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Неалкогольная жировая болезнь печени: аспекты ведения коморбидного пациента
Неалкогольная жировая болезнь печени: аспекты ведения коморбидного пациента
Демидова Т.Ю., Ушанова Ф.О. Неалкогольная жировая болезнь печени: аспекты ведения коморбидного пациента. Терапевтический архив. 2023;95(10):888–895. DOI: 10.26442/00403660.2023.10.202435
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
На фоне стремительного роста распространенности ожирения во всем мире увеличивается частота развития связанных с ним метаболических расстройств. Неалкогольная жировая болезнь печени (НАЖБП) признана основным печеночным проявлением метаболического синдрома. В настоящее время НАЖБП поражает около 25–30% населения мира и в большинстве случаев ассоциирована с ожирением и сахарным диабетом 2-го типа, а также с повышенным сердечно-сосудистым риском. Диагностика НАЖБП включает лабораторные и инструментальные методы исследования, различные неинвазивные тесты, а «золотым стандартом» подтверждения диагноза является биопсия печени. Ввиду большей доступности и достаточной информативности на первый план в обследовании пациентов группы риска выходят ультразвуковые методы исследования. Краеугольным камнем в ведении таких пациентов остается модификация образа жизни, однако, с учетом сложного патогенеза заболевания, лечение НАЖБП может включать несколько терапевтических стратегий. В лечении коморбидных пациентов применяются некоторые группы сахароснижающих препаратов, включая агонисты рецепторов глюкагоноподобного пептида-1, ингибиторы натрий-глюкозного котранспортера-2, пиоглитазон, гиполипидемические препараты, препараты для лечения ожирения. Свою эффективность в снижении повреждения печени за счет антиоксидантного, антифибротического, липидрегулирующего действия продемонстрировали так называемые гепатопротекторы, включая эссенциальные фосфолипиды (ЭФЛ). По данным ряда работ, ЭФЛ способствуют снижению выраженности стеатоза, улучшая как объективные, так и субъективные проявления печеночной дисфункции. В связи с этим руководства различных стран включают препараты группы ЭФЛ в протокол лечения пациентов с НАЖБП как в монотерапии, так и в комбинации с другими препаратами.
Ключевые слова: неалкогольная жировая болезнь печени, метаболически ассоциированная болезнь печени, метаболический синдром, жировой гепатоз, инсулинорезистентность, эссенциальные фосфолипиды
Keywords: non-alcoholic fatty liver disease, metabolically associated liver disease, metabolic syndrome, fatty liver, insulin resistance, essential phospholipids
Ключевые слова: неалкогольная жировая болезнь печени, метаболически ассоциированная болезнь печени, метаболический синдром, жировой гепатоз, инсулинорезистентность, эссенциальные фосфолипиды
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Keywords: non-alcoholic fatty liver disease, metabolically associated liver disease, metabolic syndrome, fatty liver, insulin resistance, essential phospholipids
Полный текст
Список литературы
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DOI:10.1136/gutjnl-2020-322786
12. Eslam M, Sanyal AJ, George J; International Consensus Panel. MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020;158(7):1999-2014.e1. DOI:10.1053/j.gastro.2019.11.312
13. Younossi ZM, Rinella ME, Sanyal AJ, et al. From NAFLD to MAFLD: implications of a premature change in terminology. Hepatology. 2021;73:1194-8. DOI:10.1002/hep.31420
14. Grander С, Grabherr F, Tilg H. Non-alcoholic fatty liver disease: pathophysiological concepts and treatment options. Cardiovasc Res. 2023;119(9):1787-98. DOI:10.1093/cvr/cvad095
