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Роль неалкогольной жировой болезни печени в развитии сердечно-сосудистых заболеваний - Научно-практический журнал Cardioсоматика Том 9, №1 (2018)
Роль неалкогольной жировой болезни печени в развитии сердечно-сосудистых заболеваний
Еганян Р.А. Роль неалкогольной жировой болезни печени в развитии сердечно-сосудистых заболеваний. CardioСоматика. 2018; 9 (1): 47–53. DOI: 10.26442/2221-7185_2018.1.47-53
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Аннотация
В обзоре описаны патогенетические механизмы взаимосвязи между сердечно-сосудистыми заболеваниями и неалкогольной жировой болезнью печени (НАЖБП), что является обоснованием для выбора терапевтических мишеней вмешательства. Обсуждены роли инсулинорезистентности, оксидативного стресса, воспаления, дислипидемии, кишечной микрофлоры, наследственности в патологической связи между НАЖБП и кардиометаболическими нарушениями. Приводятся современные данные отечественных и зарубежных ученых о распространенности, этиологии, патогенезе, клинической картине и лечении данного коморбидного состояния. Даны сведения о развитии субклинического и клинического атеросклероза, а также концепция гепатокардиального континуума. В лечении НАЖБП главная роль отводится устранению или коррекции этиопатогенетических факторов развития заболевания: избыточной массе тела, ожирению, инсулинорезистентности, гипергликемии, гиперлипидемии. Особое внимание уделено вопросам диетологического комплексного вмешательства и влияния разных компонентов питания на состояние сердечно-сосудистой системы и печени.
Ключевые слова: неалкогольная жировая болезнь печени, стеатогепатит, резистентность к инсулину, кардиоваскулярный риск, кардиометаболические нарушения, атеросклероз.
Key words: non-alcoholic fatty liver disease, steatohepatotis, insuline resistance, cardiovascular risk, cardiometabolic disorders, atherosclerosis.
Ключевые слова: неалкогольная жировая болезнь печени, стеатогепатит, резистентность к инсулину, кардиоваскулярный риск, кардиометаболические нарушения, атеросклероз.
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Key words: non-alcoholic fatty liver disease, steatohepatotis, insuline resistance, cardiovascular risk, cardiometabolic disorders, atherosclerosis.
Полный текст
Список литературы
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5. Alberti A, Vario A, Ferrari A, Pistis R. Review article: chronic hepatitis C – natural history and cofactors. Aliment Pharmacol Ther 2005; 22 (Suppl.): 74–8.
6. Koliaki C, Szendroedi J, Kaul K et al. Adaptation of hepatic mitochondrial function in humans with non-alcoholic fatty liver is lost in steatohepatitis. Cell Metab 2015; 21 (5): 739–46.
7. Hector J, Schwarzloh B, Goehring J et al. TNF-a Alters Visfatin and Adiponectin Levels in Human Fat. Horm Metab Res 2007; 39: 250–5.
8. Alkhouri N, Tamimi TA, Yerian L et al. The inflamed liver and atherosclerosis: a link between histologic severity of nonalcoholic fatty liver disease and increased cardiovascular risk. Dig Dis Sci 2010; 55: 2644–50.
9. Luo J, Xu L, Li J, Zhao S. Nonalcoholic fatty liver disease as a potential risk factor of cardiovascular disease. Eur J Gastroenterol Hepatol 2015; 27 (3): 193–9. DOI: 10.1097/MEG.000000000 0000254
10. Lim S, Oh TJ, Koh KK. Mechanistic link between nonalcoholic fatty liver disease and cardiometabolic disorders. J Cardiol 2015; 201: 408–14. DOI: 10.1016/j.ijcard.2015.08.107
11. Драпкина О.М., Корнеева О.Н. Континуум неалкогольной жировой болезни печени: от стеатоза печени до сердечно-сосудистого риска. Рациональная фармакотерапия в кардиологии. 2016; 12 (4): 424–9. DOI: http://dx.doi.org/ 10.20996/1819-6446-2016-12-4-424-429 [in Russian]
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14. Younossi ZM, Koenig AB, Abdelatif D et al. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016; 64 (1): 73–84.
