[1]黄桢奇,周艳林,柯婷,等.中药治疗2型糖尿病合并非酒精性脂肪性肝病作用机制进展[J].陕西中医,2025,46(10):1437-封3.[doi:DOI:10.3969/j.issn.1000-7369.2025.10.028]
　HUANG Zhenqi,ZHOU Yanlin,KE Ting,et al.Research progress on the mechanism of traditional chinese medicine in treating type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease[J].,2025,46(10):1437-封3.[doi:DOI:10.3969/j.issn.1000-7369.2025.10.028]
点击复制

中药治疗2型糖尿病合并非酒精性脂肪性肝病作用机制进展

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
46
期数:
2025年10期
页码:
1437-封3
栏目:
综 述
出版日期:
2025-10-05

文章信息/Info

Title:
Research progress on the mechanism of traditional chinese medicine in treating type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease
作者:
黄桢奇1; 周艳林1; 柯婷2; 肖洋2; 3
（1.陕西中医药大学，陕西 咸阳 712000；2.陕西省中医医院，陕西 西安 710003；3.中国中医科学院研究生院，北京 100871)
Author(s):
HUANG Zhenqi1; ZHOU Yanlin1; KE Ting2; XIAO Yang2; 3
(1.Shaanxi University of Chinese Medicine,Xianyang 712000,China;2.Shaanxi Provincial Hospital of Traditional Chinese Medicine,Xi ’an 710003,China;3.Graduate School of China Academy of Chinese Medical Sciences,Beijing 100871,China)
关键词:
2型糖尿病; 非酒精性脂肪肝; 作用机制; 中药治疗; 肠-肝轴
Keywords:
Type 2 diabetes mellitus; Nonalcoholic fatty liver disease; Molecular mechanisms; Traditional Chinese medicine treatment; Gut-liver axis
分类号:
R 587.1
DOI:
DOI:10.3969/j.issn.1000-7369.2025.10.028
文献标志码:
A
摘要:
近年来2型糖尿病(T2DM)及非酒精性脂肪性肝病(NAFLD)患病率不断增加。两者常伴随发病，并互相推动疾病进程。中药治疗历史悠久，以其“多成分-多靶点、个性化”的特性而具有临床潜力。然中药治疗T2DM合并NAFLD的作用机制尚未完全明确。因此，现就胰岛素抵抗及脂代谢紊乱、氧化应激、促炎症因子生成及“肠-肝轴”紊乱等方面试阐述中药治疗T2DM合并NAFLD的疗效及作用机制，以期为临床用药提供理论依据。
Abstract:
The prevalence of type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) has been increasing in recent years.These two conditions often occur concurrently and mutually promote the progression of each other.Traditional Chinese medicine (TCM) has a long history of treatment and has clinical potential due to its characteristics of “multi-component,multi-target,and individualized”.However,the mechanism of TCM in treating T2DM combined with NAFLD is not yet fully understood.Therefore,this article attempts to elaborate on the efficacy and mechanism of TCM in treating T2DM combined with NAFLD from aspects such as insulin resistance (IR) and lipid metabolism disorder,oxidative stress,pro-inflammatory factor production,and “gut-liver axis” disorder,in order to provide a theoretical basis for clinical medication.

参考文献/References:

[1]GOLABI P,OWRANGI S,YOUNOSSI Z M.Global perspective on nonalcoholic fatty liver disease and nonalcoholic steatohepatitis- prevalence,clinical impact,economic implications and management strategies[J].Aliment Pharmacol Ther,2024,59(1):1-9.
[2]GIANNAKOGEORGOU A,RODEN M.Role of lifestyle and glucagon-like peptide-1 receptor agonists for weight loss in obesity,type 2 diabetes and steatotic liver diseases[J].Aliment Pharmacol Ther,2024,59(1):52-75.
[3]EN LI CHO E,ANG C Z,QUEK J,et al.Global prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus:An updated systematic review and meta-analysis[J].Gut,2023,72(11):2138-2148.
[4]祁月英,王笑,季璇,等.湿热困脾型2型糖尿病合并非酒精性脂肪肝的危险因素[J].吉林中医药,2023,43(12):1438-1441.
[5]BAO Y,HAN X,LIU D,et al.Gut microbiota:The key to the treatment of metabolic syndrome in traditional Chinese medicine:A case study of diabetes and nonalcoholic fatty liver disease[J].Front Immunol,2022,12(13):1072376.
[6]PADDA J,KHALID K,KHEDR A,et al.Non-alcoholic fatty liver disease and its association with diabetes mellitus[J].Cureus,2021,13(8):17321.
[7]薛世圆,刘畅,江玉波,等.2型糖尿病合并非酒精性脂肪性肝病的发病机制及治疗的研究进展[J].中国老年学杂志,2025,45(3):756-762.
[8]JUNG I,KOO D J,LEE W Y.Insulin resistance,non-alcoholic fatty liver disease and type 2 diabetes mellitus:Clinical and experimental perspective[J].Diabetes Metab J,2024,48(3):327-339.
[9]GASPAR R C,LYU K,HUBBARD B T,et al.Distinct subcellular localisation of intramyocellular lipids and reduced PKCε/PKCθ activity preserve muscle insulin sensitivity in exercise-trained mice[J].Diabetologia,2023,66(3):567-578.
[10]黄链莎,刘铜华,孙文,等.桑叶黄酮对糖尿病大鼠血糖水平的影响及机制探讨[J].中国实验方剂学杂志,2018,24(16):152-156.
[11]SNEL M,JONKER J T,SCHOONES J,et al.Ectopic fat and insulin resistance:Pathophysiology and effect of diet and lifestyle interventions[J].Int J Endocrinol,2012,2012:983814.
[12]ZHANG S,ZHANG S,ZHANG Y,et al.Activation of NRF2 by epiberberine improves oxidative stress and insulin resistance in T2DM mice and IR-HepG2 cells in an AMPK dependent manner[J].J Ethnopharmacol,2024,327:117931.
[13]SAKURAI Y,KUBOTA N,YAMAUCHI T,et al.Role of insulin resistance in MAFLD[J].Int J Mol Sci,2021,22(8):4156.
[14]LIU B,YAO Z,SONG L,et al.Vitexin alleviates lipid metabolism disorders and hepatic injury in obese mice through the PI3K/AKT/mTOR/SREBP-1c pathway[J].Eur J Med Chem,2025,287:117379.
[15]XIONG J,CHEN G,HE Y,et al.Oxymatrine reduces hepatic lipid synthesis in rat model of nonalcoholic steatohepatitis by regulating Sirt1/AMPK and LXR/Plin2/SREBP-1c pathways[J].Chem Biol Interact,2025,407:111370.
[16]ARROYAVE-OSPINA J C,WU Z,GENG Y,et al.Role of oxidative stress in the pathogenesis of non-alcoholic fatty liver disease:Implications for prevention and therapy[J].Antioxidants(Basel),2021,10(2):174.
[17]CHEN Z,TIAN R,SHE Z,et al.Role of oxidative stress in the pathogenesis of nonalcoholic fatty liver disease[J].Free Radic Biol Med,2020,152:116-141.
[18]ZHANG W,CHENG Q,YIN L,et al.Jujuboside a through YY1/CYP2E1 signaling alleviated type 2 diabetes-associated fatty liver disease by ameliorating hepatic lipid accumulation,inflammation,and oxidative stress[J].Chem Biol Interact,2024,400:111157.
[19]SMOLKOVA K,MIKO E,KOVACS T,et al.Nuclear factor erythroid 2-related factor 2 in regulating cancer metabolism[J].Antioxid Redox Signal,2020,33(13):966-997.
[20]李昂昂,梁晓,李军梅,等.中药调控氧化应激干预急性肺损伤的研究进展[J].中国实验方剂学杂志,2025,31(10):1-15.
