medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-7-104-114medsovet-6868Research ArticleЗаболевания билиарной системы и печениLiver diseasesПринципы диагностики и лечения алкоголь-индуцированного фиброза печениPrinciples of diagnosis and treatment of alcohol-induced liver fibrosishttps://orcid.org/0000-0001-9809-8015ГарбузенкоД. В.GarbuzenkoD. V.

Гарбузенко Дмитрий Викторович - доктор медицинских наук, профессор, профессор кафедры факультетской хирургии.

454092, Челябинск, ул. Воровского, д. 64.

Dmitry V. Garbuzenko - Dr. Sci. (Med.), Professor, Professor of Department of Faculty Surgery, South Ural State Medical University.

64, Vorovskiy St., Chelyabinsk, 454092.

garb@inbox.ruЮжно-Уральский государственный медицинский университетРоссияSouth Ural State Medical UniversityRussian Federation20221405202207104114Copyright © Гарбузенко Д.В., 20222022Гарбузенко Д.В.Garbuzenko D.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6868

Связанные со злоупотреблением алкоголем заболевания печени являются одной из ведущих причин смерти во всем мире прежде всего вследствие осложнений цирроза печени (ЦП). Раннее выявление алкоголь-индуцированного фиброза печени (ФП) представляет собой сложную задачу, поскольку нередко алкогольная болезнь печени (АБП) клинически проявляет себя лишь на поздних стадиях. Учитывая, что страдают ей далеко не все алкоголики, широкое применение биопсии печени для верификации диагноза не целесообразно. Несмотря на разнообразие предложенных неинвазивных методов оценки тяжести ФП у пациентов с АБП, ни один из них не имеет достаточной валидации и поэтому не может быть рекомендован для широкой клинической практики. При этом наиболее хорошо изученная транзиентная эластография из-за неоптимальной специфичности оказалась эффективной только для исключения клинически значимого ФП или ЦП. Единственным проверенным подходом к лечению АБП служит стойкое и полное воздержание от алкоголя. Если принципы ведения пациентов с тяжелыми формами острого гепатита остаются неизменными с 1970-х гг. и основаны главным образом на использовании кортикостероидов, то утвержденные клиническими рекомендациями схемы антифибротической терапии АБП в настоящее время отсутствуют. Вместе с тем современные достижения  в понимании патофизиологических механизмов  этого  заболевания послужили толчком к разработке путей решения проблемы. В частности, обеспечение эубиоза кишечника может быть важной целью профилактики и лечения алкоголь-индуцированного ФП. Для подтверждения этой и других гипотез, связанных с антифибротической терапией АБП, и принятия их в качестве стандарта оказания медицинской помощи необходимы рандомизированные контролируемые мультицентровые исследования с участием большого числа пациентов.

Alcohol-related liver diseases are one of the leading causes of death worldwide, primarily due to complications of liver cirrhosis (LC). Early detection of alcohol-induced liver fibrosis (LF) is a difficult task, since often  alcoholic liver disease (ALD) is clinically manifested only at late stages. Given that not all alcoholic suffer from ALD, the widespread use of liver biopsy to verify the diagnosis is not advisable. Despite the variety of proposed non-invasive methods for assessing the severity of LF in patients with ALD, none of them has sufficient validation and therefore cannot be recommended for widespread use in clinical practice. The most well-studied transient elastography, due to its suboptimal specificity, can be effectively used only to exclude clinically significant LF or LC. The only proven approach to treat ALD is persistent and total alcohol abstinence. While the therapeutic options for patients with severe forms of acute hepatitis remain unchanged since the 70s of the last century and are based mainly on the use of corticosteroids, currently, there are no approaches to antifibrotic therapy of ALD approved by the guidelines. At the same time, modern achievements in understanding the pathophysiological mechanisms  of this disease  have served  as an impetus  for  the development  of ways to solve  the problem. In particular, providing intestinal eubiosis may be an important goal for the prevention and treatment of alcohol-induced LF. Randomized controlled multicenter trials involving a large number of patients are needed to confirm this and other hypotheses related to antifibrotic therapy of ALD and to accept them as a standard of medical care.

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