15. Ivashkin V.T., Drapkina O.M., Maev I.V. i dr. Rasprostranennost' nealkogol'noi zhirovoi bolezni pecheni u patsientov ambulatorno-poliklinicheskoi praktiki v Rossiiskoi Federatsii: rezul'taty issledovaniia DIREG 2. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2015; 6: 31–41. [in Russian]
16. Ivashkin VT, Drapkina OM. The prevalence of nonalcoholic fatty liver disease in Russian Federation. GUT 2009; 58: 1207.
17. Fraser IS, Critchley HO, Munro MG et al. Health-related quality of life and economic burden of abnormal uterine bleeding. Expert Rev Obstet Gynecol 2009; 4 (2): 179–89.
18. Ivashkin V.T., Maevskaia M.V., Pavlov Ch.S. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniiu nealkogol'noi zhirovoi bolezni pecheni Rossiiskogo obshchestva po izucheniiu pecheni i Rossiiskoi gastroenterologicheskoi assotsiatsii. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2016; 2: 24–42. [in Russian]
19. Patil R, Sood GK. Non-alcoholic fatty liver disease and cardiovascular risk. World J Gastrointest Pathophysiol 2017; 8 (2): 51–8. DOI: 10.4291/wjgp.v8.i2.51
20. Targher G, Arcaro G. Non-alcoholic fatty liver disease and increased risk of cardiovascular disease. Atherosclerosis 2007; 191: 235–40.
21. Fargion S, Porzio M, Fracanzani A. Nonalcoholic fatty liver disease and vascular disease: State-of-the-art. World J Gastroenterol 2014; 20 (37): 13306–324. DOI: 10.3748/wjg.v20.i37.13306
22. Mellinger JL, Pencina KM, Massaro JM et al. Hepatic steatosis and cardiovascular disease outcomes: An analysis of the Framingham Heart Study. J Hepatol 2015; 63 (2): 470–6. DOI: 10.1016/j.jhep.2015.02.045
23. Bhatia LS, Curzen NP, Calder PC, Byrne CD. Non-alcoholic fatty liver disease: a new and important cardiovascular risk factor? Eur Heart J 2012; 33 (10): 1190–200.
24. Pacifico L, Chiesa C, Anania C et al. Nonalcoholic fatty liver disease and the heart in children and adolescents. World J Gastroenterol 2014; 20 (27): 9055–907.
25. Maliavskaia S.I., Lebedev A.V. Metabolicheskii portret detei s ozhireniem. Ros. vestn. perinatologii i pediatrii. 2011; 60 (6): 73–8. [in Russian]
26. Calori G, Lattuada G, Ragogna F et al. Fatty liver index and mortality: the Cremona study in the 15th year of follow-up. Hepatology 2011; 54 (1): 145–52.
27. Roden M. Mechanisms of disease: hepatic steatosis in type 2 diabetes-pathogenesis and clinical relevance. Nat Clin Pract Endocrinol Metab 2006; 2 (6): 335–48.
28. Roitberg G.E., Sharkhun O.O., Platonova O.E., Ushakova T.I. Nealkogol'naia zhirovaia bolezn' pecheni kak faktor riska ateroskleroza. Vestn. RGMU. 2008; 6: 5–10. [in Russian]
29. Platonova O.E. Risk razvitiia ateroskleroza u patsientov s nealkogol'noi zhirovoi bolezn'iu pecheni pri insulinorezistentnosti. Avtoref. dis. ... kand. med. nauk. M., 2009. [in Russian]
30. Basar O, Akbal E, Köklü S et al. Increased H-FABP concentrations in nonalcoholic fatty liver disease. Possible marker for subclinical myocardial damage and subclinical atherosclerosis. Herz 2013; 38 (4): 417–22. DOI: 10.1007/s00059-012-3714-x
31. Pais R, Giral P, Khan JF et al. LIDO Study group, Fatty liver is an independent predictor of early carotid atherosclerosis. J Hepatol 2016; 65 (1): 95–102. DOI: 10.1016/j.jhep.2016.02.023
32. Kim HC, Kim DJ, Huh KB. Association between nonalcoholic fatty liver disease and carotid intima media thickness according to the presence of metabolic syndrome. Atherosclerosis 2009; 204 (2): 521–5.
