脂质代谢紊乱在代谢功能障碍脂肪性肝病中的研究进展
Progress in Research on Lipid Metabolism Dysregulation in Metabolic Dysfunction-Associated Fatty Liver Disease
DOI: 10.12677/acm.2026.161230, PDF,   
作者: 刘成成, 黄 梦, 龚 欢, 赵婷婷, 贺 娜*:西安医学院第一附属医院消化内科,陕西 西安
关键词: 脂质代谢代谢功能障碍相关脂肪性肝病胰岛素抵抗Lipid Metabolism MAFLD Insulin Resistance
摘要: 代谢功能障碍相关脂肪性肝病(MAFLD)已成为全球慢性肝病的主要病因,其发生发展与脂质代谢紊乱密切相关。本文系统综述了脂质代谢异常在MAFLD发病机制中的作用,重点阐述甘油三酯、游离脂肪酸、胆固醇及脂毒性介导肝脏损伤的分子机制,并总结了靶向脂质代谢通路的潜在治疗策略。通过整合现有研究进展,本文旨在为MAFLD的早期无创诊断及基于脂质代谢通路的治疗策略提供理论依据和新的研究视角。
Abstract: Metabolic dysfunction-associated fatty liver disease (MAFLD) has emerged as the leading cause of chronic liver disease worldwide, with its pathogenesis closely linked to disturbances in lipid metabolism. This review examines the role of lipid metabolic abnormalities in the onset and progression of MAFLD, with a particular focus on the molecular mechanisms by which triglycerides, free fatty acids, cholesterol, and lipotoxicity contribute to hepatic injury. Furthermore, it provides an overview of therapeutic strategies targeting lipid metabolic pathways. By integrating current research advances, this article aims to offer insights into the early non-invasive diagnosis of MAFLD and the development of lipid-based therapeutic approaches.
文章引用:刘成成, 黄梦, 龚欢, 赵婷婷, 贺娜. 脂质代谢紊乱在代谢功能障碍脂肪性肝病中的研究进展[J]. 临床医学进展, 2026, 16(1): 1809-1817. https://doi.org/10.12677/acm.2026.161230

参考文献

[1] Eslam, M., Newsome, P.N., Sarin, S.K., Anstee, Q.M., Targher, G., Romero-Gomez, M., et al. (2020) A New Definition for Metabolic Dysfunction-Associated Fatty Liver Disease: An International Expert Consensus Statement. Journal of Hepatology, 73, 202-209. [Google Scholar] [CrossRef] [PubMed]
[2] Eslam, M., Sarin, S.K., Wong, V.W., Fan, J., Kawaguchi, T., Ahn, S.H., et al. (2020) The Asian Pacific Association for the Study of the Liver Clinical Practice Guidelines for the Diagnosis and Management of Metabolic Associated Fatty Liver Disease. Hepatology International, 14, 889-919. [Google Scholar] [CrossRef] [PubMed]
[3] Portincasa, P. (2023) NAFLD, MAFLD, and Beyond: One or Several Acronyms for Better Comprehension and Patient Care. Internal and Emergency Medicine, 18, 993-1006. [Google Scholar] [CrossRef] [PubMed]
[4] Portincasa, P., Khalil, M., Mahdi, L., Perniola, V., Idone, V., Graziani, A., et al. (2024) Metabolic Dysfunction-Associated Steatotic Liver Disease: From Pathogenesis to Current Therapeutic Options. International Journal of Molecular Sciences, 25, Article No. 5640. [Google Scholar] [CrossRef] [PubMed]
[5] Song, S.J., Lai, J.C., Wong, G.L., Wong, V.W. and Yip, T.C. (2024) Can We Use Old NAFLD Data under the New MASLD Definition? Journal of Hepatology, 80, e54-e56. [Google Scholar] [CrossRef] [PubMed]
[6] Zhou, X., Targher, G., Byrne, C.D., Somers, V., Kim, S.U., Chahal, C.A.A., et al. (2023) An International Multidisciplinary Consensus Statement on MAFLD and the Risk of CVD. Hepatology International, 17, 773-791. [Google Scholar] [CrossRef] [PubMed]
