确的临床感染症状或体征。机体免疫系统不能识别原籍菌易位所成为的外籍菌，在机体不同环境和免疫功能作用下，外籍菌为适应生存而变异为部分或完全缺壁的细菌，称细菌L 型［18 － 19］。有研究表明细菌L 型是银屑病重要的致病菌。肠道细菌初始入血是细菌型，刺激机体引起T、B 细胞的活跃趋势，各类细胞因子产生，不断产生轻微的内源性感染，如初期的孤立红疹、瘙痒等。机体正常免疫功能作用下，可以限制进入血流的“外籍菌( 正常菌群) ”，不引起皮肤炎症性病变; 或红疹逐渐消失，疾病转归。当肠道细菌不断入血，机体的内源性感染损伤，免疫功能失调加重，逐渐转化为全身性疾病，即银屑病所表现的慢性、炎症性、全身皮肤感染状态。**

上述结论来自【18】

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上述内容来自【36】

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文中提到了阿维A（但是副作用不小）

上面内容来自【11】

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**在另一个实验中\[28\]也发现唾液乳杆菌LA307和鼠李糖乳杆菌LA305也有显著抑制银屑病  
炎症效果，可能是通过调节肠道菌群来保持体内稳  
态**

【14】

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**BF839能抗癌。**

上述内容来自【5】

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**提到了其他人的文献：**

**戊糖乳杆菌、唾液乳杆菌**

**上述内容来自【14】**

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部分益生菌会分泌葡萄糖醛酸酶，一旦益生菌数量降低、葡萄糖醛酸酶分泌减少，会造成蛋白消化酶在肠道中保留，并对肠黏膜产生消化破坏的作用。

**上述内容来自【17】**

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四君子汤复方剂

小鼠胃肠道中乳杆菌、双歧杆菌数量明显增加，而肠球菌数量明显减少，从而使得紊乱的肠道菌群恢复正常。

**上述内容来自【20】**

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**丁酸盐食物要多吃粗纤维，粗纤维能形成丁酸盐【24】**

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**拟**杆菌门的副拟杆菌属、厚壁菌门的普拉梭菌属等显著降低\[4\]，这种改变会破坏肠道微生物与机体之间的平衡，菌群可从能量吸收、短链脂肪酸、胆碱、胆汁酸代谢和脑肠轴等多种途径影响宿主的健康\[5\]，从而加重银屑病。

四君子汤复方剂

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When I was a third-year naturopathic medical student in 1973, one of my professors (Bob Carroll, dc, nd) started the first class of the year with the provocative statement, “Death begins in the colon!” I was skeptical. Having just finished basic sciences, the textbooks were very clear that the gut was a perfect protective membrane only allowing in nutrients the body needed. He then went on to lecture about how patients with digestive problems were more “toxic” and that by restoring proper digestive function and healthy flora, many experienced improved health. While I could see during clinic rotations that improving digestion and recommending eating natural yogurt helped patients with diverse diseases, I remained skeptical until I graduated in 1975.

During the first year of practice, I subscribed to several journals to read during those slow times building patient flow. I was quite diverse in my reading, ranging from the Lancet (which, though conventional medicine, had a surprising number of articles on nutrition and environmental medicine), the American Journal of Clinical Nutrition (back then, very conservative and dismissive of nutritional supplements), and a half dozen others. To my great surprise, I read a startling and controversial study reporting that in healthy animals, up to 1% of ingested proteins are absorbed intact and absorption increases to as much as 10% during severe gastrointestinal infection. My immediate thought was that “old” doctor Carroll might be right!

（

1973年，当我还是一名自然疗法医学三年级学生时，我的一位教授（哥伦比亚特区鲍勃·卡罗尔）以一句挑衅性的话开始了今年的第一节课：“死亡始于结肠！”我对此表示怀疑。刚刚完成基础科学的教科书非常清楚，肠道是一个完美的保护膜，只允许身体需要的营养。然后，他继续讲述消化问题患者如何更“有毒”，通过恢复适当的消化功能和健康的菌群，许多人的健康状况得到了改善。虽然我在临床轮换期间看到，改善消化和推荐食用天然酸奶有助于患有多种疾病的患者，但直到1975年毕业，我一直持怀疑态度。

在实习的第一年，我订阅了几本杂志，以便在建立患者流的缓慢时期阅读。我的阅读内容非常多样化，从《柳叶刀》（Lancet）（尽管是传统医学，但有大量关于营养和环境医学的文章）、美国临床营养学杂志（American Journal of Clinical nutrition）（当时对营养补剂非常保守和不屑一顾），以及六篇其他文章。令我大吃一惊的是，我读到了一份令人震惊且有争议的研究报告，报告称在健康动物中，高达1%的摄入蛋白质被完整吸收，在严重胃肠道感染期间，吸收增加到高达10%。我立刻想到“老”卡罗尔医生可能是对的！

