肝脾相关、肠-肝轴和酒精性肝病

Theory of Liver and Spleen Related,“Gut-liver Axis” and Alcoholic Liver Disease

目的:分析酒精性肝病(ALD)的发生、发展与"肠-肝轴"、肝脾相关理论的关系,探讨ALD的病理机制和中医药研究思路。方法:通过回顾整理中医学肝脾理论的相关内容,并查阅近年国内外与ALD、"肠-肝轴"相关研究报道,分析中医肝脾相关理论和现代医学"肠-肝轴"学说在生理、病理和治疗方面的内在相关,以及两者对ALD防治的临床指导意义。结果:ALD患者存在异常的"肠-肝轴",过量酒精摄入引起的肠道通透性增加及肠道菌群改变是促进ALD发生发展的重要因素。结果提示传统中医酒湿伤脾、肝脾相关理论与肠-肝轴具有相通之处,肝脾同治法则贯穿于历代医家及现代治疗学中,肠道是防治酒精性肝病的重要靶位。结论:针对"肠-肝轴"的病理机制进行药理与物质基础研究,对传统中医肝脾相关理论的现代诠释以及提高中医药防治ALD的疗效提供了新的思路。

Objective:To analyze the relations among alcoholic liver disease,the theory of "gut-liver axis" and "liver and spleen related",and to explore the pathological mechanism of alcoholic liver disease and the research ideas of traditional Chinese medicine.Methods:Through reviewing the relevant contents of the theory of liver and spleen in traditional Chinese medicine,and looking up the research progress on ALD and the "gut-liver axis" in recent years,we analyzed the internal correlation in the physiology,pathology and treatment between the theory of "gut-liver axis" and "liver and spleen related",as well as the clinical guiding significance of the two theorys for the prevention and treatment of ALD.Results:There was an abnormal "gut-liver axis" in ALD.The increase of intestinal permeability and the change of intestinal flora induced by excessive alcohol intake were important factors to promote the progress of ALD.The pathogeny of "gut-liver axis" in alcoholic liver injury was similar to that of "liquor wet injury to spleen" and "liver and spleen related" in traditional Chinese medicine.The idea of treating both liver and spleen was permeated by physicians in the past dynasties and modern studies.The intestinal tract was an important target for the prevention and treatment of alcoholic liver disease.Conclusion:On the basis of the pathological mechanism of "gut-liver axis",the study of pharmacological function and material basis was carried out.It provided an important idea for the modern interpretation of the theory of liver and spleen related to traditional Chinese medicine and the improvement of the prevention and treatment of alcoholic liver disease by traditional Chinese medicine.