代谢相关脂肪性肝病患者微生态治疗指南

中国研究型医院学会肝病（中西医结合）专业委员会; 浙江省慢性肝病重症化精准诊治与规模转化重点实验室&温州医科大学附属第一医院肝病诊疗中心

doi:10.12449/JCH260408

代谢相关脂肪性肝病患者微生态治疗指南

DOI: 10.12449/JCH260408

基金项目:

浙江省重大研发项目（领雁） (2025C02135);

浙江省自然基金重大项目 (461230125);

国家自然科学基金面上项目 (80217077)

利益冲突声明：所有作者均声明不存在利益冲突。

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出版历程
- 收稿日期: 2026-01-14
- 录用日期: 2026-03-15
- 出版日期: 2026-04-25

Guidelines for microecological therapy in patients with metabolic associated fatty liver disease

Research funding:

Zhejiang Provincial Major R&D Project （Leading Goose） (2025C02135);

Zhejiang Provincial Natural Science Foundation Major Project (461230125);

National Natural Science Foundation of China General Program (80217077)

摘要

摘要: 本指南针对代谢相关脂肪性肝病（MAFLD）的微生态治疗提出规范建议。指南系统阐述了“肠-肝轴”紊乱在MAFLD发病机制中的核心作用，并明确了肠道微生态失衡的诊断方法。重点推荐了益生菌、益生元、合生元、后生元等多种微生态制剂的应用，并详细规范了粪菌移植的供体筛选、制剂制备、适应证、操作流程、随访监测及疗效评估标准。本指南旨在为临床医师应用微生态疗法治疗MAFLD提供基于循证医学的决策依据，以改善患者管理并确保治疗安全有效。
- 代谢相关脂肪性肝病 /
- 微生态 /
- 胃肠道微生物组 /
- 粪菌移植 /
- 诊疗准则
Abstract: These guidelines put forward standardized recommendations for microecological therapy in patients with metabolic associated fatty liver disease （MAFLD）. They systematically elaborate the core role of gut-liver axis dysfunction in the pathogenesis of MAFLD， and clarify the diagnostic approaches for intestinal microecological dysbiosis. The guidelines highlight recommendations on the clinical application of a full spectrum of microecological preparations including probiotics， prebiotics， synbiotics and postbiotics， and specify in detail the donor screening， therapeutic preparation manufacturing， indications， operational procedures， follow-up monitoring， and efficacy evaluation criteria for fecal microbiota transplantation. These guidelines aim to provide clinicians with an evidence-based foundation for clinical decision-making in the application of microecological therapy for MAFLD， so as to optimize patient management and ensure the safety and efficacy of the treatment.
- Metabolic Associated Fatty Liver Disease /
- Microbiome /
- Gastrointestinal Microbiome /
- Fecal Microbiota Transplantation /
- Practice Guideline

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表 1 推荐意见的推荐强度和证据等级

Table 1. Recommendation strength and evidence level of recommendation

分级	说明
证据质量
高质量（A）	证据来源于至少一项设计合理的多中心随机对照试验，后续研究对当前评估结果改变的可能性较小
中质量（B）	证据来源于至少一项设计良好的非随机临床试验、队列研究或病例对照研究，后续研究有可能影响当前的评估结果
低质量（C）	证据来源于临床经验、描述性案例研究、专家委员会的报告、权威组织机构意见，后续研究很有可能改变当前的评估结果
推荐强度
强推荐	充分考虑证据质量、潜在疗效及预后，具有较高的成本-获益比，强烈支持推荐使用
弱推荐	证据价值参差不齐，推荐意见存在不确定性，或推荐意见成本-获益比不高，对推荐意见持保守态度

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