减重手术治疗非酒精性脂肪性肝病的作用机制

The mechanism of bariatric surgery in the treatment of non-alcoholic fatty liver disease

非酒精性脂肪性肝病(NAFLD)作为1种代谢性疾病,近年来在人群中的发病率不断上升。除改变生活方式和常规药物治疗外,以Roux-en-Y胃旁路术和袖状胃切除术为代表的减重手术逐渐成为治疗NAFLD的可选方案。但是减重手术改善NAFLD的作用机制尚待完善。“多次打击理论”作为近年来逐渐获得认可的学说,认为NAFLD是由胰岛素抵抗、胆汁酸代谢和肠道菌群等多种机制共同作用形成。笔者回顾相关文献,结合临床实践,对减重手术直接或间接治疗NAFLD的相关机制进行探讨。

Non-alcoholic fatty liver disease(NAFLD),as a metabolic disease,has shown a constant upward trend in prevalence among the people in recent years.In addition to changing lifestyles and conventional drug treatment,bariatric surgery,represented by Roux-en-Y gastric bypass surgery and sleeve gastrectomy,has gradually become one of the treatment options for NAFLD.However,the mechanism of bariatric surgery in treating NAFLD remains to be studied.The"multiplehit theory",which has gradually been recognized in recent years,believes that NAFLD is formed by the combined effect of multiple mechanisms such as insulin resistance,bile acid metabolism pathway,and intestinal flora.Based on relevant literatures and clinical practices,the authors explore the relevant mechanisms of bariatric surgery for direct or indirect treatment of NAFLD.