Gut–Liver axis

肠 - 肝轴
  • 文章类型: Journal Article
    背景:厚朴酚(MAG)具有保肝活性,然而,MAG是否以及如何调节肠道菌群以缓解脂肪肝出血性综合征(FLHS)尚不清楚.因此,我们研究了MAG在FLHS蛋鸡中的作用机制,重点是肠-肝轴的改变。我们将540只56周龄的Hy线白色蛋鸡用FLSH随机分为4组。饲喂鸟类的高脂肪低蛋白(HFLP)饮食(CON)或HELP饮食,并补充了200、400和600mg/kg的MAG(分别为M1,M2和M3),持续9周。
    结果:添加厚朴酚通过调节脂质代谢,提高产蛋率,改善肝功能损害和功能障碍,改善肠道屏障功能,并塑造肠道微生物群和色氨酸代谢谱。日粮补充MAG在不同程度上下调了脂质合成基因的表达,上调了脂质转运基因的表达。补充200和400mg/kg的MAG可改善肠道屏障功能,绒毛高度和紧密连接相关基因的mRNA表达增加证明了这一点。微生物概况信息显示,MAG改变了肠道微生物群,特别是通过提高乳酸菌的丰度,粪杆菌,和Butyricicocus。此外,非靶向代谢组学分析表明,MAG对色氨酸代谢产物有显著的促进作用,与富含MAG的肠道菌群呈正相关。色氨酸代谢产物的增加可以激活芳香烃受体(AhR),并通过下调促炎细胞因子如白细胞介素-1β(IL-1β)的基因表达水平来缓解肝脏炎症和免疫反应。肿瘤坏死因子-α(TNF-α),和白细胞介素-6(IL-6)在肝脏。粪便微生物群移植(FMT)实验进一步证实,肝脏保护作用可能是由MAG改变的肠道微生物群及其代谢产物介导的。
    结论:厚朴酚可以通过积极调节脂质合成和转运代谢来预防和缓解蛋鸡FLHS,改善肠道屏障功能,通过肠道微生物群-吲哚代谢物-肝AhR串扰重塑肠道微生物群和代谢物谱来缓解肝脏炎症。这些发现阐明了MAG缓解FLHS的机制,并为通过调节肠道微生物群及其代谢产物预防肝脏疾病提供了一种有前途的方法。
    BACKGROUND: Magnolol (MAG) exhibits hepatoprotective activity, however, whether and how MAG regulates the gut microbiota to alleviate fatty liver hemorrhagic syndrome (FLHS) remains unclear. Therefore, we investigated the mechanism of MAG in FLHS laying hens with an emphasis on alterations in the gut-liver axis. We randomly divided 540 56-week-old Hy-line white laying hens with FLSH into 4 groups. The birds were fed a high-fat low-protein (HFLP) diet (CON) or HELP diets supplemented with 200, 400, and 600 mg/kg of MAG (M1, M2, and M3, respectively) for 9 weeks.
    RESULTS: Magnolol supplementation increased the laying rate and ameliorated hepatic damage and dysfunction by regulating lipid metabolism, improving intestinal barrier function, and shaping the gut microbiota and tryptophan metabolic profiles. Dietary MAG supplementation downregulated the expression of lipid synthesis genes and upregulated the expression of lipid transport genes at varying degrees. The intestinal barrier function was improved by 200 and 400 mg/kg of MAG supplementation, as evidenced by the increased villus height and mRNA expression of tight junction related genes. Microbiological profile information revealed that MAG changed the gut microbiota, especially by elevating the abundances of Lactobacillus, Faecalibacterium, and Butyricicoccus. Moreover, non-targeted metabolomic analysis showed that MAG significantly promoted tryptophan metabolites, which was positively correlated with the MAG-enriched gut microbiota. The increased tryptophan metabolites could activate aryl hydrocarbon receptor (AhR) and relieved hepatic inflammation and immune response evidenced by the downregulated the gene expression levels of pro-inflammatory cytokines such as interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in the liver. The fecal microbiota transplantation (FMT) experiments further confirmed that the hepatoprotective effect is likely mediated by MAG-altered gut microbiota and their metabolites.