[7] Wang, T., Wang, R., Bu, Z., Targher, G., Byrne, C.D., Sun, D., et al. (2022) Association of Metabolic Dysfunction-Associated Fatty Liver Disease with Kidney Disease. Nature Reviews Nephrology, 18, 259-268. [Google Scholar] [CrossRef] [PubMed]
[8] Mantovani, A., Petracca, G., Beatrice, G., Csermely, A., Tilg, H., Byrne, C.D., et al. (2021) Non-Alcoholic Fatty Liver Disease and Increased Risk of Incident Extrahepatic Cancers: A Meta-Analysis of Observational Cohort Studies. Gut, 71, 778-788. [Google Scholar] [CrossRef] [PubMed]
[9] Gao, F., Chen, G., Byrne, C.D., Targher, G., Cheung, T.T. and Zheng, M. (2023) Metabolic Dysfunction-Associated Fatty Liver Disease and Hepatocellular Carcinoma: Present and Future. Hepatobiliary Surgery and Nutrition, 12, 945-948. [Google Scholar] [CrossRef] [PubMed]
[10] Lou, T., Yang, R. and Fan, J. (2024) The Global Burden of Fatty Liver Disease: The Major Impact of China. Hepatobiliary Surgery and Nutrition, 13, 119-123. [Google Scholar] [CrossRef] [PubMed]
[11] Lonardo, A., Mantovani, A., Petta, S., Carraro, A., Byrne, C.D. and Targher, G. (2022) Metabolic Mechanisms for and Treatment of NAFLD or NASH Occurring after Liver Transplantation. Nature Reviews Endocrinology, 18, 638-650. [Google Scholar] [CrossRef] [PubMed]
[12] Kaylan, K.B. and Paul, S. (2024) NAFLD No More: A Review of Current Guidelines in the Diagnosis and Evaluation of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Current Diabetes Reports, 25, Article No. 5. [Google Scholar] [CrossRef] [PubMed]
[13] Kwo, P.Y., Cohen, S.M. and Lim, J.K. (2017) ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. American Journal of Gastroenterology, 112, 18-35. [Google Scholar] [CrossRef] [PubMed]
[14] Portillo-Sanchez, P., Bril, F., Maximos, M., Lomonaco, R., Biernacki, D., Orsak, B., et al. (2015) High Prevalence of Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus and Normal Plasma Aminotransferase Levels. The Journal of Clinical Endocrinology & Metabolism, 100, 2231-2238. [Google Scholar] [CrossRef] [PubMed]
[15] Loomba, R. and Adams, L.A. (2019) The 20% Rule of NASH Progression: The Natural History of Advanced Fibrosis and Cirrhosis Caused by Nash. Hepatology, 70, 1885-1888. [Google Scholar] [CrossRef] [PubMed]
[16] Mantovani, A., Byrne, C.D., Bonora, E. and Targher, G. (2018) Nonalcoholic Fatty Liver Disease and Risk of Incident Type 2 Diabetes: A Meta-Analysis. Diabetes Care, 41, 372-382. [Google Scholar] [CrossRef] [PubMed]
[17] Patel, S., Siddiqui, M.B., Roman, J.H., Zhang, E., Lee, E., Shen, S., et al. (2021) Association between Lipoprotein Particles and Atherosclerotic Events in Nonalcoholic Fatty Liver Disease. Clinical Gastroenterology and Hepatology, 19, 2202-2204. [Google Scholar] [CrossRef] [PubMed]
