胆道镜探查对肠肝轴影响的研究进展

杨 继业1, 周 瀛*2
1、青海大学临床医学院
2、青海大学附属医院，肝胆胰外科

摘要


肠肝轴（GLA）是肠道与肝脏通过门静脉、胆道及系统循环形成的双向通信网络，其稳态与多种肝病密切相关。本研究探讨胆道镜操作对肠肝轴的影响机制：器械机械刺激可损伤Oddi括约肌，引发胆血反流与肝脏炎症；造影剂及灌注液干扰肠道黏液分泌与胆汁成分，削弱肠道屏障功能；操作导致的微生物群扰动可加剧菌群失衡与内毒素易位；胆汁酸肠肝循环中断则通过抑制法尼醇X受体（FXR）/成纤维细胞生长因子19（FGF19）信号通路，诱发脂糖代谢紊乱及肝纤维化风险。当前研究缺乏对胆道镜操作后肠肝轴动态变化的前瞻性分析，且存在样本获取局限性。未来需通过FXR激动剂、微生物干预及技术优化（如降低灌注压力）改善临床结局，并深化多维度纵向研究以明确长期影响。

关键词


肠肝轴；胆道镜；肠道微生物菌群；法尼醇X受体（FXR）；Oddi括约肌

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参考


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