    CONCLUSIONS: Magnolol can be an outstanding supplement for the prevention and mitigation of FLHS in laying hens by positively regulating lipid synthesis and transport metabolism, improving the intestinal barrier function, and relieving hepatic inflammation by reshaping the gut microbiota and metabolite profiles through gut microbiota-indole metabolite-hepatic AhR crosstalk. These findings elucidate the mechanisms by which MAG alleviates FLHS and provide a promising method for preventing liver diseases by modulating gut microbiota and their metabolites.
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  • 文章类型: Journal Article
    我们旨在将发表的关于布拉氏酵母菌(SB)用于治疗各种肝脏疾病(CRD42022378050)的研究结果系统化。搜索于2022年8月1日使用PubMed和Scopus进行。PubMed搜索于2024年6月15日更新。该综述包括16项研究:10项实验动物研究(EAS)和6项随机对照试验(RCT)。CNCMI-745菌株用于68.8%的纳入研究。SB减少了许多肝硬化表现的严重程度,并降低了RCT的Child-Pugh评分。SB降低TNF-α的血清浓度,IL-1β,IL-6和IL-4在患有代谢功能障碍相关的脂肪变性肝病(MASLD)的动物中;降低大鼠实验性肝硬化中的血清TNF-α和IL-6水平;并降低失代偿性肝硬化中的CRP水平。MASLD的EAS显示SB降低了肝脏脂肪变性和炎症,降低了肝脏TNF-α基因的表达,IL-1β,干扰素-γ,IL-10在实验性肝硬化和MASLD的研究中,SB降低TGF-β基因的肝脏表达,α-SMA,和胶原蛋白以及肝纤维化。SB降低了大肠杆菌(变形杆菌)的丰度,增加了肠道微生物群中拟杆菌的丰度,防止肠道屏障通透性增加,减少细菌移位和内毒素血症。
    We aimed to systematize the results of published studies on the use of Saccharomyces boulardii (SB) for the treatment of various liver disorders (CRD42022378050). Searches were conducted using PubMed and Scopus on 1 August 2022. The PubMed search was updated on 15 June 2024. The review included sixteen studies: ten experimental animal studies (EASs) and six randomized controlled trials (RCTs). The CNCM I-745 strain was used in 68.8% of the included studies. SB reduced the severity of many manifestations of cirrhosis, and lowered the Child-Pugh scores in RCT. SB reduced the serum concentrations of TNF-α, IL-1β, IL-6, and IL-4 in animals with metabolic dysfunction-associated steatotic liver disease (MASLD); lowered the serum TNF-α and IL-6 levels in experimental cirrhosis in rats; and reduced the CRP levels in decompensated cirrhosis. The EAS of MASLD revealed that SB reduced liver steatosis and inflammation and lowered the liver expression of genes of TNF-α, IL-1β, interferon-γ, and IL-10. In studies on experimental cirrhosis and MASLD, SB reduced the liver expression of genes of TGF-β, α-SMA, and collagen as well as liver fibrosis. SB reduced the abundance of Escherichia (Proteobacteria), increased the abundance of Bacteroidetes in the gut microbiota, prevented an increase in intestinal barrier permeability, and reduced bacterial translocation and endotoxemia.
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  • 文章类型: Journal Article
    肝胆恶性肿瘤,其中包括肝细胞癌(HCC)和胆管癌(CCA),是全球第六大最常见的癌症,也是癌症相关死亡的第三大原因。慢性炎症强烈刺激肝癌的发生,定义为纤维化沉积,肝坏死和结节再生之间的异常失衡。在这种情况下,肠-肝轴和肠道菌群已被证明在肝癌的发病机制中的关键作用,由于菌群失调和肠道通透性改变促进细菌移位,通过几种途径导致慢性肝脏炎症和肿瘤发生。关于肠道微生物群或胆道细菌在CCA发病机理中的作用,存在一些数据,和一些微生物代谢产物,如胆碱和胆汁酸,似乎表现出一种联系。在这次审查中,我们分析了肠道菌群及其代谢产物对HCC和CCA发展的影响,以及肠道菌群失调作为肝胆管肿瘤风险和抗肿瘤治疗反应的生物标志物的作用.我们还讨论了肠道菌群在肝胆管肿瘤治疗中的未来应用。
    Hepatobiliary malignancies, which include hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), are the sixth most common cancers and the third leading cause of cancer-related death worldwide. Hepatic carcinogenesis is highly stimulated by chronic inflammation, defined as fibrosis deposition, and an aberrant imbalance between liver necrosis and nodular regeneration. In this context, the gut-liver axis and gut microbiota have demonstrated a critical role in the pathogenesis of HCC, as dysbiosis and altered intestinal permeability promote bacterial translocation, leading to chronic liver inflammation and tumorigenesis through several pathways. A few data exist on the role of the gut microbiota or bacteria resident in the biliary tract in the pathogenesis of CCA, and some microbial metabolites, such as choline and bile acids, seem to show an association. In this review, we analyze the impact of the gut microbiota and its metabolites on HCC and CCA development and the role of gut dysbiosis as a biomarker of hepatobiliary cancer risk and of response during anti-tumor therapy. We also discuss the future application of gut microbiota in hepatobiliary cancer management.