从那以后，我一直非常感兴趣地关注着我们对肠道在健康和疾病中的作用的理解。中西医结合的临床医生现在非常清楚消化不良、吸收不良、肠道渗漏、小肠细菌过度生长、肠道内不适当的细菌以及其他因素是如何导致甚至可能导致疾病的。当新墨西哥州圣达菲市的迈克尔·弗里德曼（Michael Friedman）问我想在2014年10月的恢复医学大会上介绍什么话题时，我建议我可以深入研究，看看关于肠道毒素的古老观点是否与临床相关。令人高兴的是，他热情地同意了。以下是我的发现，我认为这只是冰山一角。

）

In This Issue  
As John Weeks so eloquently states, the partnership between the Institute for Functional Medicine and the Cleveland Clinic could indeed be a tipping point. This is a remarkable opportunity to demonstrate in a bastion of conventional medicine that fundamentally changing the way we think about patients is the only real solution to the health care crisis. The leadership of Senator Tom Harkin (D-IA) was pivotal for advancing integrative medicine at the federal level. His retirement, while much deserved, is cause for concern. At the events organized by the integrative medicine community to honor Senator Harkin, I interviewed the many integrative medicine leaders in attendance and recorded the evening ceremony. These will be the basis of my next editorial.

Providing further substance for my editorial, Matthew J. Bull, bsc, phd, and Nigel T. Plummer, phd, provide us a 2-part series (Part 2 forthcoming) on the human gut microbiome. The first sentence of their abstract says it all: “The bacterial cells harbored within the human gastrointestinal tract (GIT) outnumber the host’s cells by a factor of 10 and the genes encoded by the bacteria resident within the GIT outnumber their host’s genes by more than 100 times.”

One of the problems with the US Department of Agriculture’s GRAS List (Generally Recognized as Safe) is that food manufacturers appear to have used this as justification/cover for indiscriminately adding large amounts of various chemicals to the food we eat. This has in some cases resulted in unexpected and significant physiological dysfunction. Associate Editor Lara Pizzorno, mdiv, ma, lmt, provides us an in-depth look at how our modern, processed food diet has resulted in excessive intake of phosphorous causing distorted metabolism and increased risk for several diseases.

正如约翰·韦克斯（John Weeks）雄辩地指出的那样，功能医学研究所和克利夫兰诊所之间的合作关系确实可能是一个转折点。这是一个极好的机会，可以在传统医学的堡垒中证明，从根本上改变我们对患者的看法是解决医疗危机的唯一真正办法。参议员汤姆·哈金（D-IA）的领导对于在联邦层面推进综合医学至关重要。他的退休虽然当之无愧，但令人担忧。在中西医结合社区为纪念哈金参议员而组织的活动中，我采访了许多与会的中西医结合领导人，并记录了晚间仪式。这些将是我下一篇社论的基础。

为我的社论Matthew J.Bull，理学学士，博士和Nigel T.Plummer，博士提供了进一步的内容，为我们提供了一个关于人类肠道微生物组的两部分系列（第2部分即将出版）。他们摘要的第一句话说明了这一切：“人类胃肠道（GIT）内的细菌细胞数量比宿主细胞数量多10倍，GIT内细菌编码的基因数量比宿主基因数量多100倍。”

美国农业部GRAS清单（通常被认为是安全的）的一个问题是，食品制造商似乎以此为理由/掩护，不分青红皂白地向我们食用的食品中添加大量各种化学物质。在某些情况下，这会导致意外和严重的生理功能障碍。副主编Lara Pizzorno，mdiv，ma，lmt，为我们深入了解现代加工食品饮食是如何导致磷摄入过量，从而导致代谢紊乱和多种疾病风险增加的。

上述内容来自【33】

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The composition of this probiotic mixture was Bifidobacterium longum CECT 7347, B. lactis CECT 8145 and Lactobacillus rhamnosus CECT 8361 with a total of 1×109 colony-forming units (CFU) per capsule, formulated on maltodextrin.

