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«Печеночный экспресс»: диагностика и лечение болезней печени в общей практике
Вялов С.С. «Печеночный экспресс»: диагностика и лечение болезней печени в общей практике. Справочник поликлинического врача. 2018; 1: 44–50.
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Vyalov S.S. "Hepatic express": diagnosis and treatment of liver diseases in general practice. Handbook for Practitioners Doctors. 2018; 1: 44–50.
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Аннотация
В статье приводится обзор современного подхода к диагностике и лечению болезней печени в общей практике. Анализируются диагностические возможности и спектр заболеваний на амбулаторно-поликлиническом этапе оказания медицинской помощи. Приводятся диагностические критерии основных заболеваний, даются общие подходы и алгоритмы стартовой терапии.
Ключевые слова: синдром цитолиза, синдром холестаза, жировая болезнь печени, лекарственный гепатит, токсический гепатит, алкогольная болезнь печени, синдром Жильбера.
Ключевые слова: синдром цитолиза, синдром холестаза, жировая болезнь печени, лекарственный гепатит, токсический гепатит, алкогольная болезнь печени, синдром Жильбера.
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The article gives an overview of the modern approach to the diagnosis and treatment of liver diseases in general practice. Diagnostic possibilities and a spectrum of diseases at an out-patient-polyclinic stage of rendering of medical aid are analyzed. Diagnostic criteria of the main diseases are given, general approaches and algorithms of starting therapy are given.
Key words: cytolysis syndrome, cholestasis syndrome, fatty liver disease, drug hepatitis, toxic hepatitis, alcoholic liver disease, Gilbert syndrome.
Полный текст
Список литературы
1. Вялов С.С. Алкогольные поражения печени: синдром цитолиза, тактика и лечение. Справочник поликлинического врача. 2012; 4: 62–7. / Vialov S.S. Alkogol'nye porazheniia pecheni: sindrom tsitoliza, taktika i lechenie. Handbook for Practitioners Doctors. 2012; 4: 62–7. [in Russian]
2. Вялов С.С. Жировая болезнь печени: особенности патогенеза, диагностика и терапевтический потенциал. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2014; 8: 72–7. / Vialov S.S. Zhirovaia bolezn' pecheni: osobennosti patogeneza, diagnostika i terapevticheskii potentsial. Gastroenterology (Suppl. Consilium Medicum). 2014; 8: 72–7. [in Russian]
3. Вялов С.С. Неалкогольная жировая болезнь печени как компонент метаболического синдрома: жировая печень и атеросклероз. Consilium Medicum. 2012; 14 (5): 41–5. / Vialov S.S. Nealkogol'naia zhirovaia bolezn' pecheni kak komponent metabolicheskogo sindroma: zhirovaia pechen' i ateroskleroz. Consilium Medicum. 2012; 14 (5): 41–5. [in Russian]
4. Вялов С.С. Синдром холестаза: тактика диагностики и ведения пациентов. Эффективная фармакотер. в гастроэнтерологии. 2012; 6: 10–5. / Vialov S.S. Sindrom kholestaza: taktika diagnostiki i vedeniia patsientov. Effektivnaia farmakoter. v gastroenterologii. 2012; 6: 10–5. [in Russian]
5. Вялов С.С. Синдром цитолиза в гастроэнтерологии: тактика ведения пациентов в общей практике. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2013; 1: 42–8. / Vialov S.S. Sindrom tsitoliza v gastroenterologii: taktika vedeniia patsientov v obshchei praktike. Gastroenterology (Suppl. Consilium Medicum). 2013; 1: 42–8. [in Russian]
6. Вялов С.С. Скрининговые методы выявления фиброза печени. Архив внутренней медицины. 2012; 3: 48–57. / Vialov S.S. Skriningovye metody vyiavleniia fibroza pecheni. Arkhiv vnutrennei meditsiny. 2012; 3: 48–57. [in Russian]
7. Вялов С.С. Стеатогепатиты и НАЖБП: тактика лечения на поликлиническом этапе. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2012; 1: 100–5. / Vialov S.S. Steatogepatity i NAZhBP: taktika lecheniia na poliklinicheskom etape. Gastroenterology (Suppl. Consilium Medicum). 2012; 1: 100–5. [in Russian]
8. Вялов С.С., Широких А.В. Алкогольный стеатоз и хронический алкогольный гепатит: особенности патогенеза и тактика лечения. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2013; 1: 21–7. / Vialov S.S., Shirokikh A.V. Alkogol'nyi steatoz i khronicheskii alkogol'nyi gepatit: osobennosti patogeneza i taktika lecheniia. Gastroenterology (Suppl. Consilium Medicum). 2013; 1: 21–7. [in Russian]
9. Bjornsson ES, Jonasson JG. Drug-induced cholestasis. Clin Liver Dis 2013; 17: 191.
10. Chalasani N, Younossi Z, Lavine JE et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142: 1592.
11. Chang CY, Schiano TD. Review article: drug hepatotoxicity. Aliment Pharmacol Ther 2007; 25: 1135.
12. Daniel S, Ben-Menachem T, Vasudevan G et al. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 1999; 94: 3010.
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: 1388.