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  • 文章类型: Journal Article
    肠肝轴与各种肝脏疾病相关。这里,我们验证了肠道微生物群和巨噬细胞活化在吡咯啶生物碱诱导的肝窦阻塞综合征(PA-HSOS)进展中的作用,并探讨了可能的机制和新的治疗方案。
    通过野百合碱(MCT)的管饲法诱导HSOS小鼠模型。对粪便的16S核糖体DNA(16SrDNA)进行分析以确定粪便微生物群的组成。巨噬细胞清除,粪便微生物移植(FMT),和丁酸盐补充实验用于评估肠道菌群的作用,肠道屏障,和巨噬细胞活化,并探讨这三个变量之间的关系。
    在HSOS患者和小鼠模型中观察到活化的巨噬细胞和低微生物区系多样性。巨噬细胞的消耗减弱了小鼠肝脏中的炎症反应和细胞凋亡。此外,与对照FMT小鼠相比,在HSOS-FMT小鼠中检测到严重肝损伤的加重。具体来说,丁酸盐在HSOS小鼠粪便中的浓度显著降低,给予丁酸盐可以部分减轻肝损伤,改善体内外肠道屏障。此外,在HSOS-FMT小鼠和未经丁酸盐处理的小鼠中也检测到门静脉中脂多糖的升高和肝脏中M1巨噬细胞的高比例,导致严重的炎症反应并进一步加速HSOS进展。
    这些结果表明,肠道微生物群通过丁酸盐介导的改变肠屏障功能调节巨噬细胞M1极化,从而加剧了HSOS的进展。我们的研究确定了HSOS临床治疗的新策略。
    The intestinal-liver axis is associated with various liver diseases. Here, we verified the role of the gut microbiota and macrophage activation in the progression of pyrrolizidine alkaloids-induced hepatic sinusoidal obstruction syndrome (PA-HSOS), and explored the possible mechanisms and new treatment options.
    The HSOS murine model was induced by gavage of monocrotaline (MCT). An analysis of 16S ribosomal DNA (16S rDNA) of the feces was conducted to determine the composition of the fecal microbiota. Macrophage clearance, fecal microbiota transplantation (FMT), and butyrate supplementation experiments were used to assess the role of intestinal flora, gut barrier, and macrophage activation and to explore the relationships among these three variables.
    Activated macrophages and low microflora diversity were observed in HSOS patients and murine models. Depletion of macrophages attenuated inflammatory reactions and apoptosis in the mouse liver. Moreover, compared with control-FMT mice, the exacerbation of severe liver injury was detected in HSOS-FMT mice. Specifically, butyrate fecal concentrations were significantly reduced in HSOS mice, and administration of butyrate could partially alleviated liver damage and improved the intestinal barrier in vitro and in vivo. Furthermore, elevated lipopolysaccharides in the portal vein and high proportions of M1 macrophages in the liver were also detected in HSOS-FMT mice and mice without butyrate treatment, which resulted in severe inflammatory responses and further accelerated HSOS progression.
    These results suggested that the gut microbiota exacerbated HSOS progression by regulating macrophage M1 polarization via altered intestinal barrier function mediated by butyrate. Our study has identified new strategies for the clinical treatment of HSOS.
