基于肝脾相关理论辨治非酒精性脂肪性肝病  

Diagnosis and Treatment of Non-alcoholic Fatty Liver Disease Based on Theory of Liver and Spleen Relating

作　　者：李水洪 韩秀珍[1] 李岩 任娜 商洪涛[1] LI Shuihong;HAN Xiuzhen;LI Yan;REN Na;SHANG Hongtao(Affiliated Hospital to Nanjing University of Traditional Chinese Medicine,Nanjing Jiangsu China 210009)

机构地区：[1]南京中医药大学附属医院,江苏南京210009

出　　处：《中医学报》2024年第3期534-541,共8页Acta Chinese Medicine

基　　金：江苏省老年健康科研项目(LD2021004)。

摘　　要：肝脾两大藏象系统之间密切相关,在生理状态下相互促进,如疏泄与运化相互为用,藏血与统血相互协调;在病理状态下相互传变,如肝病传脾,脾病及肝,故肝脾不调是非酒精性脂肪性肝病的基本病机。治疗上以理气化湿、祛痰化瘀为主。肠-肝轴是肠道及其微生物群与肝脏之间双向沟通的重要途径,肠道黏膜屏障及肝脏的固有免疫系统对于防止肠道中的有害菌或毒性产物传播至关重要。异常的肠道微生物群可引起肠黏膜屏障破坏,从而使肠道抗原、细菌及其产物进入肝脏,引发肝脏炎症、损伤,释放的血管活性物质和炎症因子等物质随血液循环至肠道,又可进一步造成肠黏膜缺血、缺氧以及血管通透性增加等,加重肠道功能障碍,形成恶性循环。肠道微生态紊乱通过肠-肝轴途径促进非酒精性脂肪性肝病的发生发展。调和肝脾类中药可通过调控肠道微生物组成、修复肠黏膜屏障及平衡胆汁酸代谢等方面,改善非酒精性脂肪性肝病。The Liver and Spleen are closely related and promote each other in physiological states,such as the mutual use of drainage and transportation,the coordination of blood storage and blood circulation,and the mutual transmission and transformation in pathological states,such as Liver disease transmitting to the Spleen,Spleen disease to Liver disease,therefore Liver and Spleen imbalance is the basic pathogenesis of non-alcoholic fatty Liver disease.The treatment mainly focuses on regulating Qi and Dampness,removing Phlegm and removing blood stasis.The gut liver axis is an important pathway for bidirectional communication between the gut,its microbiota,and the liver.The gut mucosal barrier and the liver′s innate immune system are crucial in preventing the spread of harmful bacteria or toxic products in the gut.Abnormal gut microbiota can cause damage to the intestinal mucosal barrier,leading to the entry of intestinal antigens,bacteria,and their products into the liver,causing liver inflammation and damage.The released vasoactive substances and inflammatory factors circulate in the bloodstream to the intestine,further causing intestinal mucosal ischemia,hypoxia,and increased vascular permeability,exacerbating intestinal dysfunction and forming a vicious cycle.The disruption of gut microbiota promotes the occurrence and development of non-alcoholic fatty liver disease through the gut liver axis pathway.Traditional Chinese medicine for harmonizing liver and spleen can improve non-alcoholic fatty liver disease by regulating intestinal microbial composition,repairing intestinal mucosal barrier,and balancing bile acid metabolism.

关 键 词：非酒精性脂肪性肝病 肠-肝轴 肝脾相关 微生态失衡 调和肝脾 

分 类 号：R259.751[医药卫生—中西医结合]