糖尿病是 MASH 进展的风险因素。

IF 6.1 3区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes research and clinical practice Pub Date : 2024-09-06 DOI:10.1016/j.diabres.2024.111846
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引用次数: 0

摘要

非酒精性(现为:代谢性)脂肪性肝炎(MASH)是代谢功能障碍相关性脂肪性肝病(MASLD)的进行性炎症形式,经常与 2 型糖尿病(T2D)同时存在并相互影响,导致肝脏和心血管预后恶化。了解糖尿病相关 MASH 进展的复杂机制对于制定有效的治疗策略至关重要。本综述描述了参与这种相互作用的多方面途径,并探讨了潜在的治疗意义。脂肪组织、肠道微生物群和肝脏改变之间的协同作用在疾病进展中起着关键作用。脂肪组织功能障碍,尤其是内脏脂肪组织功能障碍,加上肠道微生物群失调,加剧了肝损伤和胰岛素抵抗。肝脏脂质积累、氧化应激和内质网应激进一步加剧了炎症和纤维化,导致疾病的严重程度。在控制与 T2D 相关的 MASH 的过程中,通过减轻体重和锻炼来调整饮食是至关重要的。此外,各种众所周知的新型降糖药物也具有降低肝脏脂质含量的潜力,在某些情况下还能改善MASH组织学。针对胰岛素受体的疗法有望控制与T2D相关的MASH,而甲状腺激素受体-β激动剂已被证明可有效治疗MASH和肝纤维化。
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Diabetes as a risk factor for MASH progression

Non-alcoholic (now: metabolic) steatohepatitis (MASH) is the progressive inflammatory form of metabolic dysfunction-associated steatotic liver disease (MASLD), which often coexists and mutually interacts with type 2 diabetes (T2D), resulting in worse hepatic and cardiovascular outcomes. Understanding the intricate mechanisms of diabetes-related MASH progression is crucial for effective therapeutic strategies. This review delineates the multifaceted pathways involved in this interplay and explores potential therapeutic implications.

The synergy between adipose tissue, gut microbiota, and hepatic alterations plays a pivotal role in disease progression. Adipose tissue dysfunction, particularly in the visceral depot, coupled with dysbiosis in the gut microbiota, exacerbates hepatic injury and insulin resistance. Hepatic lipid accumulation, oxidative stress, and endoplasmic reticulum stress further potentiate inflammation and fibrosis, contributing to disease severity. Dietary modification with weight reduction and exercise prove crucial in managing T2D-related MASH. Additionally, various well-known but also novel anti-hyperglycemic medications exhibit potential in reducing liver lipid content and, in some cases, improving MASH histology. Therapies targeting incretin receptors show promise in managing T2D-related MASH, while thyroid hormone receptor-β agonism has proven effective as a treatment of MASH and fibrosis.

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来源期刊
Diabetes research and clinical practice
Diabetes research and clinical practice 医学-内分泌学与代谢
CiteScore
10.30
自引率
3.90%
发文量
862
审稿时长
32 days
期刊介绍: Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.
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