Quigley Eamonn M, Monsour Howard P
Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas.
Semin Liver Dis. 2015 Aug;35(3):262-9. doi: 10.1055/s-0035-1562946. Epub 2015 Sep 17.
With the recognition of the various metabolic functions of the gut microbiome and of its putative role in obesity, an investigation of the contribution of the bacterial populations of the gastrointestinal tract to the metabolic syndrome and its hepatic manifestation-nonalcoholic liver disease (NAFLD)-became inevitable. Furthermore, the central role of an altered microbiome in the precipitation of infectious and noninfectious complications of liver disease was described decades ago. The contribution of the microbiome to the pathogenesis of NAFLD has been extensively studied in animal models. Convincing evidence for a central role for an altered microbiome (through multiple mechanisms), coupled with such phenomena as impaired gut barrier function and an aberrant host immune response, has been amply demonstrated. The accumulation of a similar level of evidence from human studies has proven more challenging; however, incriminating data accumulate. Although animal studies have demonstrated the benefits of interventions that modulate the microbiome and of probiotics, in particular, in reducing steatosis and preventing progression to steatohepatitis, data in man are scanty and high-quality clinical trials of probiotics and other strategies are needed.
随着对肠道微生物群各种代谢功能及其在肥胖中假定作用的认识，对胃肠道细菌群体对代谢综合征及其肝脏表现——非酒精性肝病（NAFLD）——的贡献进行研究变得不可避免。此外，几十年前就描述了微生物群改变在肝病感染性和非感染性并发症发生中的核心作用。在动物模型中，微生物群对NAFLD发病机制的贡献已得到广泛研究。已经充分证明了微生物群改变（通过多种机制）以及肠道屏障功能受损和宿主免疫反应异常等现象所起的核心作用。从人体研究中积累类似水平的证据已被证明更具挑战性；然而，有罪责的数据正在积累。尽管动物研究已经证明了调节微生物群的干预措施，特别是益生菌，在减少脂肪变性和预防进展为脂肪性肝炎方面的益处，但人体数据很少，需要对益生菌和其他策略进行高质量的临床试验。