33. Chalasani N, Younossi Z, Lavine JE et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012; 55 (6): 2005–23. DOI: 10.1002/hep.25762
34. Daurekhanov A.M., Shonbaeva A.K., Sagindykov N.N. Vliianie raka, tsirroza pecheni i khronicheskogo virusnogo gepatita na razvitie ateroskleroza. Medicine (Almaty). 2017; 2: 24–9. [in Russian]
35. Krivosheev A.B., Kuimov A.D., Popov K.V. i dr. Gendernye osobennosti nealkogol'noi zhirovoi bolezni pecheni v sochetanii s metabolicheskim sindromom. Ateroskleroz. 2016; 2: 25–30. [in Russian]
36. Drapkina O.M. Kontinuum nealkogol'noi zhirovoi bolezni pecheni: ot steatoza do serdechno-sosudistogo riska. Ratsion. farmakoterapiia v kardiologii. 2016; 12: 424–9. [in Russian]
37. Sung KC, Wild SH, Kwag HJ, Byrne CD. Fatty liver, insulin resistance, and features of metabolic syndrome: relationships with coronary artery calcium in 10,153 people. Diabetes Care 2012; 35: 2359–64.
38. Ramilli S, Pretolani S, Muscari A et al. Carotid lesions in outpatients with nonalcoholic fatty liver disease. World J Gastroenterol 2009; 15 (38): 4770–4.
39. Luo J, Xu L, Li J, Zhao S. Nonalcoholic fatty liver disease as a potential risk factor of cardiovascular disease. Eur J Gastroenterol Hepatol 2015; 27 (3): 193–9. DOI: 10.1097/MEG.000000000 0000254
40. Li N, Zhang GW, Zhang JR et al. Non-alcoholic fatty liver disease is associated with progression of arterial stiffness. Nutr Metab Cardiovasc Dis 2015; 25 (2): 218–23. DOI: 10.1016/j.numecd.2014.10.002
41. Pugh TJ, Kelly MA, Gowinsankar S et al. The landscape of genetic variation in dilated cardiomyopathy as surveyed by clinical DNA sequencing. Genet Med 2014; 16 (8): 601–8. DOI: 10,1038/gim.2013.204
42. Villanova N, Moscatiello S, Ramilli S et al. Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease. Hepatology 2005; 42: 473–80.
43. Perseghin G, Lattuada G, De Cobelli F et al. Increased mediastinal fat and impaired left ventricular energy metabolism in young men with newly found fatty liver. Hepatology 2008; 47: 51–8.
44. Hallsworth K, Hollingsworth KG, Thoma C et al. Cardiac structure and function are altered in adults with non-alcoholic fatty liver disease. J Hepatol 2013; 58: 757–62.
45. Bonapace S, Perseghin G, Molon G et al. Nonalcoholic fatty liver disease is associated with left ventricular diastolic dysfunction in patients with type 2 diabetes. Diabetes Care 2012; 35: 389–95.
46. Targher G, Valbusa F, Bonapace S et al. Non-alcoholic fatty liver disease is associated with an increased incidence of atrial fibrillation in patients with type 2 diabetes. PLoS One 2013; 8: e57183.
47. Iacobellis G, Barbarini G, Letizia C, Barbaro G. Epicardial fat thickness and nonalcoholic fatty liver disease in obese subjects. Obesity (Silver Spring) 2014; 22: 332–6.
