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Современные аспекты лечения пациентов с неалкогольной жировой болезнью печени
Современные аспекты лечения пациентов с неалкогольной жировой болезнью печени
Дичева Д.Т., Кузнецова Е.И. Современные аспекты лечения пациентов с неалкогольной жировой болезнью печени. Consilium Medicum. 2018; 20 (8): 20–23. DOI: 10.26442/2075-1753_2018.8.20-23
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Аннотация
В обзорной статье раскрываются принципы терапии пациентов с неалкогольной жировой болезнью печени (НАЖБП). Подчеркивается, что основой лечения данного заболевания является модификация образа жизни и диеты. Анализируются современные методы фармакотерапии НАЖБП.
Ключевые слова: неалкогольная жировая болезнь печени, лечение.
Ключевые слова: неалкогольная жировая болезнь печени, лечение.
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The review article presents the principles of patients with nonalcoholic fatty liver disease (NAFLD) treatment. It is outlined that lifestyle and diet modification are the basis for the disease treatment. Modern methods of NAFLD pharmacotherapy are analysed.
Key words: nonalcoholic fatty liver disease, treatment.
Key words: nonalcoholic fatty liver disease, treatment.
Полный текст
Список литературы
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6. Андреев Д.Н., Дичева Д.Т., Кузнецова Е.И., Маев И.В. Неалкогольная жировая болезнь печени: лечение с позиций доказательной медицины. Лечащий врач. 2017; 2. / Andreev D.N., Dicheva D.T., Kuznetsova E.I., Maev I.V. Nealkogol'naia zhirovaia bolezn' pecheni: lechenie s pozitsii dokazatel'noi meditsiny. Lechashchii vrach. 2017; 2. [in Russian]
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8. Marik PE, Varon J. Omega-3 supplements and the risk of cardiovascular events: A systematic review. Clin Card 2009; 32: 365–72.
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10. Wijarnpreecha K, Thongprayoon C, Ungprasert P. Coffee consumption and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016. [Epub ahead of print]
11. Ouyang X, Cirillo P, Sautin Y et al. Fructose consumption as a risk factor for nonalcoholic fatty liver disease. J Hepatol 2008; 48: 993–9.
12. Nair S, Diehl AM, Wiseman M et al. Metformin in the treatment of non-alcoholic steatohepatitis: a pilot open label trial. Aliment Pharmacol Ther 2004; 20: 23–8.
13. Haukeland JW, Konopski Z, Eggesbo HB et al. Metformin in patients with nonalcoholic fatty liver disease: A randomized, controlled trial. Scand J Gastroenterol 2009; 44: 853–60.
14. Aithal GP, Thomas JA, Kaye PV et al. Randomized, placebo controlled trial of pioglitazone in nondiabetic subjects with nonalcoholic steatohepatitis. Gastroenterology 2008; 135: 1176–84.
15. Cusi K, Orsak B, Bril F et al. Long-Term Pioglitazone Treatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus: A Randomized Trial. Ann Intern Med 2016; 165 (5): 305–15.
16. Belfort R, Harrison SA, Brown K et al. A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med 2006; 355: 2297–307.
17. Mas N, Tasci I, Comert B et al. Ursodeoxycholic acid treatment improves hepatocyte ultrastructure in rat liver fibrosis. World J Gastroenterol 2008; 14 (7): 1108–11.
18. Морозов С.В., Кучерявый Ю.А. Гепатопротекторы в клинической практике: рациональные аспекты использования. Пособие для врачей. М.: 4ТЕ Арт, 2011. / Morozov S.V., Kucheriavyi Iu.A. Gepatoprotektory v klinicheskoi praktike: ratsional'nye aspekty ispol'zovaniia. Posobie dlia vrachei. M.: 4TE Art, 2011. [in Russian]
19. Маев И.В., Кучерявый Ю.А., Морозов С.В. и др. Эффективность и переносимость урсодезоксихолиевой кислоты в качестве монотерапии и в комбинации с лактулозой у больных неалкогольным стеатогепатитом. Клин. перспективы гастроэнтерологии, гепатологии. 2012; 2: 3–12. / Maev I.V., Kucheriavyi Iu.A., Morozov S.V. i dr. Effektivnost' i perenosimost' ursodezoksikholievoi kisloty v kachestve monoterapii i v kombinatsii s laktulozoi u bol'nykh nealkogol'nym steatogepatitom. Klin. perspektivy gastroenterologii, gepatologii. 2012; 2: 3–12. [in Russian]
20. Amaral JD, Viana RJ, Ramalho RM et al. Bile acids: regulation of apoptosis by ursodeoxycholic acid. J Lipid Res 2009; 50 (9): 1721–34.