14. European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol 2012; 57: 399.
15. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J Hepatol 2017; 67: 145.
16. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015; 63: 971.
17. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017; 112: 18.
18. Lindor KD, Kowdley KV, Harrison ME, American College of Gastroenterology. ACG Clinical Guideline: Primary Sclerosing Cholangitis. Am J Gastroenterol 2015; 110: 646.
19. McCullough AJ. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis 2004; 8: 521.
20. Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 2000; 342: 1266.
21. Schwenzer NF, Springer F, Schraml C et al. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol 2009; 51: 433.
22. Watson KJ, Gollan JL. Gilbert's syndrome. Baillieres Clin Gastroenterol 1989; 3: 337.
2. Вялов С.С. Жировая болезнь печени: особенности патогенеза, диагностика и терапевтический потенциал. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2014; 8: 72–7. / Vialov S.S. Zhirovaia bolezn' pecheni: osobennosti patogeneza, diagnostika i terapevticheskii potentsial. Gastroenterology (Suppl. Consilium Medicum). 2014; 8: 72–7. [in Russian]
3. Вялов С.С. Неалкогольная жировая болезнь печени как компонент метаболического синдрома: жировая печень и атеросклероз. Consilium Medicum. 2012; 14 (5): 41–5. / Vialov S.S. Nealkogol'naia zhirovaia bolezn' pecheni kak komponent metabolicheskogo sindroma: zhirovaia pechen' i ateroskleroz. Consilium Medicum. 2012; 14 (5): 41–5. [in Russian]
4. Вялов С.С. Синдром холестаза: тактика диагностики и ведения пациентов. Эффективная фармакотер. в гастроэнтерологии. 2012; 6: 10–5. / Vialov S.S. Sindrom kholestaza: taktika diagnostiki i vedeniia patsientov. Effektivnaia farmakoter. v gastroenterologii. 2012; 6: 10–5. [in Russian]
5. Вялов С.С. Синдром цитолиза в гастроэнтерологии: тактика ведения пациентов в общей практике. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2013; 1: 42–8. / Vialov S.S. Sindrom tsitoliza v gastroenterologii: taktika vedeniia patsientov v obshchei praktike. Gastroenterology (Suppl. Consilium Medicum). 2013; 1: 42–8. [in Russian]
6. Вялов С.С. Скрининговые методы выявления фиброза печени. Архив внутренней медицины. 2012; 3: 48–57. / Vialov S.S. Skriningovye metody vyiavleniia fibroza pecheni. Arkhiv vnutrennei meditsiny. 2012; 3: 48–57. [in Russian]
7. Вялов С.С. Стеатогепатиты и НАЖБП: тактика лечения на поликлиническом этапе. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2012; 1: 100–5. / Vialov S.S. Steatogepatity i NAZhBP: taktika lecheniia na poliklinicheskom etape. Gastroenterology (Suppl. Consilium Medicum). 2012; 1: 100–5. [in Russian]
8. Вялов С.С., Широких А.В. Алкогольный стеатоз и хронический алкогольный гепатит: особенности патогенеза и тактика лечения. Гастроэнтерология (Прил. к журн. Consilium Medicum). 2013; 1: 21–7. / Vialov S.S., Shirokikh A.V. Alkogol'nyi steatoz i khronicheskii alkogol'nyi gepatit: osobennosti patogeneza i taktika lecheniia. Gastroenterology (Suppl. Consilium Medicum). 2013; 1: 21–7. [in Russian]
9. Bjornsson ES, Jonasson JG. Drug-induced cholestasis. Clin Liver Dis 2013; 17: 191.
10. Chalasani N, Younossi Z, Lavine JE et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142: 1592.
11. Chang CY, Schiano TD. Review article: drug hepatotoxicity. Aliment Pharmacol Ther 2007; 25: 1135.
12. Daniel S, Ben-Menachem T, Vasudevan G et al. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 1999; 94: 3010.
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: 1388.
