儿童哮喘的微生物-免疫-病毒调控网络：从机制到临床

doi:10.3969/j.issn.1006-5725.2025.20.021

Abstract

Abstract:

Pediatric asthma is a complex and heterogeneous disease， with susceptibility in early life co-shaped by the interplay of host genetics， environmental exposures， microbial colonization， and immune development. Early-life airway viral infections are a well-established risk factor， though their pathogenic effects are highly host-dependent. Emerging evidence indicates that the gut microbiome remotely regulates pulmonary immune homeostasis via metabolites such as butyrate （the gut-lung axis）， playing a pivotal role in the disease trajectory. Multi-omics research has expanded the scope of this regulatory network， identifying cross-kingdom microbial members， including the gut virome （phages） and protozoa. These members influence asthma susceptibility by activating specific immune pathways， such as the Tfh13-IgE axis and innate immune memory. Crucially， many children exposed to risk factors remain healthy， highlighting the roles of individual resilience and protective factors. Elucidating this network is crucial for clarifying disease heterogeneity and provides a basis for developing novel biomarkers （e.g.， the oropharyngeal microbiome， serum Extracellular Vesicles ［EVs］） and constructing multi-dimensional risk prediction models integrating artificial intelligence. This research ultimately aims to advance personalized precision prevention and management for pediatric asthma.

Key words: childhood asthma, early life, microbe-immune network, gut-lung axis, precision medicine

CLC Number:

R725.8

Xu QIN,Lihong. SUN. The microbe-immune-virus regulatory network in pediatric asthma：From mechanism to clinic[J]. The Journal of Practical Medicine, 2025, 41(20): 3297-3304.

Figures/Tables 2

References 64

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内型	关键驱动因素	免疫通路	临床表型
向哮喘演进型^[37]	流感嗜血杆菌富集	2型免疫上调（如骨膜素POSTN）；上皮重塑信号	持续性哮喘
单纯学龄前喘息^[37]	无特异性驱动因素	1型免疫/中性粒细胞炎症特征	短暂性喘息
病毒-细菌协同驱动型^[56]	特定细菌（肺炎链球菌）活跃转录 (脂肪酸/糖酵解通路)；常无RV	Th2/Th17通路；宿主IFN-α/γ应答下调；T细胞活化上调	高远期哮喘风险
RV-C驱动的T2高反应型^[57]	RV-C感染；莫拉菌属主导	高T2细胞因子应答（IL-4, IL-5, IL-13）；鞘脂代谢下调	高复发性喘息和哮喘风险
RSV驱动的IFN高反应型^[58]	RSV感染（可合并RV）；肺炎链球菌/卡他莫拉菌共优势；特应性背景	高IFN-α/γ应答；PI3K-Akt-mTOR信号通路激活	高远期哮喘风险
固定性气流阻塞型^[36]	嗜血杆菌属/ 奈瑟氏菌属主导	混合性粒细胞性炎症；PD-L1通路可能相关	固定性气流受限；对支气管扩张剂反应差

The microbe-immune-virus regulatory network in pediatric asthma：From mechanism to clinic

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