基于“肠–肝轴”探讨中医药防治自身免疫性肝炎的研究进展

Research Advances in Traditional Chinese Medicine for the Prevention and Treatment of Autoimmune Hepatitis Based on the “Gut-Liver Axis”

摘要: 自身免疫性肝炎(AIH)是一种由异常自身免疫反应介导的慢性肝损伤，其发病机制复杂，临床治疗以糖皮质激素和免疫抑制剂为主，但长期应用存在副作用显著、停药后易复发等局限。近年来，“肠–肝轴”理论的兴起为理解AIH的病理生理提供了新视角。研究表明，肠道菌群失调、肠道屏障功能受损及肠道源性免疫炎症信号异常激活，可通过门静脉、胆道及循环系统影响肝脏免疫微环境，在AIH的启动与进展中发挥重要作用。中医药在调控“肠–肝轴”方面展现出多靶点、多途径的综合优势。本文综述了近年来中医药通过调节肠道菌群干预AIH的临床研究进展，为基于“肠–肝轴”理论的中医药防治AIH的临床推广应用提供参考。

Abstract: Autoimmune hepatitis (AIH) is a chronic liver injury mediated by abnormal autoimmune responses and has a complex pathogenesis. Clinical treatment primarily relies on glucocorticoids and immunosuppressants, but long-term use is limited by significant side effects and a high recurrence rate upon discontinuation. Against this background, the recently proposed “gut-liver axis” theory provides new insights into the pathophysiology of AIH. Specifically, research indicates that dysbiosis of the gut microbiota, impaired intestinal barrier function, and abnormal activation of gut-derived immune inflammatory signals can influence the hepatic immune microenvironment via the portal vein, biliary tract, and circulatory system, thus playing a crucial role in the initiation and progression of AIH. In light of these findings, Traditional Chinese Medicine (TCM) demonstrates comprehensive advantages through its multi-targeted and multi-pathway regulation of the gut-liver axis. Therefore, this review summarizes recent clinical research on TCM interventions for AIH via gut microbiota modulation, and aims to provide a reference for the clinical application of TCM-based prevention and treatment strategies grounded in gut-liver axis theory.