益生菌混合物的成分为长双歧杆菌CECT 7347、乳双歧杆菌CECT 8145和鼠李糖乳杆菌CECT 8361

有效率66.7%

During the post study follow-up there were 9 relapses out of 45 patients (20%) included in the probiotic group, and 18 relapses of 43 patients assigned to the placebo group (41.9%) The p-value for the log-rank test was 0.027 (Fig. 5). Detailed information is shown in Table SI.（在研究后随访期间，益生菌组45名患者中有9名复发（20%），安慰剂组43名患者中有18名复发（41.9%），对数秩检验的p值为0.027（图5）。详细信息见表SI。）

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atopic dermatitis（过敏性皮肤炎）

Lactobacillus GG（乳杆菌GG）  
Bifidobacterium lactis（乳双歧杆菌）

上述内容来自【35】

**\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#个人观点\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#\#**

**①银屑病的人血有问题，但是本身没有问题，是被毒素污染了。**

②有抑制骨髓就变好的，这可能是住院时控制饮食导致的。

③生物制剂和激素类都是治标不治本，不应当被奉为唯一途径。

**Reference:**

【**1】**[大肠杆菌\_百度百科][Link 1]

【2】[牛皮癣看似皮肤病，实则关系到肠道\_患者][Link 2]

【3】[银屑病患者肠粘膜通透性变化的研究 - 百度学术][-]

【4[】Cell子刊：脆弱拟杆菌毒素如何促进结肠肿瘤发生 | 热心肠日报][Cell_ _]

【5】[脆弱拟杆菌BF839阻断致癌物\_哔哩哔哩\_bilibili][BF839_bilibili]

【6】[Patients with familial adenomatous polyposis harbor colonic biofilms containing tumorigenic bacteria][]

【7[】Science：在家族性息肉病人肠道里，有两种细菌促癌！ | 热心肠日报][Science_ _]

【8】[Complementary and Alternative Medicine Therapies for Psoriasis: A Systematic Review][Complementary and Alternative Medicine Therapies for Psoriasis_ A Systematic Review]

【9】[脆弱拟杆菌BF839治疗寻常型银屑病：一项单臂、开放初步临床试验 - 中国知网][BF839_ -]

【10】[Science子刊：抑制IL-36R信号或可治疗皮肤炎症和肠屏障损伤 | 热心肠日报][Science_IL-36R_ _]

【11】[肠道菌群参与寻常型银屑病病程发展的实验研究 - 豆丁网][- 1]

【12】[姜黄素通过调节肠道菌群可改善脂多糖诱导糖尿病 - 百度学术][- 2]

【13】[Gut Microbiome in Psoriasis: An Updated Review][Gut Microbiome in Psoriasis_ An Updated Review]（已经在调研手稿一中阅读过）

【14】肠道益生菌治疗银屑病研究进展

### 【15】从肠道微生态角度论治银屑病 ###

### 【16】肠道微生态与银屑病的中医研究 ###

[【17】益生菌不仅对肠道有好处，还可以对抗牛皮癣][17]

【18】银屑病与肠道菌群微生态调节机制探析

【19】银屑病患者肠粘膜通透性变化的研究（重复）

[【20】治疗银屑病，别忘记“整治”肠道菌群 - 知乎][20_ -]（无重要知识点）

[【21】肠道微生态与银屑病的中医研究--《首都医科大学学报》2019年03期][21_--_2019_03]（重复了）

[【22】益生菌不仅对肠道有好处，还可以对抗牛皮癣|免疫系统|细菌|肠道菌群\_网易订阅][17]（重复了）

[【23】益生菌与银屑病\_治疗][23]（链接错误）

【24】[GUT : 丁酸盐通过肠-脑神经回路降低食欲并激活棕色脂肪组织][GUT _ _-]

[【25】LPS的秘密 - 知乎][25_LPS_ -]（无用）

[【26】小红书][26]

[【27】LPS的秘密 - 知乎][25_LPS_ -]（重复）

[【28】Multifaceted Interactions of Bacterial Toxins With the Gastrointestinal Mucosa][28_Multifaceted Interactions of Bacterial Toxins With the Gastrointestinal Mucosa]

[【29】Absorption of botulinal toxin from the gastrointestinal tract - PubMed][29_Absorption of botulinal toxin from the gastrointestinal tract - PubMed]

[【30】Absorption of Botulinal Toxin from the Gastrointestinal Tract | Clinical Infectious Diseases | Oxford Academic（重复）][30_Absorption of Botulinal Toxin from the Gastrointestinal Tract _ Clinical Infectious Diseases _ Oxford Academic]

[【31】What Is Butyrate and Butyrate Foods to Eat | Livestrong.com][31_What Is Butyrate and Butyrate Foods to Eat _ Livestrong.com]

[【32】治疗银屑病，别忘记“整治”肠道菌群 - 知乎][32_ -]

[【33】Toxins From the Gut][33_Toxins From the Gut]