15. Duan Y, Pan X, Luo J, et al. Association of inflammatory cytokines with non-alcoholic fatty liver disease. Front Immunol. 2022;13:880298. DOI:10.3389/fimmu.2022.880298
16. Samuel VT, Liu ZX, Qu X, et al. Mechanism of hepatic insulin resistance in non-alcoholic fatty liver disease. J Biol Chem. 2004;279:32345-53. DOI:10.1074/jbc.M313478200
17. Aron-Wisnewsky J, Vigliotti C, Witjes J, et al. Gut microbiota and human NAFLD: disentangling microbial signatures from metabolic disorders. Nat Rev Gastroenterol Hepatol. 2020;17:279-97. DOI:10.1038/s41575-020-0269-9
18. Alferink LJM, Radjabzadeh D, Erler NS, et al. Metagenomics P. And hepatic steatosis in a population-based study of 1,355 adults. Hepatology. 2021;73:968-82. DOI:10.1002/hep.31417
19. Lee G, You HJ, Bajaj JS, et al. Distinct signatures of gut microbiome and metabolites associated with significant fibrosis in non-obese NAFLD. Nat Commun. 2020;11:4982. DOI:10.1038/s41467-020-18754-5
20. Parthasarathy G, Revelo X, Malhi H. Pathogenesis of Nonalcoholic Steatohepatitis: An Overview. Hepatol Communications. 2020;4(4):478‑92. DOI:10.1002/hep4.1479
21. Haas JT, Francque S, Staels B. Pathophysiology and mechanisms of nonalcoholic fatty liver disease. Annu Rev Physiol. 2016;78:181-205.
DOI:10.1146/annurev-physiol021115-105331
22. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328‑57. DOI:10.1002/hep.29367
23. Bril F, Ortiz-Lopez C, Lomonaco R, et al. Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients. Liver Internat. 2015;35:2139-46. DOI:10.1111/liv.12840
24. Xiao G, Zhu S, Xiao X, et al. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis. Hepatology. 2017;66:1486-501. DOI:10.1002/hep.29302
25. Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Gut. 2022;71:1006-19. DOI:10.1136/gutjnl-2021-324243
26. European Association for the Study of the Liver (EASL). Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol. 2021;75(3):659-89. DOI:10.1016/j.jhep.2021.05.025
27. 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;64:1388-402. DOI:10.1016/j.jhep.2015.11.004
28. Ginès P, Castera L, Lammert F, et al. Population screening for liver fibrosis: toward early diagnosis and intervention for chronic liver diseases. Hepatology. 2022;75:219-28. DOI:10.1002/hep.32163
29. Howard BV, Wylie-Rosett J. Sugar and cardiovascular disease: a statement for healthcare professionals from the committee on nutrition of the council on nutrition, physical activity, and metabolism of the American Heart Association. Circulation. 2002;106:523-7. DOI:10.1161/01.cir.0000019552.77778.04
30. Gerber L, Otgonsuren M, Mishra A, et al. Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population-based study. Aliment Pharmacol Ther. 2012;36:772-81. DOI:10.1111/apt.12038
31. 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 Int Med. 2016;165:305-15. DOI:10.7326/M15-1774
32. Kumar J, Memon RS, Shahid I, et al. Antidiabetic drugs and non-alcoholic fatty liver disease: A systematic review, meta-analysis and evidence map. Dig Liver Dis. 2021;53(1):44-51. DOI:10.1016/j.dld.2020.08.021
33. Kuchay MS, Krishan S, Mishra SK, et al. Effect of empagliflozin on liver fat in patients with type 2 diabetes and nonalcoholic fatty liver disease: a randomized controlled trial (E-LIFT trial). Diabetes Care. 2018;41:1801‑8. DOI:10.2337/dc18-0165
34. Mantovani A, Byrne CD, Scorletti E, et al. Efficacy and safety of antihyperglycaemic drugs in patients with non-alcoholic fatty liver disease with or without diabetes: an updated systematic review of randomized controlled trials. Diabetes Metab. 2020;46:427-41. DOI:10.1016/j.diabet.2019
35. Armstrong MJ, Gaunt P, Aithal GP, et al. Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet. 2016;387:679-90. DOI:10.1016/S0140-6736(15)00803-X
