PDF下载 ( 2123 KB)
中药治疗非酒精性脂肪性肝病的作用机制
DOI: 10.3969/j.issn.1001-5256.2021.02.044
作者贡献声明：刘素彤负责课题设计，资料分析，撰写论文；于中杰参与收集数据，修改论文；赵文霞负责拟定写作思路，指导撰写文章并最后定稿。
Mechanism of action of traditional Chinese medicine in treatment of nonalcoholic fatty liver disease
-
摘要: 非酒精性脂肪性肝病(NAFLD)是全球范围内最重要的肝病之一，中药治疗NAFLD疗效显著，其作用机制与改善脂质代谢、减轻肝脏炎症、调节肠道菌群、改善先天免疫和抗肝纤维化等有关。总结了目前中药治疗NALFD作用机制的现有数据，以期为临床应用提供参考。Abstract: Nonalcoholic fatty liver disease (NAFLD) is one of the most important liver diseases worldwide. Traditional Chinese medicine has a significant effect in the treatment of NAFLD, possibly by improving lipid metabolism, reducing liver inflammation, regulating intestinal flora, improving innate immunity, and reducing liver fibrosis. This article summarizes the current data on the mechanism of action of traditional Chinese medicine in the treatment of NALFD, so as to provide a reference for clinical application.
-
[1] SCHWABE RF, TABAS I, PAJVANI UB. Mechanisms of fibrosis development in nonalcoholic steatohepatitis[J]. Gastroenterology, 2020, 158(7): 1913-1928. DOI: 10.1053/j.gastro.2019.11.311 [2] DUFOUR JF, CAUSSY C, LOOMBA R. Combination therapy for non-alcoholic steatohepatitis: Rationale, opportunities and challenges[J]. Gut, 2020, 69(10): 1877-1884. DOI: 10.1136/gutjnl-2019-319104 [3] TARANTINO G, CITRO V, CAPONE D. Nonalcoholic fatty liver disease: A challenge from mechanisms to therapy[J]. J Clin Med, 2019, 9(1): 15. DOI: 10.3390/jcm9010015 [4] SHI KQ, FAN YC, LIU WY, et al. Traditional Chinese medicines benefit to nonalcoholic fatty liver disease: A systematic review and meta-analysis[J]. Mol Biol Rep, 2012, 39(10): 9715-9722. DOI: 10.1007/s11033-012-1836-0 [5] BESSONE F, RAZORI MV, ROMA MG. Molecular pathways of nonalcoholic fatty liver disease development and progression[J]. Cell Mol Life Sci, 2019, 76(1): 99-128. DOI: 10.1007/s00018-018-2947-0 [6] SANTAMARINA AB, OLIVEIRA JL, SILVA FP, et al. Green tea extract rich in epigallocatechin-3-gallate prevents fatty liver by AMPK activation via LKB1 in mice fed a high-fat diet[J]. PLoS One, 2015, 10(11): e0141227. DOI: 10.1371/journal.pone.0141227 [7] LEE JH, JUNG JY, JANG EJ, et al. Combination of honokiol and magnolol inhibits hepatic steatosis through AMPK-SREBP-1c pathway[J]. Exp Biol Med (Maywood), 2015, 240(4): 508-518. DOI: 10.1177/1535370214547123 [8] KANG OH, KIM SB, MUN SH, et al. Puerarin ameliorates hepatic steatosis by activating the PPARα and AMPK signaling pathways in hepatocytes[J]. Int J Mol Med, 2015, 35(3): 803-809. DOI: 10.3892/ijmm.2015.2074 [9] YU YQ, CHEN X, LI JX. Research on adjustment of lipid metabolism factors by extracts of Jiaogulan and Shengshanzha toward non-alcoholic steatohepatitis rats[J]. J Liaoning Univ TCM, 2012, 14(7): 168-170. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB201207065.htm余轶群, 陈希, 李军祥. 绞股蓝、生山楂水提物对非酒精性脂肪性肝炎大鼠脂质代谢相关因子的调控作用研究[J]. 辽宁中医药大学学报, 2012, 14(7): 168-170. https://www.cnki.com.cn/Article/CJFDTOTAL-LZXB201207065.htm [10] DIAO TT, ZHANG YC, CHEN C, et al. Effect and mechanism of hawthorn leaves flavonoids on blood lipid in hyperlipidemia rats[J]. Herald Med, 2020, 39(6): 757-762. