2026 年第 3 期 第 21 卷

代谢功能障碍相关脂肪性肝病从脂毒性到相关激素轴的多维度发病机制概述

A multidimensional overview of the pathogenic mechanisms of metabolic dysfunction-associated fatty liver disease: from lipotoxicity to related hormone axes

作者：牛佳乐1牛剑祥2

英文作者：Niu Jiale1 Niu Jianxiang2

单位：1内蒙古医科大学附属医院，呼和浩特010030；2内蒙古医科大学附属医院肝胆外科，呼和浩特010030

英文单位：1The Affiliated Hospital of Inner Mongolia Medical University Hohhot 010030 China; 2Department of Hepatobiliary Surgery the Affiliated Hospital of Inner Mongolia Medical University Hohhot 010030 China

关键词：代谢功能障碍相关脂肪性肝病；脂肪酸代谢；激素

英文关键词：Metabolicdysfunction-associatedfattyliverdisease;Fattyacidmetabolism;Hormones

• 摘要：

• 近年来，全球肥胖及相关代谢性疾病［如2型糖尿病、代谢功能障碍相关脂肪性肝病（MASLD）］的发病率显著上升，MASLD涉及向代谢功能障碍相关脂肪性肝炎及纤维化进展的连续疾病进程，最终可导致肝硬化与肝细胞癌。探究其发病机制有助于为疾病防控和治疗带来新颖的预防及诊疗思路，“多次打击学说”作为该疾病发病机制主流学说，肝脏脂肪变性基础上的后续打击因素已逐步被临床及实验所验证，本文通过总结探讨脂代谢、炎症、内分泌相关轴等多维度机制，旨在为MASLD的系统性诊治提供新思路。

• In recent years, the global incidence of obesity and related metabolic diseases ［such as type 2 diabetes mellitus and metabolic dysfunction-associated fatty liver disease (MASLD)］ has increased significantly. MASLD involves a continuous disease progression towards metabolic dysfunction-associated steatohepatitis and fibrosis, which can ultimately lead to liver cirrhosis and hepatocellular carcinoma. Exploring its pathogenic mechanisms is conducive to developing novel preventive, diagnostic, and therapeutic strategies for the disease. As the mainstream theory of the disease′s pathogenesis, the "multiple hit hypothesis" has been gradually verified by clinical and experimental studies regarding the subsequent hits on the basis of hepatic steatosis. This article summarizes and discusses multidimensional mechanisms including lipid metabolism, inflammation, and endocrine-related axes, aiming to provide new insights for the systematic diagnosis and treatment of MASLD.