非酒精性脂肪肝的发病机制和治疗_谢萍.pdfVIP

中西医结合学报2010 年3 月第8 卷第3 期　Journal of Chinese Integrative Medicine, March 2010, Vol.8, No.3 ·201 · Review 　　 谢萍, 周新喜, 张琴 复旦大学上海公共卫生临床中心肝病科, 上海201508 :为进 一步认识非酒精性脂肪肝(non-alcoholic fatty liver disease, NAFLD)的发病机制, 寻求NAFLD 临床最佳疗效依据, 本文作 对近年来NAFLD 的发病机制及治疗进行了归纳和分析整理,发现NAFLD 与 诸多因素有关, 其中最为重要的是活性氧簇(reactive oxygen species, ROS)的产生,在两次打击中, 以胰岛 素抵抗为基础, ROS 为中心环节, 并在 一系列相关因素如瘦素抵抗、caspase-3、Fas 及其配体、外周血自然杀 伤T 细胞、环氧合酶2、代谢性核受体、肝细胞铁沉积、铁蛋白、结合珠蛋白、视黄醇结合蛋白4、肠道菌群失 调、线粒体功能失调以及内质网压力的作用下, 共同促进了NAFLD 的进展。针对发病机制, 临床治疗除常规 改善胰岛素抵抗,抗氧化,改善脂质代谢外,还可采用核代谢配体或激活剂、铁螯合剂以及中医辨证论治方法。 :非酒精性脂肪肝;病机;治疗 Xie P, Zhou XX, Zhang Q.J Ch in In teg r Med .2010;8(3):201-209. Received Nove ber 9, 2009;accepted January 29, 2010;published online March 15, 2010. Indexed/abstracted in and full text link-out at PubMed.Journal title in PubMed:Z hong X i Y i J ie H e X ue B ao. Free full text (HTML and PDF)is available at http://www.jci journal.co . Forward linking and reference linking via CrossRef. DOI:10.3736/jci Open Access Pat hogenesis and t reat ment of non-alcoholic fatty liver disease Ping XIE, Xin-xi ZHOU, Qin ZHANG Depart ent of Liver Diseases, Shanghai Public Clinical Health Center, Fudan University, Shanghai 201508, China Abstract:In order to explore the pathogenesis of non-alcoholic fatty liver disease (NAFLD), and to find the best evidence for clinical practice, recent literature about the pathogenesis and treatment of NAFLD was analyzed, and it was found that the generationof reactive oxygenspecies (RO )is the most important factor indevelopment of NAFLD.Based on insulin resistance (IR), generation of RO is a central link inthe course oftwo hits.Other factors, such as leptin resistance, caspase-3, Fas and its ligand, peripheral natural killer T cells, cyclooxygenase-2, metabolic nuclear receptors, hepatic deposition of iron,