[18] Vali, Y., Lee, J., Boursier, J., Petta, S., Wonders, K., Tiniakos, D., et al. (2023) Biomarkers for Staging Fibrosis and Non-Alcoholic Steatohepatitis in Non-Alcoholic Fatty Liver Disease (the LITMUS Project): A Comparative Diagnostic Accuracy Study. The Lancet Gastroenterology & Hepatology, 8, 714-725. [Google Scholar] [CrossRef] [PubMed]
[19] Ekstedt, M., Hagström, H., Nasr, P., Fredrikson, M., Stål, P., Kechagias, S., et al. (2015) Fibrosis Stage Is the Strongest Predictor for Disease-Specific Mortality in NAFLD after up to 33 Years of Follow-Up. Hepatology, 61, 1547-1554. [Google Scholar] [CrossRef] [PubMed]
[20] Li, Y., Dai, C., Ruan, Y., Yang, H., Zeng, H., Huang, R., et al. (2024) Metabolic Dysfunction-Associated Fatty Liver Disease and Nonalcoholic Fatty Liver Disease from Clinical to Pathological Characteristics: A Multi-Center Cross-Sectional Study in Real World. Postgraduate Medical Journal, 100, 319-326. [Google Scholar] [CrossRef] [PubMed]
[21] Rinella, M.E., Neuschwander-Tetri, B.A., Siddiqui, M.S., Abdelmalek, M.F., Caldwell, S., Barb, D., et al. (2023) AASLD Practice Guidance on the Clinical Assessment and Management of Nonalcoholic Fatty Liver Disease. Hepatology, 77, 1797-1835. [Google Scholar] [CrossRef] [PubMed]
[22] Taylor-Weiner, A., Pokkalla, H., Han, L., Jia, C., Huss, R., Chung, C., et al. (2021) A Machine Learning Approach Enables Quantitative Measurement of Liver Histology and Disease Monitoring in Nash. Hepatology, 74, 133-147. [Google Scholar] [CrossRef] [PubMed]
[23] Petersen, K.F., Oral, E.A., Dufour, S., Befroy, D., Ariyan, C., Yu, C., et al. (2002) Leptin Reverses Insulin Resistance and Hepatic Steatosis in Patients with Severe Lipodystrophy. Journal of Clinical Investigation, 109, 1345-1350. [Google Scholar] [CrossRef] [PubMed]
[24] Loomba, R., Schork, N., Chen, C., Bettencourt, R., Bhatt, A., Ang, B., et al. (2015) Heritability of Hepatic Fibrosis and Steatosis Based on a Prospective Twin Study. Gastroenterology, 149, 1784-1793. [Google Scholar] [CrossRef] [PubMed]
[25] Park, J., Zhao, Y., Zhang, F., Zhang, S., Kwong, A.C., Zhang, Y., et al. (2023) IL-6/STAT3 Axis Dictates the Pnpla3-Mediated Susceptibility to Non-Alcoholic Fatty Liver Disease. Journal of Hepatology, 78, 45-56. [Google Scholar] [CrossRef] [PubMed]
[26] Lotta, L.A., Gulati, P., Day, F.R., Payne, F., Ongen, H., van de Bunt, M., et al. (2016) Integrative Genomic Analysis Implicates Limited Peripheral Adipose Storage Capacity in the Pathogenesis of Human Insulin Resistance. Nature Genetics, 49, 17-26. [Google Scholar] [CrossRef] [PubMed]
[27] Loomba, R., Friedman, S.L. and Shulman, G.I. (2021) Mechanisms and Disease Consequences of Nonalcoholic Fatty Liver Disease. Cell, 184, 2537-2564. [Google Scholar] [CrossRef] [PubMed]
[28] Glass, L.M., Hunt, C.M., Fuchs, M., et al. (2019) Comorbidities and Nonalcoholic Fatty Liver Disease: The Chicken, the Egg, or Both? Federal Practitioner: For the Healthcare Professionals of the VA, DoD, and PHS, 36, 64-71.
