medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-15-83-89medsovet-7075Research ArticleЗАБОЛЕВАНИЯ ПЕЧЕНИ И БИЛИАРНОЙ СИСТЕМЫLIVER DISEASESВлияние ингибиторов натрий-глюкозного котранспортера 2-го типа на неалкогольную жировую болезнь печениEffect of sodium-glucose cotransporter type 2 inhibitors on non-alcoholic fatty liver diseasehttps://orcid.org/0000-0001-9253-8075СуплотоваЛ. А.SuplotovаL. A.

Суплотова Людмила Александровна, д.м.н., профессор, заведующая курсом эндокринологии кафедры терапии Института непрерывного профессионального развития

625023, Тюмень, ул. Одесская, д. 54

Lyudmila A. Suplotova, Dr. Sci. (Med.), Professor, Head of the Endocrinology course of the Department of Therapy of the Institute of Continuous Professional Development 

54, Odesskaya St., Tyumen, 625023

suplotovala@mail.ruhttps://orcid.org/0000-0002-9973-9942КульмаметоваД. С.KulmametovaD. S.

Кульмаметова Диана Салимжановна, врач-эндокринолог

626150, Тобольск, микрорайон 3б, д. 24

Diana S. Kulmametova, Еndocrinologist 

24, 3b Мicrodistrict, Tobolsk, 626150

d.kulmametova@mail.ruhttps://orcid.org/0000-0002-1723-540XФедороваА. И.FedorovaA. I.

Федорова Алена Игоревна, врач-эндокринолог

625049, Тюмень, ул. Магнитогорская, д. 8

Alena I. Fedorova, Еndocrinologist 

8, Magnitogorskaya St., Tyumen, 625049

fai140996@mail.ruhttps://orcid.org/0000-0002-6329-593XДушинаТ. С.DushinaT. S.

Душина Татьяна Сергеевна, ассистент кафедры акушерства, гинекологии и реаниматологии с курсом клинической лабораторной диагностики Института непрерывного профессионального развития

625023, Тюмень, ул. Одесская, д. 54

Tatуana S. Dushina, Аssistant of the Department of Obstetrics, Gynecology and Resuscitation with the course Clinical and Laboratory Diagnostics of the Institute of Continuous Professional Development 

54, Odesskaya St., Tyumen, 625023

dr.dushina@mail.ruhttps://orcid.org/0000-0003-4663-0289МакароваО. Б.MakarovaO. B.

Макарова Ольга Борисовна, к.м.н., доцент, доцент курса эндокринологии кафедры терапии Института непрерывного профессионального развития

625023, Тюмень, ул. Одесская, д. 54

Olga B. Makarova, Cand. Sci. (Med.), Associate Professor of the course of Endocrinology of the Department of Therapy of the Institute of Continuous Professional Development 

54, Odesskaya St., Tyumen, 625023

dr.makarova@yahoo.comТюменский государственный медицинский университетРоссияTyumen State Medical UniversityRussian FederationОбластная больница №3РоссияRegional Hospital No. 3Russian FederationКлиническая больница «РЖД-Медицина»РоссияClinical Hospital “RZD-Medicine”Russian Federation2022051020220158389Copyright © Суплотова Л.А., Кульмаметова Д.С., Федорова А.И., Душина Т.С., Макарова О.Б., 20222022Суплотова Л.А., Кульмаметова Д.С., Федорова А.И., Душина Т.С., Макарова О.Б.Suplotovа L.A., Kulmametova D.S., Fedorova A.I., Dushina T.S., Makarova O.B.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/7075

Неалкогольная жировая болезнь печени является одним из наиболее распространенных заболеваний печени, морфологически представляя собой целый спектр патологических состояний, от стеатоза и стеатогепатита до фиброза, клиническими исходами которого может выступать цирроз печени и гепатоцеллюлярная карцинома. Частота неблагоприятных исходов течения неалкогольной жировой болезни печени значимо увеличивается на фоне сахарного диабета 2-го типа, что, вероятно, обусловлено патогенетическим синергизмом неалкогольной жировой болезни печени и сахарного диабета 2-го типа, ассоциированным с метаболическим синдромом. Общность патогенетических звеньев, как следствие, предполагает однонаправленность терапевтических подходов. В связи с чем был проведен поиск исследований и метаанализов в крупных электронных базах данных (MEDLINE, Scopus, UpToDate, КиберЛенинка) с целью изучения современных методов фармакотерапии неалкогольной жировой болезни печени и сахарного диабета 2-го типа. Результаты ряда экспериментальных и клинических исследований по оценке влияния сахароснижающих препаратов группы ингибиторов натрий-глюкозного котранспортера 2-го типа на неалкогольную жировую болезнь печени демонстрируют широкий спектр внутрипеченочных эффектов, влияющих на проявления стеатоза печени и фиброза посредством регуляции окислительного стресса, стресса эндоплазматического ретикулума, влияния на интрапеченочное воспаление, аутофагию и апоптоз, а также опосредованно влияя на печеночный метаболизм путем снижения массы тела. Кроме того, на сегодняшний день глифлозины стремятся занять совершенно новую терапевтическую нишу, демонстрируя в экспериментальных исследованиях противоканцерогенные эффекты. Таким образом, плейотропное действие ингибиторов натрий-глюкозного котранспортера 2-го типа предполагает потенциальный гепатопротективный эффект терапии неалкогольной жировой болезни печени и ее исходов.

Non-alcoholic fatty liver disease is one of the most common liver diseases, morphologically representing a whole spectrum of pathological conditions, from steatosis and steatohepatitis to fibrosis, the clinical outcomes of which can be liver cirrhosis and hepatocellular carcinoma. The frequency of adverse outcomes in the course of non-alcoholic fatty liver disease significantly increases against the background of type 2 diabetes mellitus, which is probably due to the pathogenetic synergy of non-alcoholic fatty liver disease and type 2 diabetes mellitus associated with metabolic syndrome. The commonality of pathogenetic links, as a result, suggests the unidirectionality of therapeutic approaches. In this connection, a search was made for studies and meta-analyses in large electronic databases (MEDLINE, Scopus, UpToDate, CyberLeninka) in order to study modern methods of pharmacotherapy for non-alcoholic fatty liver disease and type 2 diabetes mellitus. The results of a number of experimental and clinical studies evaluating the effect of hypoglycemic drugs of the group of sodium-glucose cotransporter type 2 inhibitors on non-alcoholic fatty liver disease demonstrate a wide range of intrahepatic effects that affect the manifestations of liver steatosis and fibrosis through the regulation of oxidative stress, endoplasmic reticulum stress, effects on intrahepatic inflammation, autophagy and apoptosis, as well as indirectly affecting hepatic metabolism, by reducing body weight. In addition, today gliflozins are rushing to occupy a completely new therapeutic niche, demonstrating anticarcinogenic effects in experimental studies. Thus, the pleiotropic effect of inhibitors of the sodium-glucose cotransporter type 2 suggests a potential hepatoprotective effect in the treatment of non-alcoholic fatty liver disease and its outcomes.

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