Неалкогольная жировая болезнь печени (НАЖБП) является одним из самых распространенных хронических заболеваний печени среди взрослого трудоспособного населения индустриально развитых стран. Установлено, что у пациентов с НАЖБП распространенность сердечно-сосудистых заболеваний и смертность от них выше, чем у больных, не имеющих ее, вне зависимости от наличия других традиционных факторов риска. В данной статье подробно рассмотрены такие возможные патогенетические механизмы формирования кардиоваскулярных рисков у пациентов с НАЖБП, как инсулинорезистентность, субклиническое воспаление, оксидативный дистресс, эндотелиальная дисфункция и нарушение секреции адипоцитокинов.
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease among the adult working-age population of industrialized countries. Patients with NAFLD have a high prevalence of cardiovascular diseases and mortality from them independently on the presence of other traditional risk factors. This article discusses in detail the possible pathogenetic mechanisms of cardiovascular risk formation in patients with NAFLD – insulin resistance, subclinical inflammation, oxidative distress, endothelial dysfunction and impaired adipocytokine secretion.
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33. Bonci E, Chiesa C, Versacci P et al. Association of Nonalcoholic Fatty Liver Disease with Subclinical Cardiovascular Changes: A Systematic Review and Meta-Analysis. Biomed Res Int 2015; 2015: 213737.
34. Sunbul M, Agirbasli M, Durmus E et al. Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness. Atherosclerosis 2014; 237 (2): 490–3.
35. Petta S, Argano C, Colomba D et al. Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: association with severity of liver disease. J Hepatology 2015; 62 (4): 928–33.
36. Alp H, Karaarslan S, Selver Eklioglu B et al. Association between nonalcoholic fatty liver disease and cardiovascular risk in obese children and adolescents. Can J Cardiol 2013; 29 (9): 1118–25.
37. Fracanzani AL, Pisano G, Consonni D et al. Epicardial Adipose Tissue (EAT) Thickness Is Associated with Cardiovascular and Liver Damage in Nonalcoholic Fatty Liver Disease. PLoS ONE 2016; 11 (9): e0162473.
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1. Neuschwander-Tetri B.A. Non-alcoholic fatty liver disease. BMC Med 2017; 14 (1): 45.
2. Demir M, Lang S, Steffen HM. Nonalcoholic fatty liver disease – current status and future directions. J Dig Dis 2015; 16 (10): 541–7.
3. World Health Organization. Obesity and overweight (2015). http://www.who.int/mediacentre/factsheets/fs311/en/
4. Gaus O.V., Akhmedov V.A. Vliianie metabolicheskogo sindroma na sostoianie parenkhimy pecheni i biliarnoi sistemy u patsientov s zhelchnokamennoi bolezn'iu. Ural. med. zhurn. 2015; 1 (124): 132–7 (in Russian).
5. Diagnostika i lechenie nealkogol'noi zhirovoi bolezni pecheni: metodicheskie rekomendatsii dlia vrachei Rossiiskogo obshchestva po izucheniiu pecheni. Pod red. V.T.Ivashkina. Moscow: MEDpress-inform, 2015 (in Russian).
6. Adams LA, Anstee QM, Tilg H, Targher G. Non‐alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut 2017; 66: 1138–53.
7. Ivashkin V.T., Drapkina O.M., Maev I.V. et al. Rasprostranennost' nealkogol'noĭ zhirovoĭ bolezni pecheni u patsientov v ambulatorno-poliklinicheskoi praktike v Rossiiskoi Federatsii: rezul'taty issledovaniia DIREG 2. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2015; 25 (6): 31–41 (in Russian).
8. Maev I.V., Kuznetsova E.I., Andreev D.N., Dicheva D.T. Current and future approaches to the diagnosis of non-alcoholic fatty liver disease. Consilium Medicum. 2015; 17 (8): 20–7 (in Russian).
9. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol 2015; 62 (1): S47–64.
10. Gaus O.V., Akhmedov V.A. Tkanevoi ingibitor matriksnykh metalloproteinaz-1 kak indikator progressiruiushchego techeniia nealkogol'noi zhirovoi bolezni pecheni u bol'nykh s metabolicheskim sindromom. Eksperim. i klin. gastroenterologiia. 2016; 7 (131): 32–7 (in Russian).
11. Livzan M.A., Akhmedov V.A., Krolevets T.S. et al. Informativnost' neinvazivnykh markerov fibroza pecheni u patsientov s nealkogol'noi zhirovoi bolezn'iu pecheni. Therapeutic Аrchive. 2016; 88 (12): 62–8 (in Russian).
12. Yopp AC, Choti MA. Non-Alcoholic Steatohepatitis-Related Hepatocellular Carcinoma: A Growing Epidemic. Dig Dis 2015; 33 (5): 642–7.