[29] Cao, L., An, Y., Liu, H., Jiang, J., Liu, W., Zhou, Y., et al. (2024) Global Epidemiology of Type 2 Diabetes in Patients with NAFLD or MAFLD: A Systematic Review and Meta-Analysis. BMC Medicine, 22, Article No. 101. [Google Scholar] [CrossRef] [PubMed]
[30] Ballestri, S., Nascimbeni, F., Romagnoli, D. and Lonardo, A. (2016) The Independent Predictors of Non-Alcoholic Steatohepatitis and Its Individual Histological Features: Insulin Resistance, Serum Uric Acid, Metabolic Syndrome, Alanine Aminotransferase and Serum Total Cholesterol Are a Clue to Pathogenesis and Candidate Targets for Treatment. Hepatology Research, 46, 1074-1087. [Google Scholar] [CrossRef] [PubMed]
[31] Ballestri, S., Zona, S., Targher, G., Romagnoli, D., Baldelli, E., Nascimbeni, F., et al. (2016) Nonalcoholic Fatty Liver Disease Is Associated with an Almost Twofold Increased Risk of Incident Type 2 Diabetes and Metabolic Syndrome. Evidence from a Systematic Review and Meta-analysis. Journal of Gastroenterology and Hepatology, 31, 936-944. [Google Scholar] [CrossRef] [PubMed]
[32] Duell, P.B., Welty, F.K., Miller, M., Chait, A., Hammond, G., Ahmad, Z., et al. (2022) Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement from the American Heart Association. Arteriosclerosis, Thrombosis, and Vascular Biology, 42, e168-e185. [Google Scholar] [CrossRef] [PubMed]
[33] Sun, D., Targher, G., Byrne, C.D., Wheeler, D.C., Wong, V.W., Fan, J., et al. (2023) An International Delphi Consensus Statement on Metabolic Dysfunction-Associated Fatty Liver Disease and Risk of Chronic Kidney Disease. Hepatobiliary Surgery and Nutrition, 12, 386-403. [Google Scholar] [CrossRef] [PubMed]
[34] Fahy, E., Cotter, D., Sud, M. and Subramaniam, S. (2011) Lipid Classification, Structures and Tools. Biochimica et Biophysica Acta (BBA)—Molecular and Cell Biology of Lipids, 1811, 637-647. [Google Scholar] [CrossRef] [PubMed]
[35] Zhu, Y., Wan, F., Liu, J., Jia, Z. and Song, T. (2024) The Critical Role of Lipid Metabolism in Health and Diseases. Nutrients, 16, Article No. 4414. [Google Scholar] [CrossRef] [PubMed]
[36] Bays, H.E., Bindlish, S. and Clayton, T.L. (2023) Obesity, Diabetes Mellitus, and Cardiometabolic Risk: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2023. Obesity Pillars, 5, Article ID: 100056. [Google Scholar] [CrossRef] [PubMed]
[37] 中国血脂管理指南修订联合专家委员会. 中国血脂管理指南(2023年) [J]. 中华心血管病杂志, 2023(3): 221-255.
[38] Krause, B.R. and Hartman, A.D. (1984) Adipose Tissue and Cholesterol Metabolism. Journal of Lipid Research, 25, 97-110. [Google Scholar] [CrossRef
[39] Rong, J., Zhang, Z., Peng, X., Li, P., Zhao, T. and Zhong, Y. (2024) Mechanisms of Hepatic and Renal Injury in Lipid Metabolism Disorders in Metabolic Syndrome. International Journal of Biological Sciences, 20, 4783-4798. [Google Scholar] [CrossRef] [PubMed]
[40] Katsiki, N., Mikhailidis, D.P. and Mantzoros, C.S. (2016) Non-Alcoholic Fatty Liver Disease and Dyslipidemia: An Update. Metabolism, 65, 1109-1123. [Google Scholar] [CrossRef] [PubMed]
[41] Sahini, N. and Borlak, J. (2014) Recent Insights into the Molecular Pathophysiology of Lipid Droplet Formation in Hepatocytes. Progress in Lipid Research, 54, 86-112. [Google Scholar] [CrossRef] [PubMed]
[42] Gluchowski, N.L., Becuwe, M., Walther, T.C. and Farese, R.V. (2017) Lipid Droplets and Liver Disease: From Basic Biology to Clinical Implications. Nature Reviews Gastroenterology & Hepatology, 14, 343-355. [Google Scholar] [CrossRef] [PubMed]
[43] Vvedenskaya, O., Rose, T.D., Knittelfelder, O., Palladini, A., Wodke, J.A.H., Schuhmann, K., et al. (2021) Nonalcoholic Fatty Liver Disease Stratification by Liver Lipidomics. Journal of Lipid Research, 62, Article ID: 100104. [Google Scholar] [CrossRef] [PubMed]