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-YYDB202006006.htm刁婷婷, 张雨晨, 陈创, 等. 山楂叶总黄酮对高脂血症大鼠血脂的影响及其机制[J]. 医药导报, 2020, 39(6): 757-762. https://www.cnki.com.cn/Article/CJFDTOTAL-YYDB202006006.htm [11] GENG RJ. Based on AMPK/SIRT1/UCP2 pathway to explore the effect of shugan huazhi capsule on liver oxidative stress in NAFLD rats[D]. Shenyang: Liaoning University of Traditional Chinese Medicine, 2018. (in Chinese)耿蕊娟. 基于AMPK/SIRT1/UCP2通路探讨疏肝化滞胶囊对NAFLD大鼠肝脏氧化应激的影响[D]. 沈阳: 辽宁中医药大学, 2018. [12] CHEN Z, YU Y, CAI J, et al. Emerging molecular targets for treatment of nonalcoholic fatty liver disease[J]. Trends Endocrinol Metab, 2019, 30(12): 903-914. DOI: 10.1016/j.tem.2019.08.006 [13] KWAK DH, KIM JS, CHANG KT, et al. Aristolochia manshuriensis Kom ethyl acetate extract protects against high-fat diet-induced non-alcoholic steatohepatitis by regulating kinase phosphorylation in mouse[J]. J Vet Sci, 2016, 17(3): 279-287. DOI: 10.4142/jvs.2016.17.3.279 [14] LIU M, XU L, YIN L, et al. Potent effects of dioscin against obesity in mice[J]. Sci Rep, 2015, 5: 7973. DOI: 10.1038/srep07973 [15] CHOI JY, KWON EY, CHOI MS. Elucidation of the metabolic and transcriptional responses of an oriental herbal medicine, bangpungtongseong-san, to nonalcoholic fatty liver disease in diet-induced obese mice[J]. J Med Food, 2019, 22(9): 928-936. DOI: 10.1089/jmf.2018.4383 [16] SANYAL AJ. Past, present and future perspectives in nonalcoholic fatty liver disease[J]. Nat Rev Gastroenterol Hepatol, 2019, 16(6): 377-386. DOI: 10.1038/s41575-019-0144-8 [17] LEE MR, PARK KI, MA JY. Leonurus japonicus houtt attenuates nonalcoholic fatty liver disease in free fatty acid-induced hepG2 cells and mice fed a high-fat diet[J]. Nutrients, 2017, 10(1): 20. DOI: 10.3390/nu10010020 [18] LI S, LIAO X, MENG F, et al. Therapeutic role of ursolic acid on ameliorating hepatic steatosis and improving metabolic disorders in high-fat diet-induced non-alcoholic fatty liver disease rats[J]. PLoS One, 2014, 9(1): e86724. DOI: 10.1371/journal.pone.0086724 [19] BAE UJ, CHOI EK, OH MR, et al. Angelica gigas ameliorates hyperglycemia and hepatic steatosis in C57BL/KsJ-db/db mice via activation of AMP-activated protein kinase signaling pathway[J]. Am J Chin Med, 2016, 44(8): 1627-1638. DOI: 10.1142/S0192415X16500919 [20] CHEN X, SU WD, LIANG RS, et al. Effect of Ganzhining on the expression of inflammatory factors in rats with nonalcoholic steatohepatitis[J]. Chin J Integr Tradit West Med on Liver, 2019, 29(4): 348-350. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201904022.htm陈欣, 苏文弟, 梁汝圣, 等. 肝脂宁对非酒精性脂肪性肝炎大鼠炎症因子表达的影响[J]. 中西医结合肝病杂志, 2019, 29(4): 348-350. