中医药调控肠道菌群治疗代谢相关脂肪性肝病的机制

Mechanism of Traditional Chinese Medicine in Regulating Gut Microbiota in Treating Metabolic-associated Fatty Liver Disease

代谢相关脂肪性肝病(MAFLD)为多系统代谢功能紊乱累及肝脏的表现,其疾病谱不仅包括脂肪性肝炎、肝纤维化、肝硬化、肝恶性肿瘤等肝脏疾病,还包括2型糖尿病、动脉粥样硬化性疾病、慢性肾脏病等肝脏外疾病,是全球范围内最常见的慢性肝病,发病机制复杂,目前缺乏有效的药物治疗。随着人们生活水平的提高及老龄化进程的加快,MAFLD的发病未来有继续增加的可能,其发生发展及防治受到广泛的关注及重视。近年来研究表明肠道菌群组成及比例异常可影响肠道菌群代谢物的变化,胆汁酸、胆碱等代谢紊乱可进一步加剧肠道菌群失调,由此形成恶性循环破坏肠道屏障功能,使肠道通透性增高,脂多糖、细菌及病毒等通过“肠肝轴”进入肝脏,促进肝脏炎症反应及脂质沉积,通过菌群移位、调节宿主能量吸收、糖脂代谢、炎症反应等一个或多个因素相互作用参与MAFLD的发生发展。中医药通过多靶点调节肠道菌群的结构和功能,促进有益菌生长,抑制有害菌形成,使肠道微生态恢复平衡,改善肠黏膜屏障功能,抑制肝脏炎症反应和脂肪变性,进而影响肝脏代谢和免疫应答,达到防治MAFLD的作用。该文通过文献检索及归纳总结,系统综述以肠道菌群为靶点的中医药治疗MAFLD的机制,以期为中医药治疗MAFLD提供思路和参考。

Metabolic-associated fatty liver disease(MAFLD)is a manifestation of multi-system metabolic dysfunction that affects the liver.Its disease spectrum not only includes fatty liver hepatitis,liver fibrosis,cirrhosis,liver malignancies,and other liver diseases but also includes extrahepatic diseases such as type 2 diabetes,atherosclerosis diseases,and chronic kidney disease.It is the most common chronic liver disease worldwide,with a complex pathogenesis and a lack of effective pharmacological treatments.With the improvement of people's living standards and the acceleration of the aging process,the incidence of MAFLD may continue to increase in the future,and its occurrence,development,prevention,and treatment have received widespread attention.Recent studies have shown that abnormal composition and proportion of gut microbiota can affect the changes in gut microbiota-derived metabolites.Metabolic disorders of bile acids and choline can further exacerbate gut microbiota imbalance,leading to a vicious cycle that destroys intestinal barrier function,increases intestinal permeability,and allows lipopolysaccharides,bacteria,viruses,and other substances to enter the liver through the''gut-liver axis''.This process promotes liver inflammation and lipid deposition.Factors such as gut microbiota shift,regulation of host energy absorption,glucose and lipid metabolism,and inflammatory response interact to participate in the occurrence and development of MAFLD.Traditional Chinese medicine regulates the structure and function of gut microbiota through multiple targets,promoting the growth of beneficial bacteria,inhibiting the formation of harmful bacteria,restoring the balance of gut microbiota,improving intestinal mucosal barrier function,inhibiting liver inflammation and lipid degeneration,and influencing liver metabolism and immune response.This ultimately contributes to the prevention and treatment of MAFLD.This article systematically reviewed the mechanism of traditional Chinese medicine(TCM)treatment of MAFLD targeting gut microbiota through a literature search,aiming to provide ideas and references for TCM treatment of MAFLD.