代谢相关脂肪性肝病进展与多系统共病的关联机制及整合管理策略

王丽苹; 李娅; 任岳波; 何婷婷; 王仲霞; 闫丽萍; 余思邈; 景婧; 孙永强; 张傲哲; 王鑫; 肖小河; 陆荫英; 王睿林

doi:10.12449/JCH260828

代谢相关脂肪性肝病进展与多系统共病的关联机制及整合管理策略

DOI: 10.12449/JCH260828

1.
中国人民解放军总医院肝病医学部中西医结合肝胆病科，北京 100039
2.
中国人民解放军总医院第五医学中心营养科，北京 100039
3.
中国人民解放军总医院肝病医学部门脉高压科，北京 100039
4.
中国人民解放军总医院肝病医学部肝病研究所，北京 100039
5.
中国人民解放军总医院肝病医学部，北京 100039

基金项目:

国家自然科学基金青年科学基金 (82505719)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：王睿林、肖小河、陆荫英负责整体思路和论文框架设计，指导、撰写、修改文章并最后定稿；李娅、任岳波、何婷婷、王仲霞、闫丽萍、余思邈、景婧、孙永强、张傲哲和王鑫负责文献查阅；王丽苹负责研究设计，初稿撰写及全文修订。

详细信息

通信作者:
王睿林， wrl7905@163.com （ORCID： 0000-0002-7129-016X）

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出版历程
- 收稿日期: 2025-11-26
- 录用日期: 2026-03-26
- 出版日期: 2026-08-25

Association mechanisms between the progression of metabolic dysfunction-associated fatty liver disease and multi-system comorbidities and integrated management strategies

1.
Department of Integrated Traditional Chinese and Western Medicine Hepatobiliary Diseases，Senior Department of Liver Disease，Chinese PLA General Hospital，Beijing 100039，China
2.
Department of Nutrition，The Fifth Medical Center of Chinese PLA General Hospital，Beijing 100039，China
3.
Department of Portal Hypertension，Senior Department of Hepatology，Chinese PLA General Hospital，Beijing 100039，China
4.
Institute of Hepatology，Senior Department of Liver Disease，Chinese PLA General Hospital，Beijing 100039，China
5.
Senior Department of Liver Disease，Chinese PLA General Hospital，Beijing 100039，China

Research funding:

National Natural Science Foundation of China Youth Science Fund Project (82505719)

More Information

Corresponding author: Wang Ruilin， wrl7905@163.com （ORCID： 0000-0002-7129-016X）

摘要

摘要: 代谢相关脂肪性肝病（MAFLD）已成为全球最常见的慢性肝病，其病理进程以“二次打击”学说为核心，肠-肝轴紊乱贯穿从脂肪变性至肝硬化乃至肝细胞癌的全病程，并通过“肠-肝-脑轴”“肝-肾轴”“肝-心轴”等多维通路，与代谢、心血管、肾脏及精神神经系统形成广泛的跨系统交互调控机制。疾病进展不仅局限于肝脏本身，更涉及全身多器官系统的功能失衡。本文系统阐述MAFLD“肝脏病理进展-多轴调控-共病发生”的关联机制，提出基于风险分层的早期筛查、靶向干预与多学科诊疗协同管理策略，并分析当前研究的局限与未来发展方向，以期为MAFLD的精准诊疗与个性化管理提供理论依据与实践指导。
- 代谢相关脂肪性肝病 /
- 肝纤维化 /
- 肠-肝轴 /
- 慢性病共病
Abstract: Metabolic dysfunction-associated fatty liver disease （MAFLD） has become the most common chronic liver disease worldwide. Its pathological process is centered on the “two-hit” theory， with gut-liver axis dysregulation running through the entire disease course from steatosis to liver cirrhosis and even hepatocellular carcinoma， and it forms an extensive cross-system regulatory mechanism with the metabolic， cardiovascular， renal， and psychological and nervous systems through multi-dimensional pathways such as the “gut-liver-brain axis”， the “liver-kidney axis”， and the “liver-heart axis”. Disease progression is not limited to the liver itself， and it also involves functional imbalance of multiple organ systems throughout the body. This article systematically elaborates on the association mechanism of “liver pathological progression-multi-axis regulation-comorbidity occurrence” in MAFLD， proposes synergistic management strategies integrating early screening based on risk stratification， targeted intervention， and multidisciplinary diagnosis and treatment， and analyzes the limitations of current research and future development directions， in order to provide a theoretical basis and practical guidance for precise diagnosis and treatment and individualized management of MAFLD.
- Metabolic Dysfunction-Associated Fatty Liver Disease /
- Hepatic Fibrosis /
- Gut-Liver Axis /
- Multiple Chronic Conditions

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