21. Lukivskaya O, Zavodnik L, Knas M, Buko V. Antioxidant mechanism of hepatoprotection by ursodeoxycholic acid in experimental alcoholic steatohepatitis. Adv Med Sci 2006; 51: 54–9.
22. Xiang Z, Chen YP, Ma KF et al. The role of ursodeoxycholic acid in non-alcoholic steatohepatitis: a systematic review. BMC Gastroenterol 2013; 13: 140.
23. Neuschwander-Tetri BA, Loomba R, Sanyal AJ et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015; 385 (9972): 956–65.
24. Марцевич С.Ю. Комбинированная гиполипидемическая терапия у пациентов с сердечно-сосудистыми заболеваниями и патологией печени. Исследование РАКУРС. Эффективная фармакотерапия. Гастроэнтерология. 2015; 4 (51). / Martsevich S.Iu. Kombinirovannaia gipolipidemicheskaia terapiia u patsientov s serdechno-sosudistymi zabolevaniiami i patologiei pecheni. Issledovanie RAKURS. Effektivnaia farmakoterapiia. Gastroenterologiia. 2015; 4 (51). [in Russian]
25. Ozel Coskin BD, Yucesov M, Gursoy S et al. Effects of ursodeoxycholic acid therapy on carotid intima media thickness, apolipoprotein A1, apolipoprotein B, and apolipoprotein B/A1 ratio in nonalcoholic steatohepatitis. J Gastroenterol Hepatol 2015; 27 (2): 142–9.
26. Ratziu V. Treatment of NASH with ursodeoxycholic acid: pro. Clin Res Hepatol Gastroenterol 2012; 36 (Suppl. 1): S41–5.
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1. Torres DM, Harrison SA. Nonalcoholic Fatty Liver Disease. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. Ed. M.Feldman, L.S.Friedman, L.J.Brandt. 10th ed. 2015.
2. 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.
3. 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. RZhGGK. 2015; 6: 31–41. [in Russian]
4. Shchekina M.I. Nealkogol'naia zhirovaia bolezn' pecheni. Consilium Medicum. 2009; 11 (8): 37–9. [in Russian]
5. Maev I.V., Andreev D.N., Dicheva D.T., Kuznetsova E.I. Nealkogol'naia zhirovaia bolezn' pecheni: posobie dlia vrachei, 2017. [in Russian]
6. Andreev D.N., Dicheva D.T., Kuznetsova E.I., Maev I.V. Nealkogol'naia zhirovaia bolezn' pecheni: lechenie s pozitsii dokazatel'noi meditsiny. Lechashchii vrach. 2017; 2. [in Russian]
7. 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. RZhGGK. 2016; 2. [in Russian]
8. Marik PE, Varon J. Omega-3 supplements and the risk of cardiovascular events: A systematic review. Clin Card 2009; 32: 365–72.
9. Zelber-Sagi S, Salomone F, Webb M et al. Coffee consumption and nonalcoholic fatty liver onset: a prospective study in the general population. Transl Res 2015; 165 (3): 428–36.
10. Wijarnpreecha K, Thongprayoon C, Ungprasert P. Coffee consumption and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016. [Epub ahead of print]
11. Ouyang X, Cirillo P, Sautin Y et al. Fructose consumption as a risk factor for nonalcoholic fatty liver disease. J Hepatol 2008; 48: 993–9.
12. Nair S, Diehl AM, Wiseman M et al. Metformin in the treatment of non-alcoholic steatohepatitis: a pilot open label trial. Aliment Pharmacol Ther 2004; 20: 23–8.
13. Haukeland JW, Konopski Z, Eggesbo HB et al. Metformin in patients with nonalcoholic fatty liver disease: A randomized, controlled trial. Scand J Gastroenterol 2009; 44: 853–60.