36. Newsome PN, Buchholtz K, Cusi K, et al. A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis. N Engl J Med. 2021;384:1113-24. DOI:10.1056/NEJMoa2028395
37. Dedov II, Mokrysheva NG, Mel’nichenko GA, et al. Obesity. Clinical guidelines. Consilium Medicum. 2021;23(4):311-25 (in Russian). DOI:10.26442/20751753.2021.4.200832
38. Chauhan M, Singh K, Thuluvath PJ. Bariatric surgery in NAFLD. Dig Dis Sci. 2022;67:408-22. DOI:10.1007/s10620-021-07317-3
39. Lassailly G, Caiazzo R, Ntandja-Wandji LC, et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis. Gastroenterology. 2020;159:1290-301. DOI:10.1053/j.gastro.2020.06.006
40. Simon TG, Duberg AS, Aleman S, et al. Lipophilic statins and risk for hepatocellular carcinoma and death in patients with chronic viral hepatitis: results from a Nationwide Swedish Population. Ann Intern Med. 2019;171(5):318-27. DOI:10.7326/M18-2753
41. Ivashkin VT, Maevskaya MV, Zharkova MS, et al. Clinical Practice Guidelines of the Russian Scientific Liver Society, Russian Gastroenterological Association, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians and National Society for Preventive Cardiology on Diagnosis and Treatment of Non-Alcoholic Liver Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(4):104‑40 (in Russian). DOI:10.22416/1382-4376-2022-32-4-104-140
42. Rinella ME, Dufour JF, Anstee QM, et al. Non-invasive evaluation of response to obeticholic acid in patients with NASH: results from the REGENERATE study. J Hepatol.
2022;76:536-48. DOI:10.1016/j.jhep.2021.10.029
43. Ando Y, Jou JH. Nonalcoholic Fatty Liver Disease and Recent Guideline Updates. Clin Liver Dis (Hoboken). 2021;17(1):23-8. DOI:10.1002/cld.1045
44. Lazebnik LB, Golovanova EV, Turkina SV, et al. Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version. Experimental and Clinical Gastroenterology. 2021;1(1):4-52 (in Russian). DOI:10.31146/1682-8658-ecg-185-1-4-52
45. Miller ER, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142(1):37-46. DOI:10.7326/0003-4819-142-1-200501040-00110
46. Abner EL, Schmitt FA, Mendiondo MS, et al. Vitamin E and all- cause mortality: a meta-analysis. Curr Aging Sci. 2011;4(2):158-70. DOI:10.2174/1874609811104020158
47. Gundermann KJ, Gundermann S, Drozdzik M, Mohan Prasad VG. Essential phospholipids in fatty liver: a scien-tific update. Clin Exp Gastroenterol. 2016;9:105-17. DOI:10.2147/CEG.S96362
48. Sas E, Grinevich V, Efimov O, Shcherbina N. Beneficial influence of polyunsaturated phosphatidylcholine enhances functional liver condition and liver structure in patients with nonalcoholic steatohepatitis accompanied by diabetes type 2. Results of prolonged randomized blinded prospective clinical study [abstract]. J Hepatol. 2013;58:S549.
49. Zhiguo L. Efficacy of polyene phosphatidylcholine in combination with metformin for diabetes complicated with non-alcoholic fatty liver disease. Inner Mongol Journal of Traditional Chinese Medicine. 2013;31:10-1.
50. Dajani AI, Abu Hammour AM, Zakaria MA, et al. Essential phospholipids as a supportive adjunct in the management of patients with NAFLD. Arab J Gastroenterol.
2015;16(3-4):99-104. DOI:10.1016/j.ajg.2015.09.001
51. Ivashkin VT, Maevskaya MV, Shirokova EN, et al. Correlation of Objective Endpoints and Subjective Patient-Reported Outcomes in NAFLD Treatment with Essential Phospholipids: Real-World Data Based on Pooled Analysis of Observational Studies. Drugs Real World Outcomes. 2021;8(3):369-82. DOI:10.1007/s40801-021-00250-x
52. Yin D, Kong L. Observation for curative effect of Essentiale in treatment of fatty liver caused by diabetes mellitus. Med J Q Ilu. 2000;15:277-8.
