小肠细菌过度生长对非酒精性肝病肝纤维化指标的影响(3)
单纯性脂肪肝病向脂肪性肝炎、肝纤维化、肝硬化转变过程中的具体机制尚未完全清楚,一般认为,肝纤维化是肝炎向肝硬化转化过程的中间阶段,病变是可逆的,是进行临床干预有效和关键时期。NAFLD患者中,SIBO发生率明显增高,可能是诱发NAFLD患者二次打击的重要因素,从而加重肝功能的损害。越来越多的研究表明,肠道菌群失调在NAFLD的发病过程中起着重要作用。因此在治疗NAFLD时,从肠道微生态的角度出发,预防和治疗肠道毒性物质对肝脏的继发性损伤,有助于预防NAFLD病情加重,降低肝纤维化、肝硬化发生。
[参考文献]
[1] Harrison SA,Kadakia S,Lang KA,et al.Nonalcoholic steatohepatitis:what we know in the new millennium[J].Am J Gastroenterol,2002,97(11):2714-2724.
[2] 周仁荣,梁兵.内毒素对离体鼠肝细胞的致伤作用[J].世界华人消化杂志,1999,7(5):424-425.
[3] 韩德武.肠源性内毒素血症与肝衰竭[J].临床肝胆病杂志,1996,12(1):50-53.
[4] Wigg AJ,Roberts-Thomson IC,Dymock RB,et al.The role of small intestinal bacterial overgrowth,intestinal permeability,endotoxaemia,and tunlour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis[J].Gut,2001,48(2):206-211.
[5] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南(2010年修订版)[J].中华肝脏病杂志,2010,18(3):163-166.
[6] 范建高,朱军,李新建,等.上海市成人脂肪肝患病率及其危险因素流行病学调查[J].中国肝脏病杂志,2005,13(2):83-88.
[7] Adams LA,Angulo P,Lindor KD.Nonalcoholic fatty liver disease[J].CMAJ,2005,172(7):899-905.
[8] Cani PD,Amar J,Iglesias MA,et al.Metabolic endotoxemia initiates Obesity and insulin resistance[J].Diabetes,2007, 56(7):1761-1772.
[9] Shanab AA,Scully P,Crosbie O,et al.Small intestinal bacterial overgrowth in nonalcoholic steatohepatitis:association with Toll -like receptor 4 expression and plasma levels of interleukin 8[J].Dig Dis Sci,2011,56(5):1524-1534.
[10] Soza A1,Riquelme A,González R,et al.Increased oroceeal transittime in patients with nonalcoholic fatty liver disease[J].Dig Dis Sci,2005,50(6):1136-1140.
[11] Wu WC,Zhao W,Li S.Small intestinal bacteria overgrowth decreases small intestinal motility in the NASH rats[J]. World J Gastroenterol,2008,14(2):313-317.
[12] 胡先平,余保平,胡柳丹.非酒精性脂肪肝大鼠结肠Cajal间质细胞超微结构的改变[J].胃肠病学,2011, 16(11):662-667.
[13] 赵龙凤,李红,韩德五.肠源性内毒素血症与肝病[J].世界华人消化杂志,2000,8(10):1145-1149.
[14] 陈宝昌,霍晓辉.非酒精性脂肪性肝炎患者血清内毒素和肿瘤坏死因子-α的检测及意义(附92例报告)[J].河北医科大学学报,2003,24(5):292-293.
[15] 贾晋斌,韩德五,许瑞龄,等.肠源性内毒素血症在实验性肝纤维化发生发展中的作用[J].中国病理生理杂志,1998,14(4):396-399.
[16] Cani PD,Amar J,Iglesias MA,et al.Metabolic endotoxemia initiates Obesity and insulin resistance[J].Diabetes,2007,56(7):1761-1772.
(收稿日期:2015-03-09 本文编辑:王红双) (李伟伟 韩红波)
[参考文献]
[1] Harrison SA,Kadakia S,Lang KA,et al.Nonalcoholic steatohepatitis:what we know in the new millennium[J].Am J Gastroenterol,2002,97(11):2714-2724.
[2] 周仁荣,梁兵.内毒素对离体鼠肝细胞的致伤作用[J].世界华人消化杂志,1999,7(5):424-425.
[3] 韩德武.肠源性内毒素血症与肝衰竭[J].临床肝胆病杂志,1996,12(1):50-53.
[4] Wigg AJ,Roberts-Thomson IC,Dymock RB,et al.The role of small intestinal bacterial overgrowth,intestinal permeability,endotoxaemia,and tunlour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis[J].Gut,2001,48(2):206-211.
[5] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南(2010年修订版)[J].中华肝脏病杂志,2010,18(3):163-166.
[6] 范建高,朱军,李新建,等.上海市成人脂肪肝患病率及其危险因素流行病学调查[J].中国肝脏病杂志,2005,13(2):83-88.
[7] Adams LA,Angulo P,Lindor KD.Nonalcoholic fatty liver disease[J].CMAJ,2005,172(7):899-905.
[8] Cani PD,Amar J,Iglesias MA,et al.Metabolic endotoxemia initiates Obesity and insulin resistance[J].Diabetes,2007, 56(7):1761-1772.
[9] Shanab AA,Scully P,Crosbie O,et al.Small intestinal bacterial overgrowth in nonalcoholic steatohepatitis:association with Toll -like receptor 4 expression and plasma levels of interleukin 8[J].Dig Dis Sci,2011,56(5):1524-1534.
[10] Soza A1,Riquelme A,González R,et al.Increased oroceeal transittime in patients with nonalcoholic fatty liver disease[J].Dig Dis Sci,2005,50(6):1136-1140.
[11] Wu WC,Zhao W,Li S.Small intestinal bacteria overgrowth decreases small intestinal motility in the NASH rats[J]. World J Gastroenterol,2008,14(2):313-317.
[12] 胡先平,余保平,胡柳丹.非酒精性脂肪肝大鼠结肠Cajal间质细胞超微结构的改变[J].胃肠病学,2011, 16(11):662-667.
[13] 赵龙凤,李红,韩德五.肠源性内毒素血症与肝病[J].世界华人消化杂志,2000,8(10):1145-1149.
[14] 陈宝昌,霍晓辉.非酒精性脂肪性肝炎患者血清内毒素和肿瘤坏死因子-α的检测及意义(附92例报告)[J].河北医科大学学报,2003,24(5):292-293.
[15] 贾晋斌,韩德五,许瑞龄,等.肠源性内毒素血症在实验性肝纤维化发生发展中的作用[J].中国病理生理杂志,1998,14(4):396-399.
[16] Cani PD,Amar J,Iglesias MA,et al.Metabolic endotoxemia initiates Obesity and insulin resistance[J].Diabetes,2007,56(7):1761-1772.
(收稿日期:2015-03-09 本文编辑:王红双) (李伟伟 韩红波)