中医学对肠道菌群与非酒精性脂肪性肝病的理论认识  

A theoretical understanding of intestinal flora and non-alcoholic fatty liver disease in TCM

作　　者：于晨阳 祝翠燕 于京芳 朱冉 王富乐 张铁峰[1] YU Chenyang

机构地区：[1]山东中医药大学,山东济南250000 [2]山东省中西医结合医院,山东济南250000

出　　处：《中医临床研究》2024年第7期28-34,共7页Clinical Journal Of Chinese Medicine

摘　　要：近年来,非酒精性脂肪性肝病全球流行率逐年升高,但发病机制至今尚未明确。中医学将非酒精性脂肪性肝病归属于“臌胀”“肝癖”“痰浊”“积聚”等,认为肝体用失调、脾肾亏虚是本病主要特点,痰、湿、浊、瘀、热为本病主要病理因素。随着对肠道菌群研究的不断深入,肠道菌群及其代谢产物有改善胰岛素抵抗、减少氧化应激、调节脂质代谢和调节免疫等多种作用,与肝脏功能及非酒精性脂肪性肝病之间的关系也受到广泛关注。许多研究揭示了肠-肝轴与非酒精性脂肪性肝病发生发展相关,饮食、抗生素、益生菌及益生元、粪菌移植、微生态制剂、噬菌体等干预措施均可以通过改变肠道菌群来缓解非酒精性脂肪性肝病。从现代医学对肠道菌群生理功能的研究中,我们发现现代医学“肠”的消化吸收、调节代谢、改善免疫等功能可属于中医“脾主运化”“脾主升清”功能的范畴。文章从中医“肝脾相关”“肝与大肠相通”“肝从左升,肺从右降,肺与大肠相表里”等理论视角出发,就中医学对肠道菌群与非酒精性脂肪性肝病关系的认识及相关治疗作一综述,阐述中医学治疗本病的理论基础,结合现代医学理念,以期为非酒精性脂肪性肝病的中医治疗提供新思路、新方法。In recent years,the prevalence of non-alcoholic fatty liver disease(NAFLD)has been increasing worldwide,but the pathogenesis is still unclear.In TCM,NAFLD is classified as tympanites,liver stuffiness,phlegm turbidity and Tangible masses.It is believed that the main characteristics of NAFLD are imbalance of liver and body function,and spleen and kidney deficiency,I and that phlegm,dampness,turbidity,blood stasis and heat are the main pathological factors.With the deepening of the research on intestinal flora,it is found that intestinal flora and its metabolites have a variety of effects such as improving insulin resistance,reducing oxidative stress,regulating lipid metabolism,and regulating immunity.The relationship between intestinal flora and liver function and NAFLD has also attracted wide attention.Many studies have revealed that the gut-liver axis is related to the occurrence and development of NAFLD.Interventions such as diet,antibiotics,probiotics and prebiotics,fecal microbiota transplantation,microecological agents,and bacteriophage can alleviate NAFLD by changing the intestinal flora.From the research on the physiological functions of intestinal flora in modern medicine,we found that the functions of intestine such as digestion and absorption,regulation of metabolism,and improvement of immunity in modern medicine can belong to the functional categories of the spleen governs transportation and transformation and the spleen ascends the nutrients in TCM.This article reviews the relationship between intestinal flora and NAFLD and related treatment in TCM from the theoretical perspectives of the relationship between liver and spleen,the communication between liver and large intestine and the liver rises from the left,the lungs falls from the right,and the lung and large intestine are exterior-interiorly related,elaborates the theoretical basis of TCM in the treatment of NAFLD,and combines with the concept of modern medicine,in order to provide new ideas and methods for the treatment of NAFLD in TCM.

关 键 词：非酒精性脂肪性肝病 肠道菌群 肝脾相关 肝与大肠相通 肺与大肠相表里 

分 类 号：R256.4[医药卫生—中医内科学]