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  • 文章类型: Journal Article
    肠道微生物群的菌群失调可能是单纯性脂肪肝(SFL)的病理生物学原因,代谢功能障碍相关脂肪性肝炎(MASH),纤维化进展,并转化为MASH相关肝细胞癌(MASH-HCC)。本研究的目的是研究这一进程中的肠道菌群失调。粪便微生物rRNA-16S测序,绝对量化,组织病理学,在高脂肪/卡路里饮食加上饮用水中的高果糖和葡萄糖(HFCD-HF/G)或对照饮食(CD)的小鼠中进行生化测试2、16周,或14个月。组织病理学检查证实SFL的早期阶段,MASH,纤维化,或MASH-HCC进展与脂质代谢紊乱,肝损伤,和肠粘膜屏障受损,如回肠粘膜中occludin的丢失所示。肠道菌群失调早在2周就发生,α多样性降低,动力学因子的扩张,乳球菌,Akkermansia;和双歧杆菌的收缩,乳酸菌,等。,在属的水平。早在MAHS开始时就发现了菌群失调,并且通过MASH纤维化和致癌进展更加深刻。此外,特定物种的扩张,例如约氏乳杆菌和解药动力学杆菌,通过优化的绝对定量方法证实。肠道菌群的动态变化在早期SFL的三个阶段进行了表征,MASH,及其HCC转型。研究结果表明,菌群失调的程度伴随着MASH进展及其向HCC的转化,并且特定微生物物种的缩小或出现可能至少部分地归因于病理性的,新陈代谢,以及肝脏纤维化进展和恶性转化的免疫学改变。
    Dysbiosis of gut microbiota may account for pathobiology in simple fatty liver (SFL), metabolic dysfunction-associated steatohepatitis (MASH), fibrotic progression, and transformation to MASH-associated hepatocellular carcinoma (MASH-HCC). The aim of the present study is to investigate gut dysbiosis in this progression. Fecal microbial rRNA-16S sequencing, absolute quantification, histopathologic, and biochemical tests were performed in mice fed high fat/calorie diet plus high fructose and glucose in drinking water (HFCD-HF/G) or control diet (CD) for 2, 16 weeks, or 14 months. Histopathologic examination verified an early stage of SFL, MASH, fibrotic, or MASH-HCC progression with disturbance of lipid metabolism, liver injury, and impaired gut mucosal barrier as indicated by loss of occludin in ileum mucosa. Gut dysbiosis occurred as early as 2 weeks with reduced α diversity, expansion of Kineothrix, Lactococcus, Akkermansia; and shrinkage in Bifidobacterium, Lactobacillus, etc., at a genus level. Dysbiosis was found as early as MAHS initiation, and was much more profound through the MASH-fibrotic and oncogenic progression. Moreover, the expansion of specific species, such as Lactobacillus johnsonii and Kineothrix alysoides, was confirmed by an optimized method for absolute quantification. Dynamic alterations of gut microbiota were characterized in three stages of early SFL, MASH, and its HCC transformation. The findings suggest that the extent of dysbiosis was accompanied with MASH progression and its transformation to HCC, and the shrinking or emerging of specific microbial species may account at least in part for pathologic, metabolic, and immunologic alterations in fibrogenic progression and malignant transition in the liver.
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  • 文章类型: Journal Article
    本文回顾了门脉高压的病理生理学,包括肝脏内部和外部的多种机制。本文从描述门脉高压的细胞和分子机制的文献开始,微血管血栓形成,正弦静脉充血,门静脉血管生成,血管收缩不足,和高动力循环。机械传导和肠-肝轴,这些是较新的研究领域,被审查。该轴的功能障碍导致慢性肝损伤,炎症,纤维化,和门静脉高压症。在随后的研究中讨论了门脉高压的后遗症。
    This article reviews the pathophysiology of portal hypertension that includes multiple mechanisms internal and external to the liver. This article starts with a review of literature describing the cellular and molecular mechanisms of portal hypertension, microvascular thrombosis, sinusoidal venous congestion, portal angiogenesis, vascular hypocontractility, and hyperdynamic circulation. Mechanotransduction and the gut-liver axis, which are newer areas of research, are reviewed. Dysfunction of this axis contributes to chronic liver injury, inflammation, fibrosis, and portal hypertension. Sequelae of portal hypertension are discussed in subsequent studies.