48. Hamaguchi M, Kojima T, Takeda N et al. Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease. World J Gastroenterol 2007; 13 (10): 1579–84.
49. Wong VW, Wong GL, Yip GW et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut 2011; 60: 1721–7.
50. Dunn W, Xu R, Wingard DL et al. Suspected Nonalcoholic Fatty Liver Disease and Mortality Risk in a Population-Based Cohort Study. Am J Gastroenterol 2008; 103: 2263–71.
51. Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol 2008; 49: 608–12.
52. Li J, Ma W, Wang S. Slower gastric emptying in high-fat diet induced obese rats is associated with attenuated plasma ghrelin and elevated plasma leptin and cholecystokinin concentrations. Regul Pept 2011; 171: 53–7.
53. Bendsen NT, Chabanova E, Thomsen HS et al. Effect of trans fatty acid intake on abdominal and liver fat deposition and blood lipids: a randomized trial in overweight postmenopausal women. Nutr Diabetes 2011; 1 (1): e4. DOI: 10.1038/nutd.2010.4
54. Ross AВ, Taylor CL, Yaktine A et al. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US), 2011.
55. Lazebnik L.B., Zvenigorodskaia L.A., Egorova E.G. i dr. Nealkogol'naia zhirovaia bolezn' pecheni pri dislipidemii i insulinorezistentnosti: skhodstvo i razlichiia; differentsirovannyi podkhod k terapii. Eksperim. i klin. gastroenterologiia. 2009; 4: 4–11. [in Russian]
56. Tutel'ian V.A., Vialkov A.I., Razumov A.N. i dr. Nauchnye osnovy zdorovogo pitaniia. M.: Panorama, 2010. [in Russian]
57. Kardiovaskuliarnaia profilaktika. Natsional'nye klinicheskie rekomendatsii. M., 2009. [in Russian]
58. Chesnokova L.V., Petrov I.M., Troshina I.A. i dr. Vliianie snizheniia massy tela na techenie nealkogol'noi zhirovoi bolezni pecheni: rezul'taty 6-mesiachnogo prospektivnogo nabliudeniia. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2015; 25 (1): 66–73. [in Russian]
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2. Пальгова Л.К. Группы риска по развитию неалкогольной жировой болезни печени: кому и как проводить скрининг. Эффективная фармакотерапия. 2017; 16: 26–30. / Pal'gova L.K. Gruppy riska po razvitiiu nealkogol'noi zhirovoi bolezni pecheni: komu i kak provodit' skrining. Effektivnaia farmakoterapiia. 2017; 16: 26–30. [in Russian]
3. World health statistics 2016: monitoring health for the SDGs, sustainable development goals. 2016.
4. Gaggini M, Morelli M, Buzzigoli E et al. Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart diseases. Nutrients 2013; 5 (5): 1544–60.
5. Alberti A, Vario A, Ferrari A, Pistis R. Review article: chronic hepatitis C – natural history and cofactors. Aliment Pharmacol Ther 2005; 22 (Suppl.): 74–8.
6. Koliaki C, Szendroedi J, Kaul K et al. Adaptation of hepatic mitochondrial function in humans with non-alcoholic fatty liver is lost in steatohepatitis. Cell Metab 2015; 21 (5): 739–46.
7. Hector J, Schwarzloh B, Goehring J et al. TNF-a Alters Visfatin and Adiponectin Levels in Human Fat. Horm Metab Res 2007; 39: 250–5.
8. Alkhouri N, Tamimi TA, Yerian L et al. The inflamed liver and atherosclerosis: a link between histologic severity of nonalcoholic fatty liver disease and increased cardiovascular risk. Dig Dis Sci 2010; 55: 2644–50.