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201904022.htm [21] TONG J, GUO JJ. Key molecular pathways in the progression of non-alcoholic steatohepatitis[J]. Eur Rev Med Pharmacol Sci, 2019, 23(19): 8515-8522. [22] CABRERA D, WREE A, POVERO D, et al. Andrographolide ameliorates inflammation and fibrogenesis and attenuates inflammasome activation in experimental non-alcoholic steatohepatitis[J]. Sci Rep, 2017, 7(1): 3491. DOI: 10.1038/s41598-017-03675-z [23] SONG CY, SHI J, ZENG X, et al. Sophocarpine alleviates hepatocyte steatosis through activating AMPK signaling pathway[J]. Toxicol In Vitro, 2013, 27(3): 1065-1071. DOI: 10.1016/j.tiv.2013.01.020 [24] WANG Y, LIU YJ, DAI J, et al. The effect of shugan lipi decoction ameliorates non-alcoholic steatohepatitis in SD rats through regulation of the LPS/TLR4 signaling pathway[J]. Chin J Integr Tradit West Med on Liver, 2019, 29(2): 167-170, 178. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201902023.htm王雅, 刘玉娟, 代静, 等. 基于LPS/TLR4通路研究疏肝理脾汤治疗NASH大鼠的作用机制[J]. 中西医结合肝病杂志, 2019, 29(2): 167-170, 178. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201902023.htm [25] ZHAO WX, ZHANG LH, CUI JJ. Research on huatan qushi huoxue recipe on inflammation and fibrosis in pathological structure of rats with non-alcoholic steatohepatitis[J]. Chin Arch Trad Chi Med, 2017, 35(9): 2229-2231. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201709005.htm赵文霞, 张丽慧, 崔健娇. 化痰祛湿活血方对非酒精性脂肪性肝炎大鼠炎症损伤及纤维化的干预作用[J]. 中华中医药学刊, 2017, 35(9): 2229-2231. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201709005.htm [26] LUO Y, TIAN G, ZHUANG Z, et al. Berberine prevents non-alcoholic steatohepatitis-derived hepatocellular carcinoma by inhibiting inflammation and angiogenesis in mice[J]. Am J Transl Res, 2019, 11(5): 2668-2682. [27] MA J, ZHOU Q, LI H. Gut microbiota and nonalcoholic fatty liver disease: Insights on mechanisms and therapy[J]. Nutrients, 2017, 9(10): 1124. DOI: 10.3390/nu9101124 [28] YU X, WANG WJ, JIN JY, et al. Linggui Zhugan Decoction combined with probiotics in the treatment of nonalcoholic fatty liver disease[J]. J Changchun Univ Chin Med, 2019, 35(5): 891-894. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX201905023.htm喻晓, 王雯婕, 金嘉悦, 等. 苓桂术甘汤联合益生菌治疗非酒精性脂肪肝[J]. 长春中医药大学学报, 2019, 35(5): 891-894. https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX201905023.htm [29] LI LS, XU XM, LU XH, et al. Effects of alisma orientale on the diversity of gut microbiota in rats fed on high-fat and high-sugar diet[J]. Chin J Microecol, 2019, 31(4): 396-401. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWS201904005.htm李丽莎, 徐小妹, 卢雪花, 等. 泽泻对高脂高糖饮食大鼠肠道菌群多样性的影响[J]. 中国微生态学杂志, 2019, 31(4): 396-401. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWS201904005.htm [30] LIU M, CHEN QC, LI LM, et al. Effects of boussingaultia saponins on metabolic syndrome and gut microbiota in mice[J]. J Dalian Med Univ, 2017, 39(5): 428-432. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-DLYK201705003.htm刘敏, 陈奇超, 李玲铭, 等. 藤三七皂苷组分对代谢综合征小鼠及其肠道菌群的调节作用[J]. 大连医科大学学报, 2017, 39(5): 428-432. https://www.cnki.com.cn/Article/CJFDTOTAL-DLYK201705003.htm [31] YAN DM, HU YY. Research progress of interaction between gut microbiota and Chinese medicine[J]. Shanghai J Tradit Chin Med, 2020, 54(S1): 199-205. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ2020S1056.htm严东明, 胡义扬. 