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  • 文章类型: Journal Article
    背景:山楂酸(MA),五环三萜酸,广泛分布于天然植物中,主要存在于橄榄和山楂的果实和叶子中。据报道,MA具有许多促进健康的功能,比如抗癌,抗炎和神经保护活性。根据之前的研究,山楂提取物具有一定的保肝作用。然而,具体机制尚不清楚,尤其是MA对肠道菌群的影响。
    结果:我们的研究表明,MA有效地抵消酒精诱导的肝损伤和氧化应激。它减轻酒精引起的肠屏障损伤,逆转通透性增加并减少脂多糖(LPS)的易位。这阻止了LPS/Toll样受体4的激活,导致TNF-α和IL-1β产生减少。此外,MA通过逆转有害细菌丰度和增强饮酒后有益细菌来重新平衡肠道微生物群。
    结论:MA,通过调节肠道微生物群,通过肠-肝轴减轻酒精诱导的肝损伤。这些发现支持MA作为功能性食品成分用于预防或治疗酒精性肝病的潜在用途。©2024化学工业学会。
    BACKGROUND: Maslinic acid (MA), a pentacyclic triterpene acid, is widely distributed in natural plants and mainly found in the fruit and leaves of olives and hawthorn. MA has been reported as having many health-promoting functions, such as anticancer, anti-inflammation and neuroprotective activities. According to previous study, hawthorn extract has certain hepatoprotective effects. However, the detailed mechanism is still unclear, especially the effect of MA on gut microbiota.
    RESULTS: Our study reveals that MA effectively counteracts alcohol-induced liver injury and oxidative stress. It mitigates alcohol-induced intestinal barrier damage, reverses increased permeability and reduces translocation of lipopolysaccharide (LPS). This prevents LPS/Toll-like receptor 4 activation, leading to decreased TNF-α and IL-1β production. Furthermore, MA rebalances gut microbiota by reversing harmful bacterial abundance and enhancing beneficial bacteria post-alcohol consumption.
    CONCLUSIONS: MA, through modulation of gut microbiota, alleviates alcohol-induced liver injury via the gut-liver axis. These findings support the potential use of MA as a functional food ingredient for preventing or treating alcoholic liver disease. © 2024 Society of Chemical Industry.
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  • 文章类型: Journal Article
    不健康的生活方式(高脂肪饮食,吸烟,酒精消费,运动太少,等。)在当前社会中容易引起脂质代谢紊乱,影响机体的健康,诱发疾病的发生。皂甙,作为植物中存在的生物活性物质,有降脂作用,减少炎症,和抗动脉粥样硬化作用。皂苷被认为参与体内脂质代谢的调节;它抑制食欲,因此,通过调节下丘脑中的pro-opiomelanocortin/可卡因苯丙胺调节转录本(POMC/CART)神经元和神经肽Y/agouti相关肽(NPY/AGRP)神经元来减少能量摄入,食欲控制中心.皂苷直接激活AMP激活蛋白激酶(AMPK)信号通路和相关转录调节因子,如过氧化物酶体增殖物激活受体(PPAR),CCAAT/增强子结合蛋白(C/EBP),和固醇调节元件结合蛋白(SREBP)增加脂肪酸氧化并抑制脂质合成。它还通过调节肠道微生物及其代谢物和衍生物-短链脂肪酸(SCFA)来调节肠道-肝脏相互作用以改善脂质代谢,胆汁酸(BAs),三甲胺(TMA),脂多糖(LPS),etal.本文综述了不同皂苷对脂质代谢紊乱的积极作用,提示肠-肝轴在改善脂质代谢过程中起着至关重要的作用,可作为治疗靶点,为脂质代谢紊乱的治疗提供新策略。
    Unhealthy lifestyles (high-fat diet, smoking, alcohol consumption, too little exercise, etc.) in the current society are prone to cause lipid metabolism disorders affecting the health of the organism and inducing the occurrence of diseases. Saponins, as biologically active substances present in plants, have lipid-lowering, inflammation-reducing, and anti-atherosclerotic effects. Saponins are thought to be involved in the regulation of lipid metabolism in the body; it suppresses the appetite and, thus, reduces energy intake by modulating pro-opiomelanocortin/Cocaine amphetamine regulated transcript (POMC/CART) neurons and neuropeptide Y/agouti-related peptide (NPY/AGRP) neurons in the hypothalamus, the appetite control center. Saponins directly activate the AMP-activated protein kinase (AMPK) signaling pathway and related transcriptional regulators such as peroxisome-proliferator-activated-receptors (PPAR), CCAAT/enhancer-binding proteins (C/EBP), and sterol-regulatory element binding proteins (SREBP) increase fatty acid oxidation and inhibit lipid synthesis. It also modulates gut-liver interactions to improve lipid metabolism by regulating gut microbes and their metabolites and derivatives-short-chain fatty acids (SCFAs), bile acids (BAs), trimethylamine (TMA), lipopolysaccharide (LPS), et al. This paper reviews the positive effects of different saponins on lipid metabolism disorders, suggesting that the gut-liver axis plays a crucial role in improving lipid metabolism processes and may be used as a therapeutic target to provide new strategies for treating lipid metabolism disorders.
