鼠李糖乳杆菌与儿童非酒精性脂肪肝病研究进展

Advances in Lactobacillus rhamnosus GG and pediatric nonalcoholic fatty liver disease

非酒精性脂肪肝病(NAFLD)已成为儿童最常见的慢性肝病之一,其疾病谱包括非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎及其相关肝纤维化、肝硬化和肝细胞癌。在肥胖儿童中,至少有50%的儿童表现出一定程度的NAFLD。在NAFLD进展中起主要作用的是游离脂肪酸水平增加和胰岛素抵抗,致使肝细胞中三酰甘油过度聚积。鼠李糖乳杆菌是目前研究最为彻底的一种肠道益生菌,其在NAFLD进展中发挥的作用已越来越被重视。鼠李糖乳杆菌通过改善肠道菌群紊乱,增加肠道屏障完整性,促进脂肪酸β-氧化,通过调节胆汁酸代谢减少肝脏三酰甘油聚积来改善或延缓儿童NAFLD。新的研究表明,miRNAs从多条通路参与调控以改善NAFLD所致的脂质代谢紊乱,对脂质代谢紊乱相关外泌体的研究为儿童脂肪肝的早期无创诊断提供了可能。本综述主要讨论了鼠李糖乳杆菌可从多个代谢环节改善或延缓儿童NAFLD,旨在为儿童NAFLD的治疗及早期诊断提供新的思路和靶标。

Nonalcoholic fatty liver disease(NAFLD)has become one of the most common chronic liver diseases in children,which has a wide spectrum including the nonalcoholic steatohepatitis(NASH),fibrosis,cirrhosis and hepatocellular carcinoma(HCC)with its clinical consequences.At least 50%of obese children present NAFLD.Increased levels of free fatty acids and insulin resistance play major roles in NAFLD progression,resulting in excessive accumulation of triglycerides in hepatocytes.Lactobacillus rhamnoides is one of the most thoroughly studied intestinal probiotics,and its role in NAFLD progress has been growingly concerned.Lactobacillus rhamnosus GG alleviates NAFLD in children by improving intestinal microbiota dysbiosis,increasing intestinal barrier integrity,promoting fatty acidβ-oxidation,and reducing hepatic triglyceride accumulation via regulating bile acid metabolism.Recent studies have shown that microRNAs are involved in multiple pathways to alleviate NAFLD-associated lipid metabolism disorders,which are functional as noninvasive diagnostic marker of fatty liver disease in children.This review mainly summarizes that Lactobacillus rhamnosus GG improves NAFLD in children from multiple metabolic pathways,aiming to provide a new strategy and target for the treatment and early diagnosis of NAFLD in children.