53. Dajani AI, Popovic B. Essential phospholipids for nonalcoholic fatty liver disease associated with metabolic syndrome: A systematic review and network meta-analysis. World J Clin Cases. 2020;8(21):5235-49. DOI:10.12998/wjcc.v8.i21.5235
54. Maev IV, Samsonov AA, Palgova LK, et al. Real-world comorbidities and treatment patterns among patients with non-alcoholic fatty liver disease receiving phosphatidylcholine as adjunctive therapy in Russia. BMJ Open Gastroenterol. 2019;18;6(1):e000307. DOI:10.1136/bmjgast-2019-00030
55. Manzillo G, Piccinino F, Surrenti C, et al. Multicentre Double-Blind Placebo-Controlled Study of Intravenous and Oral S-Adenosyl-LMethionine (SAMe) in Cholestatic Patients with Liver Disease. Drug Invest. 1994;24:90-100. DOI:10.1007/BF03258369
56. Shankar R, Virukalpattigopalratham MP, Singh T. Heptral (Ademetionine) in intrahepatic cholestasis due to chronic non-alcoholic liver disease: subgroup analysis of results of a multicentre observational study in India. J Clin Experim Hepatol. 2014;4(S2):s30-8.
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;64:73-84. DOI:10.1002/hep.28431
3. Tilg H, Moschen AR, Roden M. NAFLD and diabetes mellitus. Nat Rev Gastroenterol Hepatol. 2017;14:32-42. DOI:10.1038/nrgastro.2016.147
4. Younossi Z, Anstee QM, Marietti M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15:11-20. DOI:10.1038/nrgastro.2017.109
5. Huber Y, Schulz A, Schmidtmann I, et al. Prevalence and risk factors of advanced liver fibrosis in a population-based study in Germany. Hepatol Commun. 2022;6:1457-66. DOI:10.1002/hep4.1899
6. Charlton MR, Burns JM, Pedersen RA, et al. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology.
2011;141:1249-53. DOI:10.1053/j.gastro.2011.06.061
7. Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32(9):1431-7. DOI:10.1038/ijo.2008.102
8. Zhou YY, Zhou XD, Wu SJ, et al. Nonalcoholic fatty liver disease contributes to subclinical atherosclerosis: a systematic review and meta-analysis. Hepatol Commun. 2018;2(4):376-92. DOI:10.1002/hep4.1155
9. 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(3):589-600.
DOI:10.1016/ j.jhep.2016.05.013
10. Golabi P, Paik JM, Eberly K, et al. Causes of death in patients with non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease and chronic viral hepatitis B and C. Ann Hepatol. 2022;27:100556. DOI:10.1016/j.aohep.2021.100556
11. Simon TG, Roelstraete B, Khalili H, et al. Mortality in biopsyconfirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut. 2021;70:1375-82.