14. Aithal GP, Thomas JA, Kaye PV et al. Randomized, placebo controlled trial of pioglitazone in nondiabetic subjects with nonalcoholic steatohepatitis. Gastroenterology 2008; 135: 1176–84.
15. Cusi K, Orsak B, Bril F et al. Long-Term Pioglitazone Treatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus: A Randomized Trial. Ann Intern Med 2016; 165 (5): 305–15.
16. Belfort R, Harrison SA, Brown K et al. A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med 2006; 355: 2297–307.
17. Mas N, Tasci I, Comert B et al. Ursodeoxycholic acid treatment improves hepatocyte ultrastructure in rat liver fibrosis. World J Gastroenterol 2008; 14 (7): 1108–11.
18. Morozov S.V., Kucheriavyi Iu.A. Gepatoprotektory v klinicheskoi praktike: ratsional'nye aspekty ispol'zovaniia. Posobie dlia vrachei. M.: 4TE Art, 2011. [in Russian]
19. Maev I.V., Kucheriavyi Iu.A., Morozov S.V. i dr. Effektivnost' i perenosimost' ursodezoksikholievoi kisloty v kachestve monoterapii i v kombinatsii s laktulozoi u bol'nykh nealkogol'nym steatogepatitom. Klin. perspektivy gastroenterologii, gepatologii. 2012; 2: 3–12. [in Russian]
20. Amaral JD, Viana RJ, Ramalho RM et al. Bile acids: regulation of apoptosis by ursodeoxycholic acid. J Lipid Res 2009; 50 (9): 1721–34.
21. Lukivskaya O, Zavodnik L, Knas M, Buko V. Antioxidant mechanism of hepatoprotection by ursodeoxycholic acid in experimental alcoholic steatohepatitis. Adv Med Sci 2006; 51: 54–9.
22. Xiang Z, Chen YP, Ma KF et al. The role of ursodeoxycholic acid in non-alcoholic steatohepatitis: a systematic review. BMC Gastroenterol 2013; 13: 140.
23. Neuschwander-Tetri BA, Loomba R, Sanyal AJ et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015; 385 (9972): 956–65.
24. Martsevich S.Iu. Kombinirovannaia gipolipidemicheskaia terapiia u patsientov s serdechno-sosudistymi zabolevaniiami i patologiei pecheni. Issledovanie RAKURS. Effektivnaia farmakoterapiia. Gastroenterologiia. 2015; 4 (51). [in Russian]
25. Ozel Coskin BD, Yucesov M, Gursoy S et al. Effects of ursodeoxycholic acid therapy on carotid intima media thickness, apolipoprotein A1, apolipoprotein B, and apolipoprotein B/A1 ratio in nonalcoholic steatohepatitis. J Gastroenterol Hepatol 2015; 27 (2): 142–9.
26. Ratziu V. Treatment of NASH with ursodeoxycholic acid: pro. Clin Res Hepatol Gastroenterol 2012; 36 (Suppl. 1): S41–5.
2. 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.
3. 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. RZhGGK. 2015; 6: 31–41. [in Russian]
4. Shchekina M.I. Nealkogol'naia zhirovaia bolezn' pecheni. Consilium Medicum. 2009; 11 (8): 37–9. [in Russian]
5. Maev I.V., Andreev D.N., Dicheva D.T., Kuznetsova E.I. Nealkogol'naia zhirovaia bolezn' pecheni: posobie dlia vrachei, 2017. [in Russian]
6. Andreev D.N., Dicheva D.T., Kuznetsova E.I., Maev I.V. Nealkogol'naia zhirovaia bolezn' pecheni: lechenie s pozitsii dokazatel'noi meditsiny. Lechashchii vrach. 2017; 2. [in Russian]
7. 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. RZhGGK. 2016; 2. [in Russian]
8. Marik PE, Varon J. Omega-3 supplements and the risk of cardiovascular events: A systematic review. Clin Card 2009; 32: 365–72.
9. Zelber-Sagi S, Salomone F, Webb M et al. Coffee consumption and nonalcoholic fatty liver onset: a prospective study in the general population. Transl Res 2015; 165 (3): 428–36.
