非酒精性脂肪性肝病患者肝脂肪变性严重程度对肠道菌群的影响*

doi:10.3969/j.issn.1672-5069.2026.05.008

摘要/Abstract

摘要： 目的探讨非酒精性脂肪性肝病(NAFLD)患者肠道菌群结构与肝脂肪变性严重程度的相关性。方法 2024年7月~2025年7月我院收治的NAFLD患者50例和健康体检者38例,采用16S rRNA基因高通量测序技术检测粪便肠道菌群结构。NAFLD患者均接受FibroScan检测受控衰减参数(CAP),以此进行肝脂肪变分度。结果在50例NAFLD患者中,轻度肝脂肪变16例,中度19例和重度15例;NAFLD患者厚壁菌门、普拉梭菌、双歧杆菌、厌氧棍状菌和布劳特菌丰度分别为(5.1±1.2)%、(6.5±1.3)%、(7.1±1.9)%、(9.2±2.1)%和(11.8±2.9)%,均显著低于健康人【分别为(7.4±1.5)%、(10.4±2.1)%、(9.6±2.0)%、(12.3±2.6)%和(15.7±3.1)%,P＜0.05】,而拟杆菌门和变形菌门丰度分别为(40.3±3.2)%和(7.4±1.5)%,均显著高于健康人【分别为(33.5±2.8)%和(4.6±1.1)%,P＜0.05】;重度NAFLD患者厚壁菌门、普拉梭菌、双歧杆菌、厌氧棍状菌和布劳特菌丰度分别为(3.1±0.9)%、(5.1±1.0)%、(5.6±1.7)%、(7.4±1.5)%和(8.8±2.3)%,均显著低于中度NAFLD患者【分别为(5.3±1.3)%、(6.4±1.2)%、(7.1±1.9)%、(9.3±2.2)%和(12.1±3.1)%,P＜0.05】或轻度NAFLD患者【分别为(6.7±1.4)%、(7.9±1.7)%、(8.5±2.1)%、(10.8±2.5)%和(14.3±3.2)%,P＜0.05】,而拟杆菌门和变形菌门丰度分别为(44.4±3.2)%和(9.7±1.7)%,均显著高于中度NAFLD患者【分别为(41.2±3.3)%和(7.2±1.6)%,P＜0.05】或轻度NAFLD患者【分别为(35.4±3.1)%和(5.5±1.2)%,P＜0.05】。结论 NAFLD患者存在显著的肠道菌群失调,表现为厚壁菌门、普拉梭菌属、双歧杆菌属、厌氧棍状菌属和布劳特菌属丰度降低,拟杆菌门和变形菌门丰度升高,其临床意义还需要进一步探讨。

关键词: 非酒精性脂肪性肝病, 肠道菌群, 肝脂肪变性, 受控衰减参数

Abstract: Objective The aim of this study was to explore the correlation between intestinal flora changes and the severity of hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods A cohort of 50 patients with NAFLD and 38 healthy individuals were recruited in our hospital between July 2024 and July 2025, and all patients with NAFLD underwent FibroScan for controlled attenuation parameter (CAP), by which hepatic steatosis was stratified as mild, moderate and severe degree. The composition of intestinal microbiota was analyzed by utilizing 16S rRNA gene high-throughput sequencing. Results Of the 50 patients with NAFLD, mild liver steatosis was found in 16 cases, moderate in 19 cases and severe in 15 cases; the abundances of Firmicutes, Faecalibacterium prausnitzii, Bifidobacterium, Anaerorhabdus and Blautia in patients with NAFLD were (5.1±1.2) %, (6.5±1.3) %, (7.1±1.9) %, (9.2±2.1) % and (11.8±2.9) %, all significantly lower than [(7.4±1.5) %, (10.4±2.1) %, (9.6±2.0) %, (12.3±2.6) % and (15.7±3.1) %, respectively, P<0.05], while abundances of Bacteroidetes and Proteobacteria were (40.3±3.2) % and (7.4±1.5) %, both significantly higher than [(33.5±2.8) % and (4.6±1.1) %, respectively, P<0.05] in healthy controls; the abundances of Firmicutes, Faecalibacterium prausnitzii, Bifidobacterium, Anaerorhabdus and Blautia in patients with severe NAFLD were (3.1±0.9) %, (5.1±1.0) %, (5.6±1.7) %, (7.4±1.5) % and (8.8±2.3) %, all significantly lower than [(5.3±1.3) %, (6.4±1.2) %, (7.1±1.9) %, (9.3±2.2) % and (12.1±3.1) %, respectively, P<0.05] in those with moderate NAFLD or [(6.7±1.4) %, (7.9±1.7) %, (8.5±2.1) %, (10.8±2.5) % and (14.3±3.2) %, respectively, P<0.05] in those with mild NAFLD, while abundances of Bacteroidetes and Proteobacteria were (44.4±3.2) % and (9.7±1.7) %, both significantly higher than [(41.2±3.3) % and (7.2±1.6) %, P<0.05] in those with moderate NAFLD or [(35.4±3.1) % and (5.5±1.2) %, P<0.05] in mild NAFLD. Conclusion There is a significant imbalance of intestinal flora in patients with NAFLD, which is manifested as decreased abundances of Firmicutes, Faecalibacterium prausnitzii, Bifidobacterium, Anaerorhabdus and Blautia, and increased abundances of Bacteroides and Proteobacteria, which needs further clarification.

Key words: Non-alcoholic fatty liver disease, Intestinal flora, Liver steatosis, Controlled attenuation parameter

李静, 张文杰, 杨晓娟, 马蓉霞, 陈芳芳. 非酒精性脂肪性肝病患者肝脂肪变性严重程度对肠道菌群的影响^*[J]. 实用肝脏病杂志, 2026, 29(5): 669-672.

Li Jing, Zhang Wenjie, Yang Xiaojuan, et al. Intestinal flora changes in patients with non-alcoholic fatty liver disease[J]. Journal of Practical Hepatology, 2026, 29(5): 669-672.

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非酒精性脂肪性肝病患者肝脂肪变性严重程度对肠道菌群的影响^*

Intestinal flora changes in patients with non-alcoholic fatty liver disease

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