DOI:10.1136/gutjnl-2020-322786
12. Eslam M, Sanyal AJ, George J; International Consensus Panel. MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020;158(7):1999-2014.e1. DOI:10.1053/j.gastro.2019.11.312
13. Younossi ZM, Rinella ME, Sanyal AJ, et al. From NAFLD to MAFLD: implications of a premature change in terminology. Hepatology. 2021;73:1194-8. DOI:10.1002/hep.31420
14. Grander С, Grabherr F, Tilg H. Non-alcoholic fatty liver disease: pathophysiological concepts and treatment options. Cardiovasc Res. 2023;119(9):1787-98. DOI:10.1093/cvr/cvad095
15. Duan Y, Pan X, Luo J, et al. Association of inflammatory cytokines with non-alcoholic fatty liver disease. Front Immunol. 2022;13:880298. DOI:10.3389/fimmu.2022.880298
16. Samuel VT, Liu ZX, Qu X, et al. Mechanism of hepatic insulin resistance in non-alcoholic fatty liver disease. J Biol Chem. 2004;279:32345-53. DOI:10.1074/jbc.M313478200
17. Aron-Wisnewsky J, Vigliotti C, Witjes J, et al. Gut microbiota and human NAFLD: disentangling microbial signatures from metabolic disorders. Nat Rev Gastroenterol Hepatol. 2020;17:279-97. DOI:10.1038/s41575-020-0269-9
18. Alferink LJM, Radjabzadeh D, Erler NS, et al. Metagenomics P. And hepatic steatosis in a population-based study of 1,355 adults. Hepatology. 2021;73:968-82. DOI:10.1002/hep.31417
19. Lee G, You HJ, Bajaj JS, et al. Distinct signatures of gut microbiome and metabolites associated with significant fibrosis in non-obese NAFLD. Nat Commun. 2020;11:4982. DOI:10.1038/s41467-020-18754-5
20. Parthasarathy G, Revelo X, Malhi H. Pathogenesis of Nonalcoholic Steatohepatitis: An Overview. Hepatol Communications. 2020;4(4):478‑92. DOI:10.1002/hep4.1479
21. Haas JT, Francque S, Staels B. Pathophysiology and mechanisms of nonalcoholic fatty liver disease. Annu Rev Physiol. 2016;78:181-205.
DOI:10.1146/annurev-physiol021115-105331
22. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328‑57. DOI:10.1002/hep.29367
23. Bril F, Ortiz-Lopez C, Lomonaco R, et al. Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients. Liver Internat. 2015;35:2139-46. DOI:10.1111/liv.12840
24. Xiao G, Zhu S, Xiao X, et al. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis. Hepatology. 2017;66:1486-501. DOI:10.1002/hep.29302
25. Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Gut. 2022;71:1006-19. DOI:10.1136/gutjnl-2021-324243
26. European Association for the Study of the Liver (EASL). Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update. J Hepatol. 2021;75(3):659-89. DOI:10.1016/j.jhep.2021.05.025
27. 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;64:1388-402. DOI:10.1016/j.jhep.2015.11.004
28. Ginès P, Castera L, Lammert F, et al. Population screening for liver fibrosis: toward early diagnosis and intervention for chronic liver diseases. Hepatology. 2022;75:219-28. DOI:10.1002/hep.32163
29. Howard BV, Wylie-Rosett J. Sugar and cardiovascular disease: a statement for healthcare professionals from the committee on nutrition of the council on nutrition, physical activity, and metabolism of the American Heart Association. Circulation. 2002;106:523-7. DOI:10.1161/01.cir.0000019552.77778.04
30. Gerber L, Otgonsuren M, Mishra A, et al. Non-alcoholic fatty liver disease (NAFLD) is associated with low level of physical activity: a population-based study. Aliment Pharmacol Ther. 2012;36:772-81. DOI:10.1111/apt.12038
31. 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 Int Med. 2016;165:305-15. DOI:10.7326/M15-1774
32. Kumar J, Memon RS, Shahid I, et al. Antidiabetic drugs and non-alcoholic fatty liver disease: A systematic review, meta-analysis and evidence map. Dig Liver Dis. 2021;53(1):44-51. DOI:10.1016/j.dld.2020.08.021
33. Kuchay MS, Krishan S, Mishra SK, et al. Effect of empagliflozin on liver fat in patients with type 2 diabetes and nonalcoholic fatty liver disease: a randomized controlled trial (E-LIFT trial). Diabetes Care. 2018;41:1801‑8. DOI:10.2337/dc18-0165