[【34】Efficacy and Safety of Oral Administration of a Mixture of Probiotic Strains in Patients with Psoriasis: A Randomized Controlled Clinical Trial | HTML | Acta Dermato-Venereologica][34_Efficacy and Safety of Oral Administration of a Mixture of Probiotic Strains in Patients with Psoriasis_ A Randomized Controlled Clinical Trial _ HTML _ Acta Dermato-Venereologica]

【35】Treatment efficacy of probiotics on atopic dermatitis，zooming in on infants

【36】银屑灵对过度增殖人角质形成细胞STAT3通路干预的影响

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[Link 1]: https://baike.baidu.com/item/%E5%A4%A7%E8%82%A0%E6%9D%86%E8%8F%8C/556836?fr=aladdin
[Link 2]: https://www.sohu.com/a/434802866_120511723
[-]: https://xueshu.baidu.com/usercenter/paper/show?paperid=bbcfc23cdf56fb777a5f06e45a5bb7c6&sc_from=pingtai4&cmd=paper_forward&title=%E9%93%B6%E5%B1%91%E7%97%85%E6%82%A3%E8%80%85%E8%82%A0%E7%B2%98%E8%86%9C%E9%80%9A%E9%80%8F%E6%80%A7%E5%8F%98%E5%8C%96%E7%9A%84%E7%A0%94%E7%A9%B6&wise=0
[Cell_ _]: https://www.mr-gut.cn/papers/read/1074043583
[BF839_bilibili]: https://www.bilibili.com/video/av416877855/
[Patients with familial adenomatous polyposis harbor colonic biofilms containing tumorigenic bacteria]: https://www.science.org/doi/10.1126/science.aah3648
[Science_ _]: https://www.mr-gut.cn/papers/read/1037872544
[Complementary and Alternative Medicine Therapies for Psoriasis_ A Systematic Review]: https://pubmed.ncbi.nlm.nih.gov/30193251/
[BF839_ -]: https://kns.cnki.net/kcms/detail/detail.aspx?dbcode=CAPJ&dbname=CAPJLAST&filename=SHWU20210618003&uniplatform=NZKPT&v=8IWtJbjwE6Qg1C%25mmd2B4xvx9LQ5CO26XtFG%25mmd2ByXWluZTRyehiU8pxJ2X1JF0yZWW8tvE2
[Science_IL-36R_ _]: https://www.mr-gut.cn/papers/read/1095337208
[- 1]: https://www.docin.com/p-2403238817.html&dpage=1&key=%E9%93%B6%E5%B1%91%E7%97%85%E6%80%8E%E4%B9%88%E6%B2%BB&isPay=-1&toflash=0&toImg=0
[- 2]: https://xueshu.baidu.com/usercenter/paper/show?paperid=d9be1455ad407e11f60e3c85033df2a4&site=xueshu_se
[Gut Microbiome in Psoriasis_ An Updated Review]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350295/
[17]: https://www.163.com/dy/article/FQBBK8GJ05372F7N.html
[20_ -]: https://zhuanlan.zhihu.com/p/137526365
[21_--_2019_03]: https://www.cnki.com.cn/Article/CJFDTotal-SDYD201903009.htm
[23]: https://www.sohu.com/a/357819884_120051898
[GUT _ _-]: http://www.360doc.com/content/18/0511/21/30227855_753193776.shtml
[25_LPS_ -]: https://zhuanlan.zhihu.com/p/258624761
[26]: https://www.xiaohongshu.com/discovery/item/5fec6321000000000101efd8
[28_Multifaceted Interactions of Bacterial Toxins With the Gastrointestinal Mucosa]: https://www.medscape.com/viewarticle/747838
[29_Absorption of botulinal toxin from the gastrointestinal tract - PubMed]: https://pubmed.ncbi.nlm.nih.gov/399373/
[30_Absorption of Botulinal Toxin from the Gastrointestinal Tract _ Clinical Infectious Diseases _ Oxford Academic]: https://academic.oup.com/cid/article-abstract/1/4/663/485346?redirectedFrom=fulltext
[31_What Is Butyrate and Butyrate Foods to Eat _ Livestrong.com]: https://www.livestrong.com/article/553726-what-foods-are-high-in-butyrate/
[32_ -]: https://zhuanlan.zhihu.com/p/137526365?utm_source=wechat_session
[33_Toxins From the Gut]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566437/
[34_Efficacy and Safety of Oral Administration of a Mixture of Probiotic Strains in Patients with Psoriasis_ A Randomized Controlled Clinical Trial _ HTML _ Acta Dermato-Venereologica]: https://www.medicaljournals.se/acta/content/html/10.2340/00015555-3305