Department of Internal Medicine I, Gastroenterology, Endocrinology &Metabolism, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Department of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University, c/o Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
Nat Rev Gastroenterol Hepatol. 2017 Jan;14(1):32-42. doi: 10.1038/nrgastro.2016.147. Epub 2016 Oct 12.
The liver constitutes a key organ in systemic metabolism, contributing substantially to the development of insulin resistance and type 2 diabetes mellitus (T2DM). The mechanisms underlying these processes are not entirely understood, but involve hepatic fat accumulation, alterations of energy metabolism and inflammatory signals derived from various cell types including immune cells. Lipotoxins, mitochondrial function, cytokines and adipocytokines have been proposed to play a major part in both NAFLD and T2DM. Patients with NAFLD are commonly insulin resistant. On the other hand, a large number of patients with T2DM develop NAFLD with its inflammatory complication, NASH. The high incidence of NASH in patients with T2DM leads to further complications, such as liver cirrhosis and hepatocellular carcinoma, which are increasingly recognized. Therapeutic concepts such as thiazolidinediones (glitazones) for treating T2DM also show some efficacy in the treatment of NASH. This Review will describe the multifaceted and complex interactions between the liver and T2DM.
肝脏是全身代谢的关键器官，对胰岛素抵抗和 2 型糖尿病（T2DM）的发生发展有重要作用。尽管这些过程的机制尚不完全清楚，但涉及肝脂肪堆积、能量代谢改变以及来自包括免疫细胞在内的各种细胞的炎症信号。内毒素、线粒体功能、细胞因子和脂肪因子被认为在非酒精性脂肪性肝病（NAFLD）和 T2DM 中都发挥着重要作用。NAFLD 患者通常存在胰岛素抵抗。另一方面，大量 T2DM 患者会发生伴有炎症并发症的非酒精性脂肪性肝炎（NASH）。T2DM 患者中 NASH 的高发生率导致了进一步的并发症，如肝硬化和肝细胞癌，这些并发症正日益受到重视。治疗 T2DM 的噻唑烷二酮类（格列酮类）等治疗方法对 NASH 的治疗也显示出一定的疗效。本文将描述肝脏与 T2DM 之间的多方面和复杂的相互作用。