[44] Listenberger, L.L., Han, X., Lewis, S.E., Cases, S., Farese, R.V., Ory, D.S., et al. (2003) Triglyceride Accumulation Protects against Fatty Acid-Induced Lipotoxicity. Proceedings of the National Academy of Sciences, 100, 3077-3082. [Google Scholar] [CrossRef] [PubMed]
[45] Yamaguchi, K., Yang, L., McCall, S., Huang, J., Yu, X.X., Pandey, S.K., et al. (2007) Inhibiting Triglyceride Synthesis Improves Hepatic Steatosis but Exacerbates Liver Damage and Fibrosis in Obese Mice with Nonalcoholic Steatohepatitis. Hepatology, 45, 1366-1374. [Google Scholar] [CrossRef] [PubMed]
[46] Horn, C.L., Morales., A.L., Savard, C., Farrell, G.C. and Ioannou, G.N. (2021) Role of Cholesterol-Associated Steatohepatitis in the Development of Nash. Hepatology Communications, 6, 12-35. [Google Scholar] [CrossRef] [PubMed]
[47] Cusi, K. (2012) Role of Obesity and Lipotoxicity in the Development of Nonalcoholic Steatohepatitis: Pathophysiology and Clinical Implications. Gastroenterology, 142, 711-725.e6. [Google Scholar] [CrossRef] [PubMed]
[48] Koliaki, C. and Roden, M. (2013) Hepatic Energy Metabolism in Human Diabetes Mellitus, Obesity and Non-Alcoholic Fatty Liver Disease. Molecular and Cellular Endocrinology, 379, 35-42. [Google Scholar] [CrossRef] [PubMed]
[49] Silbernagel, G., Kovarova, M., Cegan, A., Machann, J., Schick, F., Lehmann, R., et al. (2012) High Hepatic SCD1 Activity Is Associated with Low Liver Fat Content in Healthy Subjects under a Lipogenic Diet. The Journal of Clinical Endocrinology & Metabolism, 97, E2288-E2292. [Google Scholar] [CrossRef] [PubMed]
[50] Heyens, L.J.M., Busschots, D., Koek, G.H., Robaeys, G. and Francque, S. (2021) Liver Fibrosis in Non-Alcoholic Fatty Liver Disease: From Liver Biopsy to Non-Invasive Biomarkers in Diagnosis and Treatment. Frontiers in Medicine, 8, Article ID: 615978. [Google Scholar] [CrossRef] [PubMed]
[51] Arguello, G., Balboa, E., Arrese, M. and Zanlungo, S. (2015) Recent Insights on the Role of Cholesterol in Non-Alcoholic Fatty Liver Disease. Biochimica et Biophysica Acta (BBA)—Molecular Basis of Disease, 1852, 1765-1778. [Google Scholar] [CrossRef] [PubMed]
[52] Vos, D.Y. and van de Sluis, B. (2021) Function of the Endolysosomal Network in Cholesterol Homeostasis and Metabolic-Associated Fatty Liver Disease (MAFLD). Molecular Metabolism, 50, Article ID: 101146. [Google Scholar] [CrossRef] [PubMed]
[53] Liu, L., Wang, C., Hu, Z., Deng, S., Yang, S., Zhu, X., et al. (2024) Not Only Baseline but Cumulative Exposure of Remnant Cholesterol Predicts the Development of Nonalcoholic Fatty Liver Disease: A Cohort Study. Environmental Health and Preventive Medicine, 29, Article No. 5. [Google Scholar] [CrossRef] [PubMed]
[54] Lin, R., Sun, Q., Xin, X., Ng, C.H., Valenti, L., Hu, Y., et al. (2024) Comparative Efficacy of THR-β Agonists, FGF-21 Analogues, GLP-1R Agonists, Glp-1-Based Polyagonists, and Pan-Ppar Agonists for MASLD: A Systematic Review and Network Meta-Analysis. Metabolism, 161, Article ID: 156043. [Google Scholar] [CrossRef] [PubMed]
[55] Wang, W., Kong, Y., Wang, X., Wang, Z., Tang, C., Li, J., et al. (2023) Identification of Novel SCD1 Inhibitor Alleviates Nonalcoholic Fatty Liver Disease: Critical Role of Liver-Adipose Axis. Cell Communication and Signaling, 21, Article No. 268. [Google Scholar] [CrossRef] [PubMed]
[56] Vidal-Cevallos, P. and Chávez-Tapia, N. (2024) Resmetirom, the Long-Awaited First Treatment for Metabolic Dysfunction-Associated Steatohepatitis and Liver Fibrosis? Med, 5, 375-376. [Google Scholar] [CrossRef] [PubMed]
[57] Kolodziejczyk, A.A., Zheng, D., Shibolet, O. and Elinav, E. (2018) The Role of the Microbiome in NAFLD and NASH. EMBO Molecular Medicine, 11, EMMM201809302. [Google Scholar] [CrossRef] [PubMed]