34. Mantovani A, Byrne CD, Scorletti E, et al. Efficacy and safety of antihyperglycaemic drugs in patients with non-alcoholic fatty liver disease with or without diabetes: an updated systematic review of randomized controlled trials. Diabetes Metab. 2020;46:427-41. DOI:10.1016/j.diabet.2019
35. Armstrong MJ, Gaunt P, Aithal GP, et al. Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study. Lancet. 2016;387:679-90. DOI:10.1016/S0140-6736(15)00803-X
36. Newsome PN, Buchholtz K, Cusi K, et al. A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis. N Engl J Med. 2021;384:1113-24. DOI:10.1056/NEJMoa2028395
37. Дедов И.И., Мокрышева Н.Г., Мельниченко Г.А., и др. Ожирение. Клинические рекомендации. Consilium Medicum. 2021;23(4):311-25 [Dedov II, Mokrysheva NG, Mel’nichenko GA, et al. Obesity. Clinical guidelines. Consilium Medicum. 2021;23(4):311-25 (in Russian)]. DOI:10.26442/20751753.2021.4.200832
38. Chauhan M, Singh K, Thuluvath PJ. Bariatric surgery in NAFLD. Dig Dis Sci. 2022;67:408-22. DOI:10.1007/s10620-021-07317-3
39. Lassailly G, Caiazzo R, Ntandja-Wandji LC, et al. Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis. Gastroenterology. 2020;159:1290-301. DOI:10.1053/j.gastro.2020.06.006
40. Simon TG, Duberg AS, Aleman S, et al. Lipophilic statins and risk for hepatocellular carcinoma and death in patients with chronic viral hepatitis: results from a Nationwide Swedish Population. Ann Intern Med. 2019;171(5):318-27. DOI:10.7326/M18-2753
41. Ивашкин В.Т., Маевская М.В., Жаркова М.С., и др. Клинические рекомендации Российского общества по изучению печени, Российской гастроэнтерологической ассоциации, Российской ассоциации эндокринологов, Российской ассоциации геронтологов и гериатров и Национального общества профилактической кардиологии по диагностике и лечению неалкогольной жировой болезни печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2022;32(4):104-40 [Ivashkin VT, Maevskaya MV, Zharkova MS, et al. Clinical Practice Guidelines of the Russian Scientific Liver Society, Russian Gastroenterological Association, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians and National Society for Preventive Cardiology on Diagnosis and Treatment of Non-Alcoholic Liver Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(4):104‑40 (in Russian)]. DOI:10.22416/1382-4376-2022-32-4-104-140
42. Rinella ME, Dufour JF, Anstee QM, et al. Non-invasive evaluation of response to obeticholic acid in patients with NASH: results from the REGENERATE study. J Hepatol.
2022;76:536-48. DOI:10.1016/j.jhep.2021.10.029
43. Ando Y, Jou JH. Nonalcoholic Fatty Liver Disease and Recent Guideline Updates. Clin Liver Dis (Hoboken). 2021;17(1):23-8. DOI:10.1002/cld.1045
44. Лазебник Л.Б., Голованова Е.В., Туркина С.В., и др. Неалкогольная жировая болезнь печени у взрослых: клиника, диагностика, лечение. Рекомендации для терапевтов, третья версия. Экспериментальная и клиническая гастроэнтерология. 2021;1(1):4-52 [Lazebnik LB, Golovanova EV, Turkina SV, et al. Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version. Experimental and Clinical Gastroenterology. 2021;1(1):4-52 (in Russian)]. DOI:10.31146/1682-8658-ecg-185-1-4-52
45. Miller ER, Pastor-Barriuso R, Dalal D, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142(1):37-46. DOI:10.7326/0003-4819-142-1-200501040-00110
46. Abner EL, Schmitt FA, Mendiondo MS, et al. Vitamin E and all- cause mortality: a meta-analysis. Curr Aging Sci. 2011;4(2):158-70. DOI:10.2174/1874609811104020158
47. Gundermann KJ, Gundermann S, Drozdzik M, Mohan Prasad VG. Essential phospholipids in fatty liver: a scien-tific update. Clin Exp Gastroenterol. 2016;9:105-17. DOI:10.2147/CEG.S96362
48. Sas E, Grinevich V, Efimov O, Shcherbina N. Beneficial influence of polyunsaturated phosphatidylcholine enhances functional liver condition and liver structure in patients with nonalcoholic steatohepatitis accompanied by diabetes type 2. Results of prolonged randomized blinded prospective clinical study [abstract]. J Hepatol. 2013;58:S549.
