田 威,颜赞友,马锐利,张 帆

本文综述了肥胖症与消化系统疾病之间的复杂关系及其发病机制。肥胖作为一种全球性流行病，其发病率不断上升，已成为多种消化系统疾病的高危因素。详细探讨肥胖症通过脂质代谢紊乱、胰岛素抵抗、炎症反应和肠道通透性增加等机制对消化系统的影响，并分析肥胖症与胃食管反流病（GERD）、胃部疾病、肥胖性腹泻综合征、炎症性肠病（IBD）、非酒精性脂肪肝病（NAFLD）、急性胰腺炎和消化系统肿瘤等疾病的相关性。肥胖症不仅直接影响消化系统的生理功能，还通过肠道菌群失衡和代谢紊乱加剧疾病的发生与发展。尽管现有研究揭示了部分机制，但肥胖与消化系统疾病的因果关系尚未完全明确。未来研究需进一步探索肥胖症与肠道菌群的相互作用及其对全身代谢的影响，为开发更有效的治疗策略提供理论支持。

肥胖症；消化系统疾病；肥胖腹泻综合征；非酒精性脂肪肝；胰腺炎

[1] 中华医学会内分泌学分会.肥胖患者的长期体重管理及药物临床应用指南(2024版)[J].中华内分泌代谢杂志,2024,40(7):545-564. [2] 中华人民共和国国家卫生健康委员会医政司.肥胖症中国诊疗指南(2024年版)[J/OL].协和医学杂志,1-60[2025-01-22]. [3] 曲伸,陆灏,宋勇峰.基于临床的肥胖症多学科诊疗共识(2021年版)[J].中华肥胖与代谢病电子杂志,2021,7(04):211-226. [4] Abdallah Ismail N,Ragab SH,Abd Elbaky A,Shoeib AR,Alhosary Y,Fekry D.Frequency of Firmicutes and Bacteroidetes in gut microbiota in obese and normal weight Egyptian children and adults.Arch Med Sci.2011 Jun;7(3):501-7. [5] 王雨,林志健,边猛,等.维药菊苣提取物对高尿酸血症状态下肠道屏障的影响[J].中华中医药杂志,2018,33(05):1718-1723. [6] Cani PD,Possemiers S,Van de Wiele T,Guiot Y,Everard A,Rottier O,Geurts L,Naslain D,Neyrinck A,Lambert DM,Muccioli GG,Delzenne NM.Changes in gut microbiota control inflammation in obese mice through a mechanism involving GLP-2-driven improvement of gut permeability.Gut.2009 Aug;58(8):1091-103. [7] Eusebi LH,Ratnakumaran R,Yuan Y,Solaymani-Dodaran M,Bazzoli F,Ford AC.Global prevalence of,and risk factors for, gastro- oesophageal reflux symptoms:a meta-analysis.Gut.2018 Mar;67(3):430-440. [8] Che F,Nguyen B,Cohen A,Nguyen NT.Prevalence of hiatal hernia in the morbidly obese.Surg Obes Relat Dis.2013 Nov-Dec;9(6):920-4. [9] Burgerhart JS,van de Meeberg PC,Siersema PD,Smout AJ.Nocturnal and daytime esophageal acid exposure in normal-weight, overweight,and obese patients with reflux symptoms.Eur J Gastroenterol Hepatol.2014 Jan;26(1):6-10. [10] Yen HH,Tseng PH,Shih MC,Yang PJ,Lin MT,Lee PC.Derangement of esophageal anatomy and motility in morbidly obese patients:a prospective study based on high-resolution impedance manometry.Surg Obes Relat Dis.2020 Dec;16(12):2006-2015. [11] Yu HX,Wang XL,Zhang LN,Zhang J,Zhao W.Involvement of the TLR4/NF-κB Signaling Pathway in the Repair of Esophageal Mucosa Injury in Rats with Gastroesophageal Reflux Disease.Cell Physiol Biochem.2018;51(4):1645-1657. [12] Baghdadi J,Chaudhary N,Pei Z,Yang L.Microbiome,innate immunity,and esophageal adenocarcinoma.Clin Lab Med.2014 Dec; 34(4):721-32. [13] Yang L,Chaudhary N,Baghdadi J,Pei Z.Microbiome in reflux disorders and esophageal adenocarcinoma.Cancer J.2014 May-Jun; 20(3):207-10. [14] Yang L,Cai H,Tou J,Gu W,Shu X,Zhang T,Yang X,Shen Z,Jiang M.The role of the 5-hydroxytryptamine pathway in reflux-induced esophageal mucosal injury in rats.World J Surg Oncol.2012 Oct 23;10:219. [15] 卢小芳,王悦芬,王彦刚.5-HT通路异常与胃食管反流病[J].