肠道菌群与中药的相互作用研究进展[J]. 上海中医药杂志, 2020, 54(S1): 199-205. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZZ2020S1056.htm [32] MAI JY, GAO YQ, CAI Z, et al. Influence of shenge decoction on intestinal barrier injury and expression of tight junction protein Occludin in intestinal mucosa in rats with non-alcoholic steatohepatitis[J]. Chin J Integr Tradit West Med on Liver, 2016, 26(4): 228-230, 258. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201604014.htm麦静愔, 高月求, 蔡峥, 等. 参葛方对非酒精性脂肪性肝炎大鼠肠道黏膜屏障损伤和紧密连接蛋白Occludin表达的影响[J]. 中西医结合肝病杂志, 2016, 26(4): 228-230, 258. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201604014.htm [33] XU L, FU J, FANG F, et al. Effect of modfied yinchen wuling san in treating non-alcoholic fatty liver disease with moisture and heat implication and on intestinal microflora[J]. Chin J Exp Tradit Med Form, 2019, 25(12): 127-132. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201912020.htm徐立, 符晶, 方芳, 等. 加味茵陈五苓散治疗湿热蕴结型非酒精性脂肪性肝病的疗效及对肠道菌群的影响[J]. 中国实验方剂学杂志, 2019, 25(12): 127-132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFX201912020.htm [34] NARAYANAN S, SURETTE FA, HAHN YS. The immune landscape in nonalcoholic steatohepatitis[J]. Immune Netw, 2016, 16(3): 147-158. DOI: 10.4110/in.2016.16.3.147 [35] CAI J, ZHANG XJ, LI H. The role of innate immune cells in nonalcoholic steatohepatitis[J]. Hepatology, 2019, 70(3): 1026-1037. DOI: 10.1002/hep.30506 [36] LI Y, LI K, SHEN TB. Effect of qinghua decoction combined life-style intervening on 60 NASH patients with phlegmy syndrome[J]. Chin J Integr Tradit West Med on Liver, 2015, 25(1): 18-20. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201501006.htm李莹, 李坤, 沈天白. 清化方联合生活方式干预治疗痰湿体质非酒精性脂肪性肝炎的临床研究[J]. 中西医结合肝病杂志, 2015, 25(1): 18-20. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201501006.htm [37] GUO C, ZENG L. Effect of Shuganjianpi decoction in the prevention of alcohol-induced steatosis in HepG2 cells[J]. J Prac Hepatol, 2016, 19(2): 160-163. (in Chinese) DOI: 10.3969/j.issn.1672-5069.2016.02.009郭灿, 曾莉. 疏肝健脾方含药血清对酒精性损伤HepG2细胞脂肪变性的保护作用[J]. 实用肝脏病杂志, 2016, 19(2): 160-163. DOI: 10.3969/j.issn.1672-5069.2016.02.009 [38] XIONG HR. Chikusetsu saponin IVa ameliorates fatty liver disease through inhibiting CD36-NLRP3 signaling pathway[D]. Yichang: China Three Gorges University, 2019. (in Chinese)熊海容. 基于CD36-NLRP3信号通路研究竹节参皂苷IVa改善脂肪性肝病的实验研究[D]. 宜昌: 三峡大学, 2019. [39] HAN C, ZHENG LY, LYU JH, et al. Inhibitory effects of total glucosides of paeony on lipid infiltration and fibrosis in NAFLD rats induced by fructose and high-fat diet[J]. Herald Med, 2014, 33(10): 1294-1299. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-YYDB201410012.htm韩超, 郑琳颖, 吕俊华, 等. 白芍总苷对非酒精性脂肪性肝病大鼠脂质浸润及纤维化的抑制作用[J]. 医药导报, 2014, 33(10): 1294-1299. https://www.cnki.com.cn/Article/CJFDTOTAL-YYDB201410012.htm [40] GONG Y, FAN W, ZHANG Y, et al. Protective effect of ginkgo biloba extract on liver nonalcoholic steatohepatitis rats[J]. Chongqing Med J, 2015, 44(30): 4190-4192. (in Chinese) DOI: 10.3969/j.issn.1671-8348.2015.30.005龚毅, 范伟, 张莹, 等. 