14. European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol 2012; 57: 399.
15. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J Hepatol 2017; 67: 145.
16. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015; 63: 971.
17. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017; 112: 18.
18. Lindor KD, Kowdley KV, Harrison ME, American College of Gastroenterology. ACG Clinical Guideline: Primary Sclerosing Cholangitis. Am J Gastroenterol 2015; 110: 646.
19. McCullough AJ. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis 2004; 8: 521.
20. Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 2000; 342: 1266.
21. Schwenzer NF, Springer F, Schraml C et al. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol 2009; 51: 433.
22. Watson KJ, Gollan JL. Gilbert's syndrome. Baillieres Clin Gastroenterol 1989; 3: 337.
________________________________________________
1. Vialov S.S. Alkogol'nye porazheniia pecheni: sindrom tsitoliza, taktika i lechenie. Handbook for Practitioners Doctors. 2012; 4: 62–7. [in Russian]
2. Vialov S.S. Zhirovaia bolezn' pecheni: osobennosti patogeneza, diagnostika i terapevticheskii potentsial. Gastroenterology (Suppl. Consilium Medicum). 2014; 8: 72–7. [in Russian]
3. Vialov S.S. Nealkogol'naia zhirovaia bolezn' pecheni kak komponent metabolicheskogo sindroma: zhirovaia pechen' i ateroskleroz. Consilium Medicum. 2012; 14 (5): 41–5. [in Russian]
4. Vialov S.S. Sindrom kholestaza: taktika diagnostiki i vedeniia patsientov. Effektivnaia farmakoter. v gastroenterologii. 2012; 6: 10–5. [in Russian]
5. Vialov S.S. Sindrom tsitoliza v gastroenterologii: taktika vedeniia patsientov v obshchei praktike. Gastroenterology (Suppl. Consilium Medicum). 2013; 1: 42–8. [in Russian]
6. Vialov S.S. Skriningovye metody vyiavleniia fibroza pecheni. Arkhiv vnutrennei meditsiny. 2012; 3: 48–57. [in Russian]
7. Vialov S.S. Steatogepatity i NAZhBP: taktika lecheniia na poliklinicheskom etape. Gastroenterology (Suppl. Consilium Medicum). 2012; 1: 100–5. [in Russian]
8. Vialov S.S., Shirokikh A.V. Alkogol'nyi steatoz i khronicheskii alkogol'nyi gepatit: osobennosti patogeneza i taktika lecheniia. Gastroenterology (Suppl. Consilium Medicum). 2013; 1: 21–7. [in Russian]
9. Bjornsson ES, Jonasson JG. Drug-induced cholestasis. Clin Liver Dis 2013; 17: 191.
10. Chalasani N, Younossi Z, Lavine JE et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142: 1592.
11. Chang CY, Schiano TD. Review article: drug hepatotoxicity. Aliment Pharmacol Ther 2007; 25: 1135.
12. Daniel S, Ben-Menachem T, Vasudevan G et al. Prospective evaluation of unexplained chronic liver transaminase abnormalities in asymptomatic and symptomatic patients. Am J Gastroenterol 1999; 94: 3010.
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: 1388.
14. European Association for the Study of Liver. EASL clinical practical guidelines: management of alcoholic liver disease. J Hepatol 2012; 57: 399.
15. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J Hepatol 2017; 67: 145.
16. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis. J Hepatol 2015; 63: 971.
17. Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol 2017; 112: 18.
18. Lindor KD, Kowdley KV, Harrison ME, American College of Gastroenterology. ACG Clinical Guideline: Primary Sclerosing Cholangitis. Am J Gastroenterol 2015; 110: 646.
19. McCullough AJ. The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease. Clin Liver Dis 2004; 8: 521.
20. Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med 2000; 342: 1266.
21. Schwenzer NF, Springer F, Schraml C et al. Non-invasive assessment and quantification of liver steatosis by ultrasound, computed tomography and magnetic resonance. J Hepatol 2009; 51: 433.
22. Watson KJ, Gollan JL. Gilbert's syndrome. Baillieres Clin Gastroenterol 1989; 3: 337.
Авторы
С.С.Вялов
ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, Москва, ул. Миклухо-Маклая, д. 8, корп. 1
doctor@vyalov.com
ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, Москва, ул. Миклухо-Маклая, д. 8, корп. 1
doctor@vyalov.com
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S.S.Vyalov
People’s Friendship University of Russia. 117198, Russian Federation, Moscow, ul. Miklukho-Maklaia, d. 8, korp. 1
doctor@vyalov.com
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