国际消化病杂志,2014,34(03):163-166. [16] Ansari S,Haboubi H,Haboubi N.Obesity management for the gastroenterologist.Frontline Gastroenterol.2020 Apr 27;12(3):235-245. [17] Abulmeaty MMA,Aljuraiban GS,Aldisi D,Albaran B,Aldossari Z,Alsager T,Razak S,Almuhtadi Y,El-Shorbagy E,Berika M,Al Zaben M,Almajwal A.Association of Gastric Myoelectric Activity with Dietary Intakes,Substrate Utilization,and Energy Expenditure in Adults with Obesity.Nutrients.2022 Sep 28;14(19):4021. [18] Delgado-Aros S,Locke GR 3rd,Camilleri M,Talley NJ,Fett S,Zinsmeister AR,Melton LJ 3rd.Obesity is associated with increased risk of gastrointestinal symptoms:a population-based study.Am J Gastroenterol.2004 Sep;99(9):1801-6. [19] 韩珂,王祥耀,茹楠,等.肥胖成人慢性腹泻患病率的系统评价和Meta分析[J].中华胃肠内镜电子杂志,2023,10(2):115-120. [20] 令狐恩强.令狐氏肥胖腹泻综合征[J].中华胃肠内镜电子杂志,2021,8(04):145-146. [21] Niu XT,Wang XY,Wang Y,Han K,Ru N,Xiang JY,Linghu EQ.Transcriptome analysis suggests broad jejunal alterations in Linghu's obesity-diarrhea syndrome:A pilot study.World J Gastroenterol.2024 Jun 7;30(21):2777-2792. [22] Abboud KY,Reis SK,Martelli ME,Zordão OP,Tannihão F,de Souza AZZ,Assalin HB,Guadagnini D,Rocha GZ,Saad MJA,Prada PO. Oral Glutamine Supplementation Reduces Obesity,Pro-Inflammatory Markers,and Improves Insulin Sensitivity in DIO Wistar Rats and Reduces Waist Circumference in Overweight and Obese Humans.Nutrients.2019 Mar 1;11(3):536. [23] Laviano A,Molfino A,Lacaria MT,Canelli A,De Leo S,Preziosa I,Rossi Fanelli F.Glutamine supplementation favors weight loss in nondieting obese female patients.A pilot study.Eur J Clin Nutr.2014 Nov;68(11):1264-6. [24] Wang Y,Wang X,Niu X,Han K,Ru N,Xiang J,Linghu E.Identification of COL3A1 as a candidate protein involved in the crosstalk between obesity and diarrhea using quantitative proteomics and machine learning.Eur J Pharmacol.2024 Oct 15;981:176881. [25] Strober W,Fuss IJ.Proinflammatory cytokines in the pathogenesis of inflammatory bowel diseases.Gastroenterology.2011 May; 140(6):1756-1767. [26] Wang W,Han Y,Yin W,Wang Q,Wu Y,Du M.Intestinal and hepatic benefits of BBR-EVO on DSS-induced experimental colitis in mice. Front Microbiol.2024 Sep 4;15:1428327. [27] Başaranoğlu M,Örmeci N.Nonalcoholic fatty liver disease:diagnosis,pathogenesis,and management.Turk J Gastroenterol.2014 Apr; 25(2):127-32. [28] Li