非酒精性脂肪肝病患者粪便中短链脂肪酸改变的临床研究

目的探索非酒精性脂肪肝病（NAFLD）不同状态下粪便短链脂肪酸（SCFAs）的差异,为寻找NAFLD疾病发生发展机制和可能的治疗靶点提供支持。方法通过气相色谱-质谱分析,检测非酒精性脂肪肝（NAFL）、非酒精性脂肪肝炎（NASH）、NAFLD相关肝硬化粪便中乙酸、丙酸、丁酸三种主要SCFAs水平和构成差异。结果纳入分析80例,其中健康志愿者9例,NAFL患者27例,NASH患者20例,NAFLD相关肝硬化24例。NAFLD相关肝硬化组患者SCFAs总含量（P=0.004,P=0.0001,P=0.001）、粪便丁酸（P=0.045,P=0.0001,P=0.0001）、乙酸水平（P=0.010,P=0.0001,P=0.012）分别显著低于健康志愿者、NAFL组和NASH组,丙酸水平（P=0.024）显著低于NAFL组。NAFLD相关肝硬化组患者SCFAs中丁酸所占比例显著低于NASH组（P=0.016）。结论 NAFLD肝硬化患者粪便存在主要SCFAs水平的降低,其中丁酸构成比例降低更为明显,这可能是NAFLD进入肝硬化特征改变之一,提示SCFAs水平变化对NAFLD疾病进展可能有一定预测作用,补充肠道SCFAs可能作为NAFLD相关肝硬化新的治疗靶点。

Clinical Study on Changes of Faecal SCFAs in Patients with Nonalcoholic Fatty Liver Disease.

Objective To explore differences of fecal short-chain fatty acids(SCFAs)in different states of non-alcoholic fatty liver disease(NAFLD), and to find mechanism of occurrence and development of NAFLD and possible therapeutic targets. Methods Gas chromatography-mass spectrometry was used to detect three main SCFAs(acetic acid, propionic acid and butyric acid)in stools of NAFLD, non-alcoholic steatohepatitis(NASH)and NAFLD related cirrhosis. Results 80 cases were included, including 9 healthy volunteers, 27 NAFL patients, 20 NASH patients and 24 NAFLD related cirrhosis. For patients in NAFLD-related cirrhosis group, SCFAs total content(P=0.004, P=0.0001, P=0.001), fecal butyric acid(P=0.045, P=0.0001, P=0.0001), acetic acid level(P=0.010, P=0.0001, P=0.012)were significantly lower than those of healthy volunteers, NAFL and NASH group. Propionic acid(P=0.024)was significantly lower than that of NAFL group. Butyric acid in SCFAs was significantly lower than that in NASH group(P=0.016). Conclusion SCFAs in stool of patients with NAFLD would decrease, especially butyric acid. When NAFLD would enter into cirrhosis, it may be one of characteristics, suggesting that SCFAs changes may have a certain predictive effect. Intestinal SCFAs supplementation may serve as a new therapeutic targets for NAFLD related cirrhosis.