Роль неалкогольной жировой болезни печени в развитии сердечно-сосудистых заболеваний
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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Eganyan R.A. The role of non-alcoholic fatty liver disease in the development of cardiovascular diseases. Cardiosomatics. 2018; 9 (1): 47–53. DOI: 10.26442/2221-7185_2018.1.47-53
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
________________________________________________
Eganyan R.A. The role of non-alcoholic fatty liver disease in the development of cardiovascular diseases. Cardiosomatics. 2018; 9 (1): 47–53. DOI: 10.26442/2221-7185_2018.1.47-53
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.
The review describes the pathogenetic mechanisms of the relationship between cardiovascular disease and non-alcoholic fatty liver disease (NAFLD), which is the rationale for selecting therapeutic targets for intervention. The role of insulin resistance, oxidative stress, inflammation, dyslipidemia, intestinal microflora, heredity in the pathological relationship between NAFLD and cardiometabolic disorders are discussed. Present-day data of domestic and foreign scientists on prevalence, etiology, pathogenesis, clinical picture and treatment of this comorbid state are presented. Information is given on the development of subclinical and clinical atherosclerosis, as well as the concept of the hepatocardial continuum. In the treatment of NAFLD, the main role is given to the elimination or correction of etiopathogenetic factors of the development of the disease, excessive body weight, obesity, insulin resistance, hyperglycemia, hyperlipidemia. Particular attention is paid to the issues of dietetic complex intervention and the influence of various nutrition components on the state of the cardiovascular system and the liver.
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1. Xin X, Linlin L, Quanyong D et al. Research advances in the relationship between nonalcoholic fatty liver disease and atherosclerosis. Lipids Health Dis 2015; 14: 158. DOI: 10.1186/s12944-015-0141-z
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.
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]
12. Diagnostika i lechenie nealkogol'noi zhirovoi bolezni pecheni. Pod red. V.T.Ivashkina. M.: ROPIP, 2015. [in Russian]
13. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol 2016; 64 (6): 1388–402.
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.
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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
________________________________________________
R.A.Eganyan
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