中药单体治疗非酒精性脂肪性肝病作用机制的研究进展

Research Progress on the Mechanisms of Action of Single Chinese Herbal Compounds in Treating Non-Alcoholic Fatty Liver Disease

摘要: 非酒精性脂肪性肝病(NAFLD)已成为全球最常见的慢性肝病，目前尚无获批的特异性治疗药物，探索有效的干预策略具有重要临床意义。中药单体因靶点多样、机制明确、可溯源性强，是抗NAFLD药物研发的重要来源。本文系统检索数据库中2020~2025年相关研究并结合经典文献，从调节脂质代谢、改善胰岛素抵抗、抗氧化应激、抑制炎症、调控自噬与铁死亡、调节肠道菌群与肠肝轴等六个方面，综述了小檗碱、黄芩苷、丹酚酸、绿原酸、人参皂苷、大黄素、白藜芦醇等代表性中药单体治疗NAFLD的作用机制；总结了小檗碱、姜黄素、水飞蓟宾等单体的临床研究证据。现有证据表明，中药单体主要通过AMPK/ SREBP-1c/PPARα信号轴抑制脂质合成并促进脂肪酸氧化，同时经Nrf2、NF-κB、NLRP3炎症小体及肠肝轴等多条通路发挥综合调控作用。但多数证据来自细胞与动物实验，临床随机对照试验数量有限，且存在生物利用度低、剂量效应关系不清等问题。未来应在MASLD新命名框架下，借助多组学与类器官等模型深化机制研究，开展高质量、多中心的临床研究，并探索单体间及单体与现有药物的协同策略。

Abstract: Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide, yet no approved specific therapies are currently available, making the exploration of effective intervention strategies clinically significant. Due to their diverse targets, well-defined mechanisms, and strong traceability, single compounds from traditional Chinese medicine (TCM) represent a crucial source for developing anti-NAFLD drugs. This review systematically searched databases for relevant studies published between 2020 and 2025 and integrated classical literature to summarize the therapeutic mechanisms of representative TCM monomers—including berberine, baicalin, salvianolic acid, chlorogenic acid, ginsenosides, emodin, and resveratrol—in treating NAFLD through six key aspects: regulation of lipid metabolism, improvement of insulin resistance, antioxidant stress, suppression of inflammation, modulation of autophagy and ferroptosis, and regulation of gut microbiota and the gut-liver axis. Clinical evidence for monomers such as berberine, curcumin, and silybin is also summarized. Current evidence indicates that TCM monomers primarily inhibit lipid synthesis and promote fatty acid oxidation via the AMPK/SREBP-1c/PPARα signaling axis, while exerting comprehensive regulatory effects through multiple pathways including Nrf2, NF-κB, NLRP3 inflammasome, and the gut-liver axis. However, most data originate from in vitro and animal studies, clinical randomized controlled trials remain limited, and challenges such as low bioavailability and unclear dose-response relationships persist. Future research should deepen mechanistic understanding using multi-omics and organoid models under the new MASLD nomenclature framework, conduct high-quality, multicenter clinical trials, and explore synergistic strategies among monomers and with existing drugs.