肠道菌群在MASLD发生发展中的作用机制及干预策略研究进展

Research Progress on the Mechanisms and Intervention Strategies of Gut Microbiota in the Development and Progression of MASLD

摘要: 代谢相关脂肪性肝病(MASLD)已成为全球最常见的慢性肝病之一，其发病率呈上升趋势。近年来，肠道菌群失衡被认为在MASLD的发生和进展中发挥重要作用，尤其通过肠–肝轴调控肝脏脂肪代谢、免疫反应与代谢稳态。肠道菌群的改变导致肠道屏障功能受损，内毒素如脂多糖(LPS)进入肝脏，激活免疫反应，进而加重肝脏的慢性低度炎症和脂肪积累。短链脂肪酸(SCFAs)的减少和胆汁酸代谢失调也是MASLD的重要机制，二者通过调节肝脏代谢、免疫反应及胰岛素信号传导，促进肝脏脂肪积聚。肠道菌群失衡的干预策略，如饮食、运动、益生菌和益生元的应用，已被提出并显示出一定的临床效果。未来的研究将进一步探讨肠道菌群与MASLD之间的因果关系及个性化干预策略，旨在为MASLD的治疗提供新思路和理论依据。

Abstract: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has become one of the most prevalent chronic liver diseases worldwide, with an increasing incidence in recent years. Emerging evidence indicates that gut microbiota dysbiosis plays a pivotal role in the onset and progression of MASLD, primarily through the gut-liver axis in regulating hepatic lipid metabolism, immune responses, and metabolic homeostasis. Alterations in gut microbiota may impair intestinal barrier integrity, facilitating the translocation of endotoxins such as Lipopolysaccharide (LPS) into the liver, thereby triggering immune activation and aggravating chronic low-grade inflammation and hepatic lipid accumulation. In addition, reduced Short-Chain Fatty Acids (SCFAs) and disordered bile acid metabolism are key mechanisms in MASLD; both contribute to hepatic steatosis by modulating metabolic pathways, immune responses, and insulin signaling. Interventions targeting dysbiosis—including dietary modification, physical activity, and the use of probiotics and prebiotics—have been proposed and have shown potential clinical benefits. Future studies should further clarify the causal relationship between gut microbiota and MASLD and develop personalized microbiota-based interventions, providing novel insights and theoretical support for MASLD management.