References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/2079-701X-2021-15-68-76

medsovet-6427

Research Article

ЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИ

DISEASES OF THE BILIARY SYSTEM AND LIVER

Гепатобилиарный континуум: неалкогольная жировая болезнь печени, желчнокаменная болезнь… Что еще?

Hepatobiliary continuum: non-alcoholic fatty liver disease, cholelithiasis ... what else?

Буеверов

А. О.

Bueverov

A. O.

д.м.н., профессор кафедры медико-социальной экспертизы, неотложной и поликлинической терапии; ведущий научный сотрудник отделения гепатологии

119991, Москва, ул. Трубецкая, д. 8, стр. 2; 129110, Москва, ул. Щепкина, д. 61/2, корп. 1

Dr. Sci. (Med.), Department of Medical and Social Expertise, Emergency and Outpatient Therapy ; Lead Researcher, Department of Hepatology

8, Bldg. 2, Trubetskaya St., Moscow, 119991; Bldg. 1, 61/2, Schepkin St., Moscow, 129110

bcl72@yandex.ru

Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Московский областной научно-исследовательский клинический институт имени М.Ф. Владимирского, Фонд поддержки и развития доказательной медициныРоссияInstitute of Professional Education, Sechenov First Moscow State Medical University (Sechenov University); Moscow Regional Research Clinical Institute named after M.F. VladimirskyRussian Federation

2021

17102021

0156876

2021

Буеверов А.О.

Bueverov A.O.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-sovet.pro/jour/article/view/6427

Функция желчного пузыря не ограничивается, как считалось ранее, накоплением и концентрацией желчи между приемами пищи. Доказано, что он является важным звеном связи печени и кишечника в печеночно-пузырно-кишечной оси, поддерживая метаболический гомеостаз холестерина, триглицеридов и желчных кислот. Отношения между метаболической неалкогольной жировой болезнью печени и желчнокаменной болезнью весьма сложные и, по-видимому, взаимоотягощающие. Не вызывает сомнений факт повышенного риска желчнокаменной болезни у пациентов с неалкогольной жировой болезнью печени, что связано в первую очередь с общими патогенетическими механизмами. К ним относятся центральная и периферическая инсулинорезистентность, изменение экспрессии транскрипционных факторов: печеночного Х-рецептора, фарнезоидного Х-рецептора (FXR) и мембранных рецепторов желчных кислот (TGR5). Одновременно предполагается влияние желчнокаменной болезни на течение неалкогольной жировой болезни печени, хотя патогенетические факторы этой ассоциации пока остаются недостаточно изученными. Накапливаются данные о повышенном риске у пациентов с неалкогольной жировой болезнью печени другой патологии билиарного тракта, в частности полипов желчного пузыря и опухолей желчевыводящих путей. В последние годы появились убедительные данные о роли холецистэктомии в прогрессировании неалкогольной жировой болезни печени, что может быть обусловлено нарушением эндокринного баланса и сигнальной функции желчных кислот, возможно, в сочетании с развитием синдрома избыточного бактериального роста в тонкой кишке. Общие терапевтические подходы к лечению взаимосвязанной гепатобилиарной патологии могут включать инсулиносенситайзеры нового поколения, агонисты FXR, а также урсодезоксихолевую кислоту. Таким образом, связь неалкогольной жировой болезни печени и патологии билиарного тракта представляется комплексной и многогранной, а ее дальнейшее изучение открывает перспективы разработки новых методов лечения.

The relationship between metabolic non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GSD) is complex and seemingly interrelated. There is no doubt that there is an increased risk of cholelithiasis in patients with NAFLD, which is primarily associated with general pathogenetic mechanisms. These include central and peripheral insulin resistance, changes in the expression of transcription factors (hepatic X-receptor, farnesoid X-receptor (FXR) and membrane bile acid receptors (TGR5)). At the same time, the effect of gallstone disease on the course of NAFLD is assumed, although the pathogenetic factors of this association are still insufficient. There are accumulating data on an increased risk of other pathologies of the biliary tract in patients with NAFLD, in particular, of gallbladder polyps and tumors of the biliary tract. Recently there have been convincing data on the role of cholecystectomy in the progression of NAFLD, which may be due to disruption of endocrine balance and signaling function of bile acids, as well as the development of bacterial overgrowth in the small intestine. General therapeutic approaches to the treatment of interrelated hepatobiliary pathology may include new generation insulinsensitizers, FXR agonists, and ursodeoxycholic acid. The link between NAFLD and the pathology of the biliary tract is complex and multifaceted, and its further study opens up prospects for the development of new methods of treatment.

неалкогольная жировая болезнь печенижелчнокаменная болезньполипы желчного пузыряопухоли билиарного трактахолецистэктомияпатогенезлечение

non-alcoholic fatty liver diseasecholelithiasisgallbladder polypsbiliary tract tumorscholecystectomypathogenesistreatment

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The authors declare that there are no conflicts of interest present.