13. Wong RJ et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology 2015; 148 (3): 547–55.
14. Perumpail RB. Pathogenesis of hepatocarcinogenesis in non-cirrhotic nonalcoholic fatty liver disease: Potential mechanistic pathways. World J Hepatol 2015; 7 (22): 2384–8.
15. Rahman R et al. Primary hepatocellular carcinoma and metabolic syndrome: an update. World J Gastrointest Oncol 2013; 5 (9): 186–94.
16. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA 2015; 313 (22): 2263–73.
17. Targher G, Byrne CD, Lonardo A et al. Non‐alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta‐analysis. J Hepatol 2016; 65: 589–600.
18. Drapkina O.M., Iafarova A.A. Nealkogol'naia zhirovaia bolezn' pecheni i serdechno-sosudistyi risk: sostoianie problemy. Ratsional'naia farmakoterapiia v kardiologii. 2017; 13 (5): 645–50 (in Russian).
19. Liu J, Han L, Zhu L, Yu Y. Free fatty acids, not triglycerides, are associated with non-alcoholic liver injury progression in high fat diet induced obese rats. Lipids Health Dis 2016; 15 (1): 27.
20. Wang PX et al. Hepatocyte TRAF3 promotes liver steatosis and systemic insulin resistance through targeting TAK1-dependent signaling. Nat Commun 2016; 7: 1–30.
21. Komshilova K.A., Troshina E.A. Ozhirenie i nealkogol'naia zhirovaia bolezn' pecheni: metabolicheskie riski i ikh korrektsiia. Ozhirenie i metabolizm. 2015; 2 (12): 35–9 (in Russian).
22. Dunaieva I et al. Adiponectin and a violation of metabolic control at different stages of nonalcoholic fatty liver disease in patients with type 2 diabetes. Georgian Med News 2016; 250: 40–6.
23. Osegbe I, Okpara E, Azinge E. Relationship between serum leptin and insulin resistance among obese Nigerian women. Ann Afr Med 2016; 15 (1): 14–9.
24. Ghantous CM et al. Differential Role of Leptin and Adiponectin in Cardiovascular System. Int J Endocrinol 2015; 2015: 1–13.
25. Sutton AK, Myers Jr, Olson DP. The Role of PVH Circuits in Leptin Action and Energy Balance. Ann Rev Physiol 2016; 78: 207–21.
26. Tilg H, Diehl A, Li Z et al. Cytokines and pathogenesis of nonalcoholic steatohepatitis. Gut 2005; 54: 303–6.
27. Xu X, Lu L, Dong Q et al. Research advances in the relationship between nonalcoholic fatty liver disease and atherosclerosis. Lipids Health Dis 2015; 14: 158.
28. Gencer B. et al. Association between resistin levels and cardiovascular disease events in older adults: The health, aging and body composition study. Atherosclerosis 2016; 245: 181–6.
29. Yun MR, Seo JM, Park HY. Visfatin contributes to the differentiation of monocytes into macrophages through the differential regulation of inflammatory cytokines in THP-1 cells. Cell Signal 2014; 26 (4): 705–15.
30. Waluga M et al. Visfatin and TGF-B1 in primary biliary cirrhosis and two other common liver diseases. Folia Med Cracov 2015; 55 (4): 59–70.
31. Jung UJ, Choi MS. Obesity and its metabolic complications: the role of adipokines and the relationship between obesity, inflammation, insulin resistance, dyslipidemia and nonalcoholic fatty liver disease. Int J Mol Sci 2014; 15 (4): 6184–223.
32. Bays HE et al. National Lipid Association Annual Summary of Clinical Lipidology 2016. J Clin Lipidol 2016; 10( 1): S1–S43.
33. Bonci E, Chiesa C, Versacci P et al. Association of Nonalcoholic Fatty Liver Disease with Subclinical Cardiovascular Changes: A Systematic Review and Meta-Analysis. Biomed Res Int 2015; 2015: 213737.
34. Sunbul M, Agirbasli M, Durmus E et al. Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness. Atherosclerosis 2014; 237 (2): 490–3.
35. Petta S, Argano C, Colomba D et al. Epicardial fat, cardiac geometry and cardiac function in patients with non-alcoholic fatty liver disease: association with severity of liver disease. J Hepatology 2015; 62 (4): 928–33.
36. Alp H, Karaarslan S, Selver Eklioglu B et al. Association between nonalcoholic fatty liver disease and cardiovascular risk in obese children and adolescents. Can J Cardiol 2013; 29 (9): 1118–25.
37. Fracanzani AL, Pisano G, Consonni D et al. Epicardial Adipose Tissue (EAT) Thickness Is Associated with Cardiovascular and Liver Damage in Nonalcoholic Fatty Liver Disease. PLoS ONE 2016; 11 (9): e0162473.
Авторы
М.А. Ливзан, О.В. Гаус, Н.А. Николаев
ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России, Омск, Россия