原創 MNT 醫學營養MNT 3月23日
1、
非酒精性脂肪肝（NAFLD）是一種常見的肝臟疾病，其發病率在全球範圍內呈上升趨勢,估計患病率約為25％~30％,NAFLD 通常無症狀，並與代謝綜合徵的其他表現有關。多達25％的NAFLD患者會發展為進行性炎症性肝臟疾病，稱為非酒精性脂肪性肝炎（NASH），可能會發展為肝硬化、肝癌和需要肝移植的趨勢。
2、
腸道菌群代表了一個重要的環境因素，有助於NAFLD的發展及其向NASH的發展。與NAFLD和NASH相關的微生物組相關機制包括營養不良引起的腸道內皮屏障功能失調，從而促進全身細菌移位以及腸和肝炎症。此外，腸道菌群調節的代謝產物，例如脂多糖、短鏈脂肪酸（SCFA）、膽汁酸和乙醇等的增加，可能通過多種直接和間接機制影響肝臟病理。
3、
腸道宿主與微生物組的相互作用在NAFLD和NASH的發病機理和進程中起著不同的作用。闡明這些微生物影響NAFLD和NASH發病機制的機制可能有助於確定這些常見代謝性肝病的新診斷和治療目標。
腸道菌群對NAFLD影響的機制
對於微生物組在NAFLD 及其併發症中的作用，已經提出了幾種機制。這些包括微生物組對腸道屏障和炎症反應的調節，以及由微生物群產生或修飾的代謝物，如SCFA，膽汁酸和乙醇（圖1）。
圖1：腸道菌群對NAFLD 發育和發展為NASH的影響的建議機制。
細菌代謝產物（例如SCFA和膽汁酸）可能有效參與正常的肝功能，並減少肝臟脂肪生成和炎症。共生微生物組組成，多樣性和功能的異常可能導致腸道通透性增加，LPS和其他炎性因子的產生，膽汁酸的減少的多樣性以及乙醇的產生。所有這些代謝物和因素與飲食中產生的脂質結合會導致肝臟脂肪變性，炎症和損害，可能導致肝纖維化，疤痕和NASH的發展。
資料來源
Molecular Metabolism
Volume 5, Issue 9, September 2016, Pages 782-794
ID：dx.doi.org/10.1016/j.molmet.2016.06.003
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