9. Luo J, Xu L, Li J, Zhao S. Nonalcoholic fatty liver disease as a potential risk factor of cardiovascular disease. Eur J Gastroenterol Hepatol 2015; 27 (3): 193–9. DOI: 10.1097/MEG.000000000 0000254
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23. Bhatia LS, Curzen NP, Calder PC, Byrne CD. Non-alcoholic fatty liver disease: a new and important cardiovascular risk factor? Eur Heart J 2012; 33 (10): 1190–200.
24. Pacifico L, Chiesa C, Anania C et al. Nonalcoholic fatty liver disease and the heart in children and adolescents. World J Gastroenterol 2014; 20 (27): 9055–907.
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27. Roden M. Mechanisms of disease: hepatic steatosis in type 2 diabetes-pathogenesis and clinical relevance. Nat Clin Pract Endocrinol Metab 2006; 2 (6): 335–48.
28. Ройтберг Г.Е., Шархун О.О., Платонова О.Е., Ушакова Т.И. Неалкогольная жировая болезнь печени как фактор риска атеросклероза. Вестн. РГМУ. 2008; 6: 5–10. / Roitberg G.E., Sharkhun O.O., Platonova O.E., Ushakova T.I. Nealkogol'naia zhirovaia bolezn' pecheni kak faktor riska ateroskleroza. Vestn. RGMU. 2008; 6: 5–10. [in Russian]
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30. Basar O, Akbal E, Köklü S et al. Increased H-FABP concentrations in nonalcoholic fatty liver disease. Possible marker for subclinical myocardial damage and subclinical atherosclerosis. Herz 2013; 38 (4): 417–22. DOI: 10.1007/s00059-012-3714-x
31. Pais R, Giral P, Khan JF et al. LIDO Study group, Fatty liver is an independent predictor of early carotid atherosclerosis. J Hepatol 2016; 65 (1): 95–102. DOI: 10.1016/j.jhep.2016.02.023
32. Kim HC, Kim DJ, Huh KB. Association between nonalcoholic fatty liver disease and carotid intima media thickness according to the presence of metabolic syndrome. Atherosclerosis 2009; 204 (2): 521–5.
33. Chalasani N, Younossi Z, Lavine JE et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012; 55 (6): 2005–23. DOI: 10.1002/hep.25762
34. Дауреханов А.М., Шонбаева А.К., Сагиндыков Н.Н. Влияние рака, цирроза печени и хронического вирусного гепатита на развитие атеросклероза. Medicine (Almaty). 2017; 2: 24–9. / Daurekhanov A.M., Shonbaeva A.K., Sagindykov N.N. Vliianie raka, tsirroza pecheni i khronicheskogo virusnogo gepatita na razvitie ateroskleroza. Medicine (Almaty). 2017; 2: 24–9. [in Russian]
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37. Sung KC, Wild SH, Kwag HJ, Byrne CD. Fatty liver, insulin resistance, and features of metabolic syndrome: relationships with coronary artery calcium in 10,153 people. Diabetes Care 2012; 35: 2359–64.
38. Ramilli S, Pretolani S, Muscari A et al. Carotid lesions in outpatients with nonalcoholic fatty liver disease. World J Gastroenterol 2009; 15 (38): 4770–4.
39. Luo J, Xu L, Li J, Zhao S. Nonalcoholic fatty liver disease as a potential risk factor of cardiovascular disease. Eur J Gastroenterol Hepatol 2015; 27 (3): 193–9. DOI: 10.1097/MEG.000000000 0000254
40. Li N, Zhang GW, Zhang JR et al. Non-alcoholic fatty liver disease is associated with progression of arterial stiffness. Nutr Metab Cardiovasc Dis 2015; 25 (2): 218–23. DOI: 10.1016/j.numecd.2014.10.002
41. Pugh TJ, Kelly MA, Gowinsankar S et al. The landscape of genetic variation in dilated cardiomyopathy as surveyed by clinical DNA sequencing. Genet Med 2014; 16 (8): 601–8. DOI: 10,1038/gim.2013.204
42. Villanova N, Moscatiello S, Ramilli S et al. Endothelial dysfunction and cardiovascular risk profile in nonalcoholic fatty liver disease. Hepatology 2005; 42: 473–80.
