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NAFLD与T2DM的相关研究
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Abstract:
非酒精性脂肪性肝病(nonalcoholic fatty liver disease, NAFLD)主要表现在肝脏脂肪堆积和脂肪变性，其发生与肥胖、血脂异常等因素紧密相关。与此同时，2型糖尿病(T2DM)作为一种以慢性高血糖为特征的代谢性疾病，亦与胰岛素分泌及抵抗问题有关。二者互相促进，互为因果，共享相似的病理基础——糖脂代谢紊乱。胆汁酸(bile acid, BA)作为胆汁的成分之一，在肠道中扮演着脂质和脂溶性分子乳化与吸收的角色，通过FXR、TGR5、FGF19、GLP-1等途径调节糖脂代谢和能量平衡。研究发现，NAFLD和T2DM患者的胆汁酸谱发生显著变化，胆汁酸可能与NAFLD和T2DM的发病机制和发展过程密切相关。这些发现为胆汁酸成为NAFLD和T2DM的诊断、预防和治疗中的新型生物标志物提供了科学依据。此外，胆汁酸代谢的调控机制，包括胆固醇合成途径、肠道菌群的影响以及胆汁酸的肠肝循环。深入研究胆汁酸代谢与NAFLD和T2DM之间的关系，将有助于开发基于BA代谢调控的治疗策略，从而改善患者的生活质量。因此，本文就BA代谢在NAFLD合并T2DM中的作用及临床应用前景进行综述，为该合并症的诊治提供创新的理论支持和科学依据。
Nonalcoholic Fatty Liver Disease (NAFLD), characterized by hepatic lipid accumulation and steatosis, is closely associated with factors such as obesity and dyslipidemia. Concurrently, Type 2 Diabetes Mellitus (T2DM), a metabolic disorder marked by chronic hyperglycemia, is related to issues of insulin secretion and resistance. These two conditions mutually exacerbate each other, forming a causal relationship and sharing a similar pathological basis—disorders of glucose and lipid metabolism. Bile acids (BA), as a component of bile, play a crucial role in the emulsification and absorption of lipids and lipid-soluble molecules in the intestines. They regulate glucose and lipid metabolism and energy balance through pathways involving FXR, TGR5, FGF19, and GLP-1. Studies have shown that the bile acid profile in patients with NAFLD and T2DM undergoes significant changes, suggesting that bile acids may be closely related to the pathogenesis and progression of NAFLD and T2DM. These findings provide a scientific basis for bile acids to serve as novel biomarkers in the diagnosis, prevention, and treatment of NAFLD and T2DM. Moreover, the regulatory mechanisms of bile acid metabolism, including cholesterol synthesis pathways, the influence of gut microbiota, and the enterohepatic circulation of bile acids, are of great interest. In-depth research into the relationship between bile acid metabolism and NAFLD and T2DM may facilitate the development of therapeutic strategies based on the regulation of bile acid metabolism, thereby improving the quality of life for patients. Therefore, this article reviews the role of bile acid metabolism in the coexistence of nonalcoholic fatty liver disease and Type 2 diabetes mellitus, as well as its clinical application prospects, providing innovative theoretical support and a scientific for the diagnosis and treatment of this comorbidity.
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