目的 基于NF-κB/Bcl-2通路探讨祛湿活血方对代谢功能障碍相关脂肪性肝病（MASLD）小鼠模型的治疗作用。 方法 通过给予12周高脂饲料建立MASLD小鼠模型，对照组予以普通饲料饮食。造模成功后治疗组采用祛湿活血方低、中、高剂量干预6周。采用HE染色、油红O染色观察小鼠脂质沉积及炎症浸润情况；试剂盒检测血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、甘油三酯（TG）、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、IL-1β水平和肝脏丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）水平；TUNEL法检测细胞凋亡率；RT-qPCR检测凋亡相关基因mRNA表达水平；免疫组化和蛋白免疫印迹检测肝组织核因子-κB（NF-κB）、B淋巴细胞瘤-2（Bcl-2）、Bcl-2相关X蛋白（Bax）、半胱氨酸蛋白酶-3（Caspase-3）蛋白表达情况等。 结果 祛湿活血方能显著改善肝脏内脂质沉积、氧化应激及炎症反应和肝细胞凋亡水平，降低小鼠血清ALT、AST、TG、TNF-α、IL-1β、IL-6水平，肝脏MDA水平及提高肝脏GSH-Px、SOD水平（P < 0.05，P < 0.01）。此外，该方还降低肝脏中p-NF-κB/NF-κB、Bax、Caspase-3蛋白表达水平（P < 0.05，P < 0.01）和Bax、Caspase-3 mRNA水平及提高Bcl-2 mRNA表达水平（P < 0.05，P < 0.01）。 结论 祛湿活血方能明显改善小鼠肝功能、血脂水平、氧化应激及炎症反应，从而降低肝细胞凋亡水平，其机制可能与调控NF-κB/Bcl-2通路相关。

Objective To investigate the therapeutic effects of Qushi Huoxue decoction on a mouse model of metabolic dysfunction-associated steatotic liver disease （MASLD） and to explore its underlying mechanism associated with the NF-κB/Bcl-2 signaling pathway. Methods MASLD was induced in mice by feeding them a high-fat diet for 12 weeks， while the control mice were fed a standard diet. After successful modeling， the treatment groups were given low， medium， and high doses of Qushi Huoxue decoction for 6 weeks. Hepatic lipid deposition and inflammatory infiltration were evaluated using hematoxylin–eosin （HE） and oil red O staining. The serum levels of ALT， AST， TG， TNF-α， IL-6， and IL-1β， as well as the hepatic levels of MDA， GSH-Px， and SOD， were measured with commercial assay kits. The hepatocyte apoptosis rate was determined by TUNEL assay， and the mRNA expression levels of apoptosis-related genes were measured by RT-qPCR. The protein expression levels of Bcl-2， Bax， and Caspase-3 in liver tissues were detected through immunohistochemistry and Western blot. Results Qushi Huoxue decoction significantly alleviated hepatic lipid deposition， oxidative stress， inflammatory response， and hepatocyte apoptosis. It led to a reduction in the serum levels of ALT， AST， TG， TNF-α， IL-1β， and IL-6， a decrease in the hepatic MDA level， and an increase in the hepatic GSH-Px and SOD levels （P < 0.05， P < 0.01）. Moreover， it also downregulated the protein expression levels of p-NF-κB/NF-κB， Bax， and Caspase-3 in the liver （P < 0.05， P < 0.01）， as well as the mRNA expression levels of Bax and Caspase-3， while upregulating the Bcl-2 mRNA expression （P < 0.05， P < 0.01）. Conclusions Qushi Huoxue decoction effectively enhances liver function， optimizes lipid metabolism， alleviates oxidative stress， and mitigates inflammatory responses in mice with MASLD， consequently decreasing hepatocyte apoptosis. These effects are potentially mediated via the modulation of the NF-κB/Bcl-2 signaling pathway.