Термин «стеатогепатит» (СГ) применяется для гетерогенной группы заболеваний различной этиологии, характеризующихся сходной морфологической картиной. Ранее диагноз неалкогольной жировой болезни печени подразумевал исключение других причин СГ, в последние годы предполагается возможность комбинации различных этиологических вариантов СГ. В обзоре рассмотрены терминологические, эпидемиологические и патогенетические аспекты наиболее частого сочетания – метаболического и алкогольного генеза, вопросы взаимного влияния этиопатогенетических факторов и выявления преобладающего процесса. Подробно обсуждаются вопросы существующей и перспективной патогенетической и симптоматической терапии. Основой лечения СГ является устранение известных причинных факторов и модификация образа жизни, в терапии в настоящее время следует использовать препараты, доказавшие эффективность при отдельных вариантах СГ, и симптоматическую терапию.
The term "steatohepatitis" is used for a heterogeneous group of diseases of various etiologies, characterized by a similar morphological picture. Earlier the diagnosis of non-alcoholic fatty liver disease implied the exclusion of other causes of steatohepatitis, in recent years it has been suggested that a combination of various etiological variants of steatohepatitis is possible. The review considers the terminological, epidemiological and pathogenetic aspects of the most common combination: metabolic and alcoholic genesis, the issues of the mutual influence of etiopathogenetic factors and the identification of the predominant process. Issues of existing and prospective pathogenetic and symptomatic therapy are discussed in detail. Treatment of steatohepatitis is based on the elimination of known causal factors and lifestyle modification; therapy includes medications, that have been proven to be effective in certain types of steatohepatitis and symptomatic therapy as well.
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1. EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-402. doi: 10.1016/j.jhep.2015.11.004
2. Pimpin L, Cortez-Pinto H, Negro F, et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2016;69(3):718-35. doi: 10.1016/j.jhep.2018.05.011
3. Wandji LCN, Gnemmi V, Mathurin P, Louvet A. Combined alcoholic and non-alcoholic steatohepatitis. JHEP Reports.2020;2(3):100101. doi: 10.1016/j.jhepr.2020.100101
4. Francque S, Vonghia L. Pharmacological Treatment for Non-alcoholic Fatty Liver Disease. Adv Ther. 2019;36:1052-74. doi: 10.1007/s12325-019-00898-6
5. 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. doi: 10.1002/hep.28431
6. Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980;55:434-8.
7. Powell EE, Cooksley WG, Hanson R, et al. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology. 1990;11:74-80.
8. Eslam M, Sanya AJ, George J. MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020;158(7):1999-2014. doi: 10.1053/j.gastro.2019.11.312
9. Becker U, Deis A, Sorensen TI, et al. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study. Hepatology. 1996;23(5):1025-29. doi: 10.1002/hep.510230513
10. Boyle M, Masson S, Anstee QM. The bidirectional impacts of alcohol consumption and the metabolic syndrome: Cofactors for progressive fatty liver disease. J Hepatol. 2018;68(2):251-67. doi: 10.1016/j.jhep.2017.11.006
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Авторы
К.Л. Райхельсон, Э.А. Кондрашина, Е.В. Пазенко
Научно-клинический и образовательный центр гастроэнтерологии и гепатологии ФГБОУ ВО «Санкт-Петербургский государственный университет», Санкт-Петербург, Россия
________________________________________________
K.L. Raikhelson, E.A. Kondrashina, E.V. Pazenko
Scientific, Clinical and Educational Center of Gastroenterology and Hepatology, Saint Petersburg State University, Saint Petersburg, Russia