基于脾主运化与白色脂肪棕色化的相关性探讨中医药治疗非酒精性脂肪性肝病的机制

Exploring the Mechanism of Traditional Chinese Medicine in Treatment of NAFLD based on the Correlation of Spleen Governing Transportation and Transformation with Browning of White Adipose

冷暴露或其他刺激因素可诱导白色脂肪组织中出现棕色样脂肪细胞,即白色脂肪棕色化,该过程能促进热量释放,抑制脂肪沉积。非酒精性脂肪性肝病(NAFLD)是由脂肪组织过度蓄积所诱发的慢性肝病,中医学认为本病责之脾虚痰浊壅盛、肝络瘀滞,治脾可能是NAFLD的治本之策。基于脾为后天之本、生化之源理论及现代研究成果,探讨脾主运化之功能与白色脂肪棕色化的相关性,发现脾主运化可能通过影响肠道菌群及其代谢产物、线粒体数量及其功能诱导白色脂肪褐变,同时发现中医药从脾论治可能通过诱导白色脂肪褐变,进而减少肝脏脂肪沉积、改善胰岛素抵抗、减轻炎症反应,对NAFLD发挥积极的治疗作用,可为NAFLD的中医治疗提供思路。

Exposure to cold or other stimuli may induce the appearance of brown-like adipocytes in white adipose tissue,that is,the browning of white adipose,which can promote heat release and inhibit fat deposition.Non-alcoholic fatty liver disease(NAFLD)is a chronic disorder caused by excessive accumulation of adipose tissue,which in traditional Chinese medicine(TCM),is related to spleen deficiency and exuberance of turbid phlegm,and stasis obstructing the liver collaterals.Therefore,treating spleen may be a fundamental cure for NAFLD.Based on the theoretical basis of TCM that the spleen is the foundation of acquired constitution and the source of qi and blood production,as well as the results from modern researches,this paper discussed the correlation of spleen governing transportation and transformation with white adipose browning.It is found that spleen governing transportation and transformation may induce the browning of white adipose by affecting the intestinal flora and their metabolites,and the number and function of mitochondria.At the same time,following the TCM theory that treatment from spleen,the induced browning of white adipose may further reduce liver fat deposition,improve insulin resistance,and reduce inflammation,and this understandings could play a positive role in the management of NAFLD and provide new idea for the treatment.