49. Zhiguo L. Efficacy of polyene phosphatidylcholine in combination with metformin for diabetes complicated with non-alcoholic fatty liver disease. Inner Mongol Journal of Traditional Chinese Medicine. 2013;31:10-1.
50. Dajani AI, Abu Hammour AM, Zakaria MA, et al. Essential phospholipids as a supportive adjunct in the management of patients with NAFLD. Arab J Gastroenterol.
2015;16(3-4):99-104. DOI:10.1016/j.ajg.2015.09.001
51. Ivashkin VT, Maevskaya MV, Shirokova EN, et al. Correlation of Objective Endpoints and Subjective Patient-Reported Outcomes in NAFLD Treatment with Essential Phospholipids: Real-World Data Based on Pooled Analysis of Observational Studies. Drugs Real World Outcomes. 2021;8(3):369-82. DOI:10.1007/s40801-021-00250-x
52. Yin D, Kong L. Observation for curative effect of Essentiale in treatment of fatty liver caused by diabetes mellitus. Med J Q Ilu. 2000;15:277-8.
53. Dajani AI, Popovic B. Essential phospholipids for nonalcoholic fatty liver disease associated with metabolic syndrome: A systematic review and network meta-analysis. World J Clin Cases. 2020;8(21):5235-49. DOI:10.12998/wjcc.v8.i21.5235
54. Maev IV, Samsonov AA, Palgova LK, et al. Real-world comorbidities and treatment patterns among patients with non-alcoholic fatty liver disease receiving phosphatidylcholine as adjunctive therapy in Russia. BMJ Open Gastroenterol. 2019;18;6(1):e000307. DOI:10.1136/bmjgast-2019-00030
55. Manzillo G, Piccinino F, Surrenti C, et al. Multicentre Double-Blind Placebo-Controlled Study of Intravenous and Oral S-Adenosyl-LMethionine (SAMe) in Cholestatic Patients with Liver Disease. Drug Invest. 1994;24:90-100. DOI:10.1007/BF03258369
56. Shankar R, Virukalpattigopalratham MP, Singh T. Heptral (Ademetionine) in intrahepatic cholestasis due to chronic non-alcoholic liver disease: subgroup analysis of results of a multicentre observational study in India. J Clin Experim Hepatol. 2014;4(S2):s30-8.
________________________________________________
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;64:73-84. DOI:10.1002/hep.28431
3. Tilg H, Moschen AR, Roden M. NAFLD and diabetes mellitus. Nat Rev Gastroenterol Hepatol. 2017;14:32-42. DOI:10.1038/nrgastro.2016.147
4. Younossi Z, Anstee QM, Marietti M, et al. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15:11-20. DOI:10.1038/nrgastro.2017.109
5. Huber Y, Schulz A, Schmidtmann I, et al. Prevalence and risk factors of advanced liver fibrosis in a population-based study in Germany. Hepatol Commun. 2022;6:1457-66. DOI:10.1002/hep4.1899
6. Charlton MR, Burns JM, Pedersen RA, et al. Frequency and outcomes of liver transplantation for nonalcoholic steatohepatitis in the United States. Gastroenterology.
2011;141:1249-53. DOI:10.1053/j.gastro.2011.06.061
7. Kelly T, Yang W, Chen CS, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32(9):1431-7. DOI:10.1038/ijo.2008.102
8. Zhou YY, Zhou XD, Wu SJ, et al. Nonalcoholic fatty liver disease contributes to subclinical atherosclerosis: a systematic review and meta-analysis. Hepatol Commun. 2018;2(4):376-92. DOI:10.1002/hep4.1155
9. 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(3):589-600.
