小檗碱治疗非酒精性脂肪性肝病的作用机制及联合用药研究进展  

Mechanism and Combination Therapy of Berberine in Treatment of Nonalcoholic Fatty liver Disease:A Review

作　　者：王晓杰 张恒 刘素彤 张丽慧[1] 赵文霞[1] WANG Xiaojie;ZHANG Heng;LIU Sutong;ZHANG Lihui;ZHAO Wenxia(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;The First Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450046,China;Henan General Hospital,Zhengzhou 450003,China)

机构地区：[1]河南中医药大学第一附属医院,郑州450000 [2]河南中医药大学第一临床医学院,郑州450046 [3]河南省职工医院,郑州450003

出　　处：《中国实验方剂学杂志》2025年第5期269-281,共13页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(82205086,81473651);河南省中医药科学研究专项(2023ZXZX1051);河南省特色骨干学科中医学学科建设项目(STG-ZYX02-202117);河南省中医学“双一流”创建科学研究专项(HSRP-DFCTCM-2023-3-13,HSRPDFCTCM-2023-4-02,HSRP-DFCTCM-2023-5-13,HSRP-DFCTCM-2023-7-23)。

摘　　要：非酒精性脂肪性肝病(NAFLD)是全球最常见的慢性肝病,因其发病机制复杂,临床患病率高,累及人口众多,给全世界公共卫生事业造成了巨大威胁和挑战,因此需采取积极的干预措施。目前临床上使用西药在减重、减少肝脏脂肪含量、改善糖脂代谢和胰岛素抵抗等方面疗效确切,但对于NAFLD相关性纤维化和肝硬化患者,尚缺乏足够的组织学证据支持其益处,仍需开展随机对照试验加以明确。生活方式干预是治疗NAFLD的重要基石,但存在患者执行不力、依从性低等诸多问题,临床疗效不甚理想。中医药具有多途径、多靶点的显著优势,中药活性成分小檗碱可从增加能量消耗、改善糖脂代谢、改善胰岛素抵抗、抗炎、抗氧化、调节肠道菌群、恢复胆汁酸稳态、抗纤维化等多个途径干预NAFLD的发生和发展,对NAFLD的治疗发挥积极影响。同时,笔者通过整理文献发现,BBR与中西药联合应用具有促进药物吸收、提高药物口服利用度、增加肝脏最高生物分布、增强NAFLD整体治疗效果、减少药物不良反应等显著优势,可为临床用药提供借鉴。Nonalcoholic fatty liver disease(NAFLD)is the most common chronic liver disease in the world.Because of its complex pathogenesis,high clinical prevalence and large population,it poses a great threat and challenge to public health in the world.Therefore,active intervention measures are needed.Currently,western medicine is effective in reducing weight,reducing liver fat content,improving glucose-lipid metabolism and insulin resistance.However,for patients with NAFLD-related fibrosis and cirrhosis,there is still a lack of sufficient histological evidence to support its benefits,and randomized controlled trials are still needed to clarify.Lifestyle intervention is an important cornerstone for the treatment of NAFLD,but there are many problems such as poor implementation and low compliance of patients,and the clinical efficacy is not ideal.Traditional Chinese medicine(TCM)has the significant advantages of multiple pathways and multiple targets.Berberine,the active ingredient of TCM,can interfere with the production of NAFLD from multiple pathways,including increasing energy consumption,weight loss,improving glucose lipid metabolism,improving insulin resistance,anti-inflammatory,anti-oxidation,regulating intestinal flora,restoring bile acid homeostasis,anti-fibrosis and so on,which can play a positive role in the treatment of NAFLD.At the same time,it was found that the combination of BBR with Chinese and western medicines had significant advantages in promoting drug absorption,improving oral bioavailability,increasing the highest biological distribution in the liver,enhancing the overall therapeutic effect of NAFLD,and reducing adverse drug reactions,which could provide reference for clinical medication.

关 键 词：非酒精性脂肪性肝病(NAFLD) 小檗碱 作用机制 糖脂代谢 肠道菌群 肝纤维化 联合用药 

分 类 号：R256[医药卫生—中医内科学] R856.2[医药卫生—中医学] R575