43. Perseghin G, Lattuada G, De Cobelli F et al. Increased mediastinal fat and impaired left ventricular energy metabolism in young men with newly found fatty liver. Hepatology 2008; 47: 51–8.
44. Hallsworth K, Hollingsworth KG, Thoma C et al. Cardiac structure and function are altered in adults with non-alcoholic fatty liver disease. J Hepatol 2013; 58: 757–62.
45. Bonapace S, Perseghin G, Molon G et al. Nonalcoholic fatty liver disease is associated with left ventricular diastolic dysfunction in patients with type 2 diabetes. Diabetes Care 2012; 35: 389–95.
46. Targher G, Valbusa F, Bonapace S et al. Non-alcoholic fatty liver disease is associated with an increased incidence of atrial fibrillation in patients with type 2 diabetes. PLoS One 2013; 8: e57183.
47. Iacobellis G, Barbarini G, Letizia C, Barbaro G. Epicardial fat thickness and nonalcoholic fatty liver disease in obese subjects. Obesity (Silver Spring) 2014; 22: 332–6.
48. Hamaguchi M, Kojima T, Takeda N et al. Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease. World J Gastroenterol 2007; 13 (10): 1579–84.
49. Wong VW, Wong GL, Yip GW et al. Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut 2011; 60: 1721–7.
50. Dunn W, Xu R, Wingard DL et al. Suspected Nonalcoholic Fatty Liver Disease and Mortality Risk in a Population-Based Cohort Study. Am J Gastroenterol 2008; 103: 2263–71.
51. Ong JP, Pitts A, Younossi ZM. Increased overall mortality and liver-related mortality in non-alcoholic fatty liver disease. J Hepatol 2008; 49: 608–12.
52. Li J, Ma W, Wang S. Slower gastric emptying in high-fat diet induced obese rats is associated with attenuated plasma ghrelin and elevated plasma leptin and cholecystokinin concentrations. Regul Pept 2011; 171: 53–7.
53. Bendsen NT, Chabanova E, Thomsen HS et al. Effect of trans fatty acid intake on abdominal and liver fat deposition and blood lipids: a randomized trial in overweight postmenopausal women. Nutr Diabetes 2011; 1 (1): e4. DOI: 10.1038/nutd.2010.4
54. Ross AВ, Taylor CL, Yaktine A et al. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US), 2011.
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________________________________________________
2. Pal'gova L.K. Gruppy riska po razvitiiu nealkogol'noi zhirovoi bolezni pecheni: komu i kak provodit' skrining. Effektivnaia farmakoterapiia. 2017; 16: 26–30. [in Russian]
3. World health statistics 2016: monitoring health for the SDGs, sustainable development goals. 2016.
4. Gaggini M, Morelli M, Buzzigoli E et al. Non-alcoholic fatty liver disease (NAFLD) and its connection with insulin resistance, dyslipidemia, atherosclerosis and coronary heart diseases. Nutrients 2013; 5 (5): 1544–60.
5. Alberti A, Vario A, Ferrari A, Pistis R. Review article: chronic hepatitis C – natural history and cofactors. Aliment Pharmacol Ther 2005; 22 (Suppl.): 74–8.
6. Koliaki C, Szendroedi J, Kaul K et al. Adaptation of hepatic mitochondrial function in humans with non-alcoholic fatty liver is lost in steatohepatitis. Cell Metab 2015; 21 (5): 739–46.
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Авторы
Р.А.Еганян
ФГБУ «Национальный медицинский исследовательский центр профилактической медицины» Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3
eganyan@km.ru
National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3
eganyan@km.ru
ФГБУ «Национальный медицинский исследовательский центр профилактической медицины» Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3
eganyan@km.ru
________________________________________________
National Medical Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101990, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3
eganyan@km.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.
