从肠道菌群与炎症角度探讨代谢相关脂肪性肝病从痰湿论治本质

Discussion of the essence of treating metabolism-related fatty liver disease from phlegm and dampness from the perspective of intestinal flora and inflammation

代谢相关脂肪性肝病(MAFLD)是一种多重发病机制相互作用的异质性疾病,目前尚无公认有效的治疗药物,中医药治疗以其多靶点的作用优势在治疗该病时显示出优越性。痰湿是目前普遍认可的MAFLD病机,但具体机制尚未完全阐明。现代研究显示,肠道微生物群紊乱可促进MAFLD的发生,而炎症是肠道菌群紊乱触发MAFLD发病的必经途径。文章通过阐述MAFLD痰湿病因病机、体质与肠道菌群紊乱的相关性,并将痰湿特性与慢性炎症致病特点及MAFLD的疾病演变过程相联系,提出肠道微生物群紊乱是MAFLD痰湿产生的物质基础,慢性炎症是痰湿的本质体现。并在此基础上提出了从痰湿论治MAFLD应强调健脾和调理气血,其作用机制与调节炎症和肠道菌群有关。

Metabolic associated fatty liver disease(MAFLD)is a heterogeneous disease with multiple pathogenesis interactions.There is currently no recognized effective therapeutic drug,and traditional Chinese medicine treatment has shown superiority in the treatment of this disease with its multi-target advantages.Sputum wetness is the commonly recognized pathogenesis of MAFLD at present,but the specific mechanism has not been fully elucidated.Modern studies have shown that intestinal microbiota disorders can promote the occurrence of MAFLD,and inflammation is the only way for intestinal microbiota disorders to trigger the pathogenesis of MAFLD.In this paper,by elaborating the correlation between the etiology,constitution and intestinal flora disorder of MAFLD sputum dampness,and linking the characteristics of sputum wetness with the pathogenic characteristics of chronic inflammation and the evolution of MAFLD.This paper proposes that intestinal microbiota disorder is the material basis for the production of sputum dampness in MAFLD,and chronic inflammation is the essence of sputum dampness.On this basis,it is proposed that the treatment of MAFLD from phlegm and wetness should emphasize strengthening the spleen and regulating qi and blood,and its mechanism of action is related to the regulation of inflammation and intestinal flora.