[21]ZENG Y,LUO Y,WANG L,et al.Therapeutic effect of curcumin on metabolic diseases:Evidence from clinical studies[J].Int J Mol Sci,2023,24(4):3323.
[22]TANG D,HE W J,ZHANG Z T,et al.Protective effects of Huang-Lian-Jie-Du decoction on diabetic nephropathy through regulating AGEs/RAGE/Akt/Nrf2 pathway and metabolic profiling in db/db mice[J].Phytomedicine,2022,95:153777.
[23]SHARMA S,GALI S,KUNDU A,et al.Tenovin-1,a selective SIRT1/2 inhibitor,attenuates high-fat diet-induced hepatic fibrosis via inhibition of HSC activation in ZDF rats[J].Int J Biol Sci,2024,20(9):3334-3352.
[24]VARRA F N,VARRAS M,VARRA V K,et al.Molecular and pathophysiological relationship between obesity and chronic inflammation in the manifestation of metabolic dysfunctions and their inflammationmediating treatment options (review)[J].Mol Med Rep,2024,29(6):95.
[25]姜慧,李军祥,谭祥,等.基于网络药理学和分子对接探讨健脾疏肝方治疗非酒精性脂肪性肝病的作用机制[J].西部中医药,2024,37(2):83-90.
[26]LEITE J S M,VILAS-BOAS E A,TAKAHASHI H K,et al.Liver lipid metabolism,oxidative stress,and inflammation in glutamine-supplemented ob/ob mice[J].J Nutr Biochem,2025,138:109842.
[27]NIU D,CHEN X,WANG T,et al.Protective effects of iridoid glycoside from corni fructus on type 2 diabetes with nonalcoholic fatty liver in mice[J].Biomed Res Int,2021,2021:3642463.
[28]谢静晓,王誉湘,张晓萍,等.杨桃根DMDD调控JNK/P38MAPK通路抑制2型糖尿病合并非酒精性脂肪肝小鼠肝脏内质网应激[J].广西医科大学学报,2023,40(5):786-791.
[30]YONG Q,HUANG C,CHEN B,et al.Gentiopicroside improves NASH and liver fibrosis by suppressing TLR4 and NLRP3 signaling pathways[J].Biomed Pharmacother,2024,177:116952.
[31]SKURATOVSKAIA D,KOMAR A,VULF M,et al.IL-6 reduces mitochondrial replication,and IL-6 receptors reduce chronic inflammation in NAFLD and type 2 diabetes[J].Int J Mol Sci,2021,22(4):1774.
[32]LI H,MENG Y,HE S,et al.Macrophages,chronic inflammation,and insulin resistance[J].Cells,2022,11(19):3001.
[33]ZHANG L,WANG S,LI Y,et al.Tartary buckwheat root polysaccharides ameliorate non-alcoholic fatty liver disease via the IL6-SOCS3-SREBP1c pathway[J].Food Chem Toxicol,2023,179:113997.
[34]陈彦旭,金智生,姜晓雪,等.基于JAK2/STAT3信号通路探讨红芪多糖对糖尿病肾病db/db小鼠作用机制[J].中国实验方剂学杂志,2023,29(13):65-71.
[35]SONG H,LU J,DENG R.Polysaccharides from tremella fuciformis enhance glucose and lipid metabolism in HepG2 cells through activating the AMPK signaling pathway[J].Chem Biodivers,2025,22(2):202401926.
[36]OU X,CHEN J,LI B,et al.Multiomics reveals the ameliorating effect and underlying mechanism of aqueous extracts of polygonatum sibiricum rhizome on obesity and liver fat accumulation in high-fat diet-fed mice[J].Phytomedicine,2024,132:155843.
[37]ZHOU X,ZHANG X,YU J.Gut mycobiome in metabolic diseases:Mechanisms and clinical implication[J].Biomed J,2024,47(3):100625.
[38]HUANG H C,CHEN C J,LAI Y H,et al.Momordica cochinchinensis aril ameliorates diet-induced metabolic dysfunction and non-alcoholic fatty liver by modulating gut microbiota[J].Int J Mol Sci,2021,22(5)：123-135.
[39]JAYACHANDRAN M,QU S.Non-alcoholic fatty liver disease and gut microbial dysbiosis-underlying mechanisms and gut microbiota mediated treatment strategies[J].Rev Endocr Metab Disord,2023,24(6):1189-1204.
[40]ZOU J,SONG Q,SHAW P C,et al.Tangerine peel-derived exosome-like nanovesicles alleviate hepatic steatosis induced by type 2 diabetes:Evidenced by regulating lipid metabolism and intestinal microflora[J].Int J Nanomedicine,2024,30(19):10023-10043.

