粪菌移植治疗代谢相关脂肪性肝病的理论基础和研究进展

Theoretical basis and progress of fecal microbiota transplantation in metabolic associated fatty liver disease

代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)是一组慢性进展性疾病,近年来患病率逐渐增加,已成为全球最常见的慢性肝病,但仍缺乏有效的治疗方法。越来越多的研究指出MAFLD和肠道菌群紊乱存在着密切的联系,肠道细菌丰度、多样性、比例的变化可影响细菌促炎成分和多种代谢产物的生成,经由肠肝轴改变MAFLD的疾病进展。粪菌移植(fecal microbiota transplantation,FMT)作为一种新型治疗手段,是将健康人肠道中的菌群移植到患者胃肠道内,直接纠正肠道菌群紊乱,改变代谢产物,已被广泛用于难辨梭状芽孢杆菌感染、炎症性肠病等疾病的治疗中,近年来也被用于探索治疗MAFLD。但FMT治疗MAFLD的研究尚少,具体的作用机制和疗效尚不明确,故对目前FMT在MAFLD中的潜在治疗机制和疗效做一综述。

Metabolic associated fatty liver disease(MAFLD)is a cluster of chronic,progressive diseases with an increasing prevalence rate worldwide.MAFLD has become the leading cause of chronic liver disease around the world,for which approved therapy is currently lacking.In recent years,growing evidence has demonstrated the close link between gut microbiome dysbiosis and MAFLD.The generation of pro-inflammatory bacterial components and metabolites is susceptible to the changes in the abundance,diversity,and ratio of intestinal bacteria,which could accelerate the progress of MAFLD through the gut-liver axis.As a new therapeutic strategy,fecal microbiota transplantation(FMT)is the transplantation of flora from the intestines of healthy people into the gastrointestinal tract of patients,to directly correct intestinal flora disorders and alter bacterial metabolites.FMT has been widely used in the treatment of Clostridium difficile infections and inflammatory bowel disease.The role of FMT in the treatment of MAFLD has also been explored.However,studies about FMT in MAFLD are overall scarce and the mechanism of action and the therapeutic effect of FMT on MAFLD remains ambiguous.We summarized the existing evidence on the potential molecular mechanism and effectiveness related to FMT in MAFLD.