10. Wijarnpreecha K, Thongprayoon C, Ungprasert P. Coffee consumption and risk of nonalcoholic fatty liver disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016. [Epub ahead of print]
11. Ouyang X, Cirillo P, Sautin Y et al. Fructose consumption as a risk factor for nonalcoholic fatty liver disease. J Hepatol 2008; 48: 993–9.
12. Nair S, Diehl AM, Wiseman M et al. Metformin in the treatment of non-alcoholic steatohepatitis: a pilot open label trial. Aliment Pharmacol Ther 2004; 20: 23–8.
13. Haukeland JW, Konopski Z, Eggesbo HB et al. Metformin in patients with nonalcoholic fatty liver disease: A randomized, controlled trial. Scand J Gastroenterol 2009; 44: 853–60.
14. Aithal GP, Thomas JA, Kaye PV et al. Randomized, placebo controlled trial of pioglitazone in nondiabetic subjects with nonalcoholic steatohepatitis. Gastroenterology 2008; 135: 1176–84.
15. Cusi K, Orsak B, Bril F et al. Long-Term Pioglitazone Treatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus: A Randomized Trial. Ann Intern Med 2016; 165 (5): 305–15.
16. Belfort R, Harrison SA, Brown K et al. A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med 2006; 355: 2297–307.
17. Mas N, Tasci I, Comert B et al. Ursodeoxycholic acid treatment improves hepatocyte ultrastructure in rat liver fibrosis. World J Gastroenterol 2008; 14 (7): 1108–11.
18. Morozov S.V., Kucheriavyi Iu.A. Gepatoprotektory v klinicheskoi praktike: ratsional'nye aspekty ispol'zovaniia. Posobie dlia vrachei. M.: 4TE Art, 2011. [in Russian]
19. Maev I.V., Kucheriavyi Iu.A., Morozov S.V. i dr. Effektivnost' i perenosimost' ursodezoksikholievoi kisloty v kachestve monoterapii i v kombinatsii s laktulozoi u bol'nykh nealkogol'nym steatogepatitom. Klin. perspektivy gastroenterologii, gepatologii. 2012; 2: 3–12. [in Russian]
20. Amaral JD, Viana RJ, Ramalho RM et al. Bile acids: regulation of apoptosis by ursodeoxycholic acid. J Lipid Res 2009; 50 (9): 1721–34.
21. Lukivskaya O, Zavodnik L, Knas M, Buko V. Antioxidant mechanism of hepatoprotection by ursodeoxycholic acid in experimental alcoholic steatohepatitis. Adv Med Sci 2006; 51: 54–9.
22. Xiang Z, Chen YP, Ma KF et al. The role of ursodeoxycholic acid in non-alcoholic steatohepatitis: a systematic review. BMC Gastroenterol 2013; 13: 140.
23. Neuschwander-Tetri BA, Loomba R, Sanyal AJ et al. Farnesoid X nuclear receptor ligand obeticholic acid for non-cirrhotic, non-alcoholic steatohepatitis (FLINT): a multicentre, randomised, placebo-controlled trial. Lancet 2015; 385 (9972): 956–65.
24. Martsevich S.Iu. Kombinirovannaia gipolipidemicheskaia terapiia u patsientov s serdechno-sosudistymi zabolevaniiami i patologiei pecheni. Issledovanie RAKURS. Effektivnaia farmakoterapiia. Gastroenterologiia. 2015; 4 (51). [in Russian]
25. Ozel Coskin BD, Yucesov M, Gursoy S et al. Effects of ursodeoxycholic acid therapy on carotid intima media thickness, apolipoprotein A1, apolipoprotein B, and apolipoprotein B/A1 ratio in nonalcoholic steatohepatitis. J Gastroenterol Hepatol 2015; 27 (2): 142–9.
26. Ratziu V. Treatment of NASH with ursodeoxycholic acid: pro. Clin Res Hepatol Gastroenterol 2012; 36 (Suppl. 1): S41–5.
Авторы
Д.Т.Дичева*, Е.И.Кузнецова
ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*Di.di4eva@yandex.ru
ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России. 127473, Россия, Москва, ул. Делегатская, д. 20, стр. 1
*Di.di4eva@yandex.ru
________________________________________________
D.T.Dicheva*, E.I.Kuznetsova
A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
*Di.di4eva@yandex.ru
A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1
*Di.di4eva@yandex.ru
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