银杏叶提取物对大鼠非酒精性脂肪肝炎肝脏保护作用的研究[J]. 重庆医学, 2015, 44(30): 4190-4192. DOI: 10.3969/j.issn.1671-8348.2015.30.005 [41] LIU Y, SONG HY, SHU XB, et al. Alleviation of liver fibrosis in MCD diet-induced nonalcoholic steatotic hepatitis by Jiangzhi Granule[J]. Chin J Tradit Chin Med Pharm, 2015, 30(9): 3321-3325. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201509083.htm刘洋, 宋海燕, 舒祥兵, 等. 降脂颗粒改善蛋氨酸-胆碱缺乏饮食诱导的非酒精性脂肪性肝炎的小鼠肝纤维化[J]. 中华中医药杂志, 2015, 30(9): 3321-3325. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201509083.htm [42] LIU XT, ZHAO WX. Progress of experimental research on treatment of non-alcoholic fatty liver disease with traditional Chinese medicine[J]. Chin J Integr Tradit West Med on Liver, 2012, 22(4): 251-253. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201204029.htm刘雪涛, 赵文霞. 中医治疗非酒精性脂肪性肝病实验研究进展[J]. 中西医结合肝病杂志, 2012, 22(4): 251-253. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXGB201204029.htm [43] TAN LP, SHI AH, ZHU XS, et al. Research progress on the mechanism of traditional Chinese medicine compounds in the treatment of nonalcoholic fatty liver disease base on autophagy[J]. China Med Herald, 2019, 16(34): 50-53. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201934012.htm谭丽萍, 石安华, 朱晓松, 等. 基于自噬探讨中药复方治疗非酒精性脂肪性肝病作用机制的研究进展[J]. 中国医药导报, 2019, 16(34): 50-53. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201934012.htm [44] DING S, JIANG J, ZHANG G, et al. Resveratrol and caloric restriction prevent hepatic steatosis by regulating SIRT1-autophagy pathway and alleviating endoplasmic reticulum stress in high-fat diet-fed rats[J]. PLoS One, 2017, 12(8): e0183541. DOI: 10.1371/journal.pone.0183541 [45] GONG LL, LI GR, ZHANG W, et al. Akebia saponin D decreases hepatic steatosis through autophagy modulation[J]. J Pharmacol Exp Ther, 2016, 359(3): 392-400. DOI: 10.1124/jpet.116.236562 [46] CHEN J, FENG CL, NIE ZY, et al. Effect of shugan xiaozhi decoction Ⅲ capsule on the CYP2E1 in the rat with non-alcoholic fatty liver disease[J]. J Changchun Univ Chin Med, 2017, 33(3): 351-354. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX201703003.htm陈进, 冯崇廉, 聂钊源, 等. 疏肝消脂Ⅲ方胶囊对非酒精性脂肪肝大鼠CYP2E1基因表达的影响[J]. 长春中医药大学学报, 2017, 33(3): 351-354. https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX201703003.htm [47] LI WY, YUAN CM. Research advances in integrated traditional Chinese and Western medicine therapy for nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2020, 36(4): 919-923. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2020.04.047李文怡, 袁成民. 非酒精性脂肪性肝病的中西医治疗[J]. 临床肝胆病杂志, 2020, 36(4): 919-923. DOI: 10.3969/j.issn.1001-5256.2020.04.047 [48] NAN YM, LI WC. Traditional Chinese medicines for treatment of non-alcoholic fibrosing steatohepatitis[J]. J Clin Hepatol, 2013, 29(4): 249-252. (in Chinese) http://lcgdbzz.org/article/id/LCGD201304002南月敏, 李文聪. 中药治疗非酒精性脂肪性肝纤维化的研究现状[J]. 临床肝胆病杂志, 2013, 29(4): 249-252. http://lcgdbzz.org/article/id/LCGD201304002 -
下载:
本文二维码
图(1)
计量
- 文章访问数: 1116
- HTML全文浏览量: 292
- PDF下载量: 100
- 被引次数: 0
