特应性皮炎与葡萄球菌属细菌定植相关性的研究进展

doi:10.3969/j.issn.1674-8115.2022.11.013

摘要/Abstract

摘要：

特应性皮炎（atopic dermatitis，AD）是一种以皮肤反复瘙痒和病变为主要特点的皮肤炎症性疾病。AD发病机制包括基因突变、外界环境变化引起的免疫微环境异常、皮肤屏障功能损坏等。近期研究发现，局部皮肤微生态失衡促进AD的发生。AD患者皮肤病变部位菌群相对于正常皮肤菌群多样性下降，主要表现为致病性金黄色葡萄球菌的丰度明显上升，伴随着具有抑菌能力的凝固酶阴性葡萄球菌（coagulase-negative Staphylococci，CoNS）的丰度显著降低。金黄色葡萄球菌是引起皮肤脓肿和菌血症等一系列疾病的临床重要病原菌。AD患者皮肤表面的金黄色葡萄球菌可以通过释放大量外分泌毒素、蛋白酶、超抗原等，加剧AD患者皮肤瘙痒及病变的程度。对皮肤局部微生态特别是葡萄球菌属的研究有助于挖掘诊断和预防AD的新型菌群标志物。同时，由于使用传统抗生素难以使病情较为严重的患者皮肤表面微生态恢复并维持正常状态，通过使用具有抗菌活性的皮肤共生菌维持皮肤表面微生态平衡的治疗方法给人们提出一个治疗AD患者皮肤微生态失衡的新方向。

关键词: 特应性皮炎, 微生态失衡, 金黄色葡萄球菌, 凝固酶阴性葡萄球菌, 皮肤微生物学检查, 抑菌治疗

Abstract:

Atopic dermatitis (AD) is an inflammatory disease characterized by recurrent itch and skin lesion. The pathological mechanisms of AD include the immunological disorders caused by genetic variants with environment changing and the damage of skin barrier. Recent studies have found that the topical dysbiosis of skin microbiota promotes AD. Compared to the normal skin, the diversity of the microbiome in the lesion skin decreases drastically. Especially, in company with the decreased abundance of protective coagulase-negative Staphylococci (CoNS), the load of Staphylococcus aureus (S. aureus) meets apparent increase. S. aureus is an important clinical pathogen which can cause skin infection, bacteremia, etc. Among AD patients, S. aureus can aggravate the itch and lesion of skin by expressing various toxins, proteases, superantigens, etc. Monitoring the skin flora, especially the characteristics of Staphylococci, provides new ideas for the diagnosis and treatment of AD. Meanwhile, considering the difficulties that the conventional antibiotic therapy failed to reverse and maintain the microbiota of the patient with severe symptom, the application of the commensal microbiome with antimicrobial function provides a new insight into the treatment of AD.

Key words: atopic dermatitis, microbiota dysbiosis, Staphylococcus aureus, coagulase-negative Staphylococci, skin flora examination, antimicrobial therapy

中图分类号:

R378.1⁺1

娜迪拉·努尔夏提, 李敏, 刘倩. 特应性皮炎与葡萄球菌属细菌定植相关性的研究进展[J]. 上海交通大学学报（医学版）, 2022, 42(11): 1605-1611.

NURXAT Nadira, LI Min, LIU Qian. Progress in the correlation between atopic dermatitis and colonization of Staphylococcus[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(11): 1605-1611.

图/表 1

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Microflora of the skin	Healthy control	AD lesion skin	AD nonlesion kin
Staphylococcus aureus	+	+++	++
CoNS	+	++	++
Malassezia spp.	+	++	+
Aerobacter sp.	+	-	+
Acinetobacter spp.	+	+	+
Brevibacterium spp.	+	+	+
Candida spp.	+	+	+
Corynebacterium spp.	+	+	+
Escherichia coil	+	+	+
Propionibacterium spp.	+	+	+
Klebsiella spp.	+/-	+	+/-
Micrococcus spp.	+/-	+/-	+/-
Proteus sp.	+/-	+/-	+/-
Salmonella spp.	+/-	+	+/-
Streptococcus spp.	+/-	+	+/-

Microflora of the skin	Healthy control	AD lesion skin	AD nonlesion kin
Staphylococcus aureus	+	+++	++
CoNS	+	++	++
Malassezia spp.	+	++	+
Aerobacter sp.	+	-	+
Acinetobacter spp.	+	+	+
Brevibacterium spp.	+	+	+
Candida spp.	+	+	+
Corynebacterium spp.	+	+	+
Escherichia coil	+	+	+
Propionibacterium spp.	+	+	+
Klebsiella spp.	+/-	+	+/-
Micrococcus spp.	+/-	+/-	+/-
Proteus sp.	+/-	+/-	+/-
Salmonella spp.	+/-	+	+/-
Streptococcus spp.	+/-	+	+/-

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