相似文献/References:

[1]樊橡伟,胡 勃,王向阳△.肝苏胶囊联合水飞蓟宾胶囊治疗非酒精性脂肪肝合并慢性乙肝临床研究*[J].陕西中医,2019,(2):160.
　FAN Xiangwei,HU Bo,WANG Xiangyang..The efficacy of Gansu capsules combined with Silibinin capsules in the treatment of Nonalcoholic fatty liver disease and chronic hepatitis B[J].,2019,(10):160.
[2]李向辉,卢文杰.葛黄降糖汤治疗2型糖尿病合并颈动脉硬化临床研究*[J].陕西中医,2019,(5):580.
　LI Xianghui,LU Wenjie..Effect of Gehuang Jiangtang decoction on mellitus complicated with carotid arteriosclerosis in type 2 diabetes patients[J].,2019,(10):580.
[3]蔡媛媛,蔡 敏△,程亚伟.蔡敏教授运用调肝一方治疗非酒精性脂肪肝经验总结*[J].陕西中医,2019,(9):1275.
[4]孙晓红,陈学彬△.芪精丹兰汤对伴有左心室舒张功能不全的2型糖尿病合并代谢综合征患者糖脂代谢、心率变异性的影响*[J].陕西中医,2019,(10):1336.
　SUN Xiaohong,CHEN Xuebin..Effect of Qijing Danlan decoction on glucose and lipid metabolism and heart rate variability in patients with type 2 diabetes mellitus complicated with MS with left ventricular diastolic dysfunction[J].,2019,(10):1336.
[5]訾 璐,胡小军△,王 玉,等.针刺中脘穴联合自拟茶方对2型糖尿病患者血糖水平的影响*[J].陕西中医,2019,(10):1460.
　ZI Lu,HU Xiaojun,WANG Yu,et al.Effect of zhong wan acupuncture combined with selfdesigned tea prescription on blood glucose level in patients with type 2 diabetes mellitus[J].,2019,(10):1460.
[6]王开霞,郑 超,朱晓骏,等.茵陈五苓散治疗胆汁淤积研究进展*[J].陕西中医,2019,(12):1822.
[7]李 莎,寇少杰,薛敬东.薛敬东运用“浊毒理论”治疗非酒精性脂肪肝经验总结[J].陕西中医,2021,(3):363.[doi:DOI:10.3969/j.issn.1000-7369.2020.03.025]
[8]文启友,周 伶,马若梦,等.化瘀利尿法论治2型糖尿病探析[J].陕西中医,2021,(6):761.[doi:DOI:10.3969/j.issn.1000-7369.2020.06.021]
[9]谢兆桃,周卓宁,郑 鹏,等.从中焦论治2型糖尿病患者餐后血糖波动[J].陕西中医,2021,(6):764.[doi:DOI:10.3969/j.issn.1000-7369.2020.06.022]
[10]董文娟,杨立宏,张文佳.降脂瘦身汤对非酒精性脂肪肝大鼠脂代谢及核转录因子-κB蛋白表达影响的实验研究[J].陕西中医,2021,(8):1016.[doi:DOI:10.3969/j.issn.1000-7369.2020.08.007]
　DONG Wenjuan,YANG Lihong,ZHANG Wenjia.Study of Jiangzhi Shoushen decoction on lipid metabolism and NF-κB protein expression with nonalcoholic fatty liver rats[J].,2021,(10):1016.[doi:DOI:10.3969/j.issn.1000-7369.2020.08.007]
[11]杨斯皓,马方霞,詹 云.一贯煎合六味地黄汤配合西药治疗2型糖尿病合并非酒精性脂肪肝临床疗效及对患者生活质量的评价*[J].陕西中医,2019,(8):1006.
　YANG Sihao,MA Fangxia,ZHAN Yun..Clinical efficacy and quality of life evaluation of Yiguanjian plus Liuwei Dihuang decoction with western medicine in the treatment of type 2 diabetes with nonalcoholic fatty liver disease[J].,2019,(10):1006.

备注/Memo

备注/Memo:
第二届全国名中医传承工作室建设项目[国中医药办人教函(2022)245号]；陕西省科学技术厅课题(2024SF-YBXM-522)；陕西省高水平中医药重点学科建设项目(SXZYYZDXK-2024006)
更新日期/Last Update: 2025-10-10