C,Yin X,Xie C,Zeng J,Song C,Yang G,Zhang J,Chen S,Wei P,Wang Z,Gu M,Li W,An J,Pan Y.Berberine attenuates TNBS-induced colitis in mice by improving the intestinal microbiota.Front Microbiol.2024 Aug 29;15:1463005. [29] Vaishnava S,Behrendt CL,Ismail AS,Eckmann L,Hooper LV.Paneth cells directly sense gut commensals and maintain homeostasis at the intestinal host-microbial interface.Proc Natl Acad Sci U S A.2008 Dec 30;105(52):20858-63. [30] Başaranoğlu M,Örmeci N.Nonalcoholic fatty liver disease:diagnosis,pathogenesis,and management.Turk J Gastroenterol.2014 Apr; 25(2):127-32. [31] He J,Zhang P,Shen L,Niu L,Tan Y,Chen L,Zhao Y,Bai L,Hao X,Li X,Zhang S,Zhu L.Short-Chain Fatty Acids and Their Association with Signalling Pathways in Inflammation,Glucose and Lipid Metabolism.Int J Mol Sci.2020 Sep 2;21(17):6356. [32] Zhou H,Yu B,Sun J,Liu Z,Chen H,Ge L,Chen D.Short-chain fatty acids can improve lipid and glucose metabolism independently of the pig gut microbiota.J Anim Sci Biotechnol.2021 May 6;12(1):61. [33] Wu HM,Ni XX,Xu QY,Wang Q,Li XY,Hua J.Regulation of lipid-induced macrophage polarization through modulating peroxisome proliferator-activated receptor-gamma activity affects hepatic lipid metabolism via a Toll-like receptor 4/NF-κB signaling pathway.J Gastroenterol Hepatol.2020 Nov;35(11):1998-2008. [34] López-Méndez I,Méndez-Maldonado K,Manzo-Francisco LA,Juárez-Hernández E,Uribe M,Barbero-Becerra VJ.G protein-coupled receptors:Key molecules in metabolic associated fatty liver disease development.Nutr Res.2021 Mar;87:70-79. [35] Chen Y,He X,Chen X,Li Y,Ke Y.SeP is elevated in NAFLD and participates in NAFLD pathogenesis through AMPK/ACC pathway.J Cell Physiol.2021 May;236(5):3800-3807. [36] Ziolkowska S,Binienda A,Jabłkowski M,Szemraj J,Czarny P.The Interplay between Insulin Resistance,Inflammation,Oxidative Stress,Base Excision Repair and Metabolic Syndrome in Nonalcoholic Fatty Liver Disease.Int J Mol Sci.2021 Oct 15;22(20):11128. [37] Cui Y,Wang Q,Chang R,Zhou X,Xu C.Intestinal Barrier Function-Non-alcoholic Fatty Liver Disease Interactions and Possible Role of Gut Microbiota.J Agric Food Chem.2019 Mar 13;67(10):2754-2762. [38] Hu S,Kuwabara R,de Haan BJ,Smink AM,de Vos P.Acetate and Butyrate Improveβ-cell Metabolism and Mitochondrial Respiration under Oxidative Stress.Int J Mol Sci.2020 Feb 24;21(4):1542. [39] 肖瑞,郭建锋,王琳琳,等.基于宏基因组学分析不同膳食结构非酒精性脂肪肝患者的肠道菌群特点[J/OL].食品与发酵工业, 1-10[2025-01-23]. [40] 宋婷,李佳,张茜,等.基于肠道菌群维生素K2调控肝脏胰岛素抵抗作用机制[J].中国微生态学杂志,2024,36(10):1117-1122.

点击下载PDF