DOI:10.1016/ j.jhep.2016.05.013
10. Golabi P, Paik JM, Eberly K, et al. Causes of death in patients with non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease and chronic viral hepatitis B and C. Ann Hepatol. 2022;27:100556. DOI:10.1016/j.aohep.2021.100556
11. Simon TG, Roelstraete B, Khalili H, et al. Mortality in biopsyconfirmed nonalcoholic fatty liver disease: results from a nationwide cohort. Gut. 2021;70:1375-82.
DOI:10.1136/gutjnl-2020-322786
12. Eslam M, Sanyal AJ, George J; International Consensus Panel. MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease. Gastroenterology. 2020;158(7):1999-2014.e1. DOI:10.1053/j.gastro.2019.11.312
13. Younossi ZM, Rinella ME, Sanyal AJ, et al. From NAFLD to MAFLD: implications of a premature change in terminology. Hepatology. 2021;73:1194-8. DOI:10.1002/hep.31420
14. Grander С, Grabherr F, Tilg H. Non-alcoholic fatty liver disease: pathophysiological concepts and treatment options. Cardiovasc Res. 2023;119(9):1787-98. DOI:10.1093/cvr/cvad095
15. Duan Y, Pan X, Luo J, et al. Association of inflammatory cytokines with non-alcoholic fatty liver disease. Front Immunol. 2022;13:880298. DOI:10.3389/fimmu.2022.880298
16. Samuel VT, Liu ZX, Qu X, et al. Mechanism of hepatic insulin resistance in non-alcoholic fatty liver disease. J Biol Chem. 2004;279:32345-53. DOI:10.1074/jbc.M313478200
17. Aron-Wisnewsky J, Vigliotti C, Witjes J, et al. Gut microbiota and human NAFLD: disentangling microbial signatures from metabolic disorders. Nat Rev Gastroenterol Hepatol. 2020;17:279-97. DOI:10.1038/s41575-020-0269-9
18. Alferink LJM, Radjabzadeh D, Erler NS, et al. Metagenomics P. And hepatic steatosis in a population-based study of 1,355 adults. Hepatology. 2021;73:968-82. DOI:10.1002/hep.31417
19. Lee G, You HJ, Bajaj JS, et al. Distinct signatures of gut microbiome and metabolites associated with significant fibrosis in non-obese NAFLD. Nat Commun. 2020;11:4982. DOI:10.1038/s41467-020-18754-5
20. Parthasarathy G, Revelo X, Malhi H. Pathogenesis of Nonalcoholic Steatohepatitis: An Overview. Hepatol Communications. 2020;4(4):478‑92. DOI:10.1002/hep4.1479
21. Haas JT, Francque S, Staels B. Pathophysiology and mechanisms of nonalcoholic fatty liver disease. Annu Rev Physiol. 2016;78:181-205.
DOI:10.1146/annurev-physiol021115-105331
22. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328‑57. DOI:10.1002/hep.29367
23. Bril F, Ortiz-Lopez C, Lomonaco R, et al. Clinical value of liver ultrasound for the diagnosis of nonalcoholic fatty liver disease in overweight and obese patients. Liver Internat. 2015;35:2139-46. DOI:10.1111/liv.12840
24. Xiao G, Zhu S, Xiao X, et al. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis. Hepatology. 2017;66:1486-501. DOI:10.1002/hep.29302
25. Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Gut. 2022;71:1006-19. DOI:10.1136/gutjnl-2021-324243
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Авторы
Т.Ю. Демидова, Ф.О. Ушанова*
ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*fati_2526@mail.ru
Pirogov Russian National Research Medical University, Moscow, Russia
*fati_2526@mail.ru
ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*fati_2526@mail.ru
________________________________________________
Pirogov Russian National Research Medical University, Moscow, Russia
*fati_2526@mail.ru
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