功能性便秘发病机制的研究进展

Research progress on the pathogenesis of functional constipation

摘要:

功能性便秘是一种常见的功能性胃肠疾病，其病理机制复杂且尚未完全阐明。近年来的研究表明，其发病涉及多种因素的相互作用，包括结肠神经源性和肌源性异常、Cajal间质细胞（ICC）数量减少及功能受损、排便出口梗阻、脑肠轴失调、免疫系统激活及肠道菌群紊乱等。慢传输型便秘主要与肠神经功能异常、ICC信号通路障碍和炎症反应有关；出口梗阻型便秘则多由盆底肌功能紊乱及直肠低敏感性所致。脑肠轴紊乱在功能性便秘中发挥核心作用，涉及中枢神经调控异常、激素分泌失衡及局部免疫反应增强。肠道菌群通过短链脂肪酸、胆汁酸及甲烷等代谢产物影响肠道动力与炎症状态。本文综述了功能性便秘的主要病理机制及最新研究进展，旨在为其机制研究与个体化治疗策略提供参考。

Abstract:

Functional constipation is a common functional gastrointestinal disorder with a multifactorial and incompletely understood pathogenesis. Recent studies have revealed that its development involves the interplay of multiple mechanisms, including neurogenic and myogenic dysfunction of the colon, reduction and impairment of interstitial cells of Cajal (ICCs), outlet obstruction, dysregulation of the gut-brain axis, immune activation, and gut microbiota imbalance. Slow-transit constipation is mainly associated with enteric neural abnormalities, disruption of ICC signaling, and inflammation, whereas outlet obstruction constipation often results from pelvic floor dysfunction and rectal hyposensitivity. Dysregulation of the gut-brain axis plays a central role, involving impaired central regulation, hormonal imbalance, and enhanced local immune response. Additionally, gut microbial metabolites such as short-chain fatty acids, bile acids, and methane affect colonic motility and inflammation. This review summarizes the current understanding and research progress on the pathogenesis of functional constipation, providing insights for mechanism-based and individualized therapeutic approaches.