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  • 文章类型: Journal Article
    合生元调节肠道微生物组,有助于预防肝脏疾病,如代谢功能障碍相关的脂肪肝疾病(MAFLD)。本研究旨在评估随机分组的效果,安慰剂对照,对117名代谢健康男性参与者进行为期7周的肝脏代谢双盲干预试验.人体测量数据,血液参数,和粪便样本使用线性混合模型进行分析。经过七周的干预,与安慰剂组相比,合生元组的丙氨酸转氨酶(ALT)显着降低(-14.92%,CI:-26.60--3.23%,p=0.013)。根据体脂百分比进行的分层分析显示ALT显着降低(-20.70%,CI:-40.88--0.53%,p=0.045)在体脂百分比升高的参与者中。Further,发现该组微生物组组成发生显著变化(1.16,CI:0.06-2.25,p=0.039),而在生理体脂干预组中,微生物组成保持稳定。7周合生元干预降低ALT水平,特别是在体内脂肪百分比升高的参与者中,可能是由于肠道微生物组的调节。合生元摄入可能有助于延缓MAFLD的进展,并且可以用于推荐的生活方式改变疗法。
    Synbiotics modulate the gut microbiome and contribute to the prevention of liver diseases such as metabolic-dysfunction-associated fatty liver disease (MAFLD). This study aimed to evaluate the effect of a randomized, placebo-controlled, double-blinded seven-week intervention trial on the liver metabolism in 117 metabolically healthy male participants. Anthropometric data, blood parameters, and stool samples were analyzed using linear mixed models. After seven weeks of intervention, there was a significant reduction in alanine aminotransferase (ALT) in the synbiotic group compared to the placebo group (-14.92%, CI: -26.60--3.23%, p = 0.013). A stratified analysis according to body fat percentage revealed a significant decrease in ALT (-20.70%, CI: -40.88--0.53%, p = 0.045) in participants with an elevated body fat percentage. Further, a significant change in microbiome composition (1.16, CI: 0.06-2.25, p = 0.039) in this group was found, while the microbial composition remained stable upon intervention in the group with physiological body fat. The 7-week synbiotic intervention reduced ALT levels, especially in participants with an elevated body fat percentage, possibly due to modulation of the gut microbiome. Synbiotic intake may be helpful in delaying the progression of MAFLD and could be used in addition to the recommended lifestyle modification therapy.
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  • 文章类型: Journal Article
    胃肠道由肠道微生物群居住。主要的门是Firmicutes和拟杆菌。在非酒精性脂肪性肝病中,现在更名为代谢功能障碍相关脂肪性肝病(MAFLD),Firmicutes和拟杆菌丰度的改变促进其发病机理和演变为非酒精性脂肪性肝炎,肝硬化,和肝细胞癌。出于这个原因,早期治疗是必要的,以抵消其进展。本叙述性综述的目的是评估MAFLD的不同治疗方法。MAFLD最重要的治疗方法是改变生活方式。在这方面,地中海饮食可以被认为是预防和治疗MAFLD的黄金标准。相比之下,西方饮食应该是不鼓励的。益生菌和粪便微生物移植似乎是有效的,安全,和MAFLD治疗的有效替代方案。然而,需要更多的随访时间更长的研究和更多的患者队列来强调更有效的方法来对比MAFLD.
    The gastrointestinal tract is inhabited by the gut microbiota. The main phyla are Firmicutes and Bacteroidetes. In non-alcoholic fatty liver disease, now renamed metabolic dysfunction-associated fatty liver disease (MAFLD), an alteration in Firmicutes and Bacteroidetes abundance promotes its pathogenesis and evolution into non-alcoholic steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. For this reason, early treatment is necessary to counteract its progression. The aim of the present narrative review is to evaluate the different therapeutic approaches to MAFLD. The most important treatment for MAFLD is lifestyle changes. In this regard, the Mediterranean diet could be considered the gold standard in the prevention and treatment of MAFLD. In contrast, a Western diet should be discouraged. Probiotics and fecal microbiota transplantation seem to be valid, safe, and effective alternatives for MAFLD treatment. However, more studies with a longer follow-up and with a larger cohort of patients are needed to underline the more effective approaches to contrasting MAFLD.
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