medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-355medsovet-7863Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERНеалкогольная жировая болезнь печени и риск злокачественных новообразованийNon-alcoholic fatty liver disease and the risk of malignant tumorshttps://orcid.org/0000-0002-6581-7017ЛивзанМ. А.LivzanM. A.

Ливзан Мария Анатольевна - член- корреспондент РАН, доктор медицинских наук, профессор, врач-гастроэнтеролог,  главный внештатный терапевт по Сибирскому федеральному округу, заведующая  кафедрой  факультетской терапии  и гастроэнтерологии, ректор ОмГМУ.

644099, Омск, ул. Ленина, д. 1

Maria A. Livzan - Corr. Member RAS, Dr. Sci. (Med.), Professor, Gastroenterologist, Chief Freelance  Therapist  in the  Siberian  Federal  District, Head of the Department of Faculty Therapy and Gastroenterology, Rector of Omsk State Medical University.

1, Lenin St., Omsk, 644043

mlivzan@yandex.ruhttps://orcid.org/0000-0001-6300-367XСыровенкоМ. И.SyrovenkoM. I.

Сыровенко Мария Ильинична - аспирант кафедры  факультетской терапии  и гастроэнтерологии, врач-гастроэнтеролог.

644099, Омск, ул. Ленина, д. 1

Maria I. Syrovenko - Postgraduate Student  of the Department of Faculty Therapy and Gastroenterology, Gastroenterologist, Omsk State Medical University.

1, Lenin St., Omsk, 644043

mariapli@yandex.ruhttps://orcid.org/0000-0002-7452-7230КролевецТ. С.KrolevetsT. S.

Кролевец Татьяна Сергеевна - кандидат медицинских наук, доцент кафедры факультетской терапии и гастроэнтерологии, врач-гастроэнтеролог.

644099, Омск, ул. Ленина, д. 1

Tatiana S. Krolevets - Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy and Gastroenterology, Gastroenterologist, Omsk State Medical University.

1, Lenin St., Omsk, 644043

mts-8-90@mail.ruОмский государственный медицинский университетРоссияOmsk State Medical UniversityRussian Federation2023041120230187582Copyright © Ливзан М.А., Сыровенко М.И., Кролевец Т.С., 20232023Ливзан М.А., Сыровенко М.И., Кролевец Т.С.Livzan M.A., Syrovenko M.I., Krolevets T.S.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/7863

Распространенность  неалкогольной жировой болезни печени (НАЖБП) и метаболически ассоциированной болезни печени (МАЖБП) растет во всем мире. Переход к новой терминологии (МАЖБП) позволяет не только сделать акцент на «метаболическом» генезе  этой патологии, но и учесть другие факторы, влияющие на повреждение  гепатоцитов, такие как употребление  алкоголя в низких дозах, вирусные и токсические поражения печени. В настоящее  время ожирение  является патологией, распространенность  которой растет параллельно  с МАЖБП и приводит к увеличению встречаемости  различных неинфекционных заболеваний. Большинство смертей у пациентов с НАЖБП/МАЖБП обусловлены, во-первых, неблагоприятными сердечно-сосудистыми  событиями, во-вторых, злокачественными  новообразованиями как органов пищеварения (печень, кишка, пищевод, желудок и поджелудочная  железа), так и других локализаций  (рак почки у мужчин, рак молочной железы у женщин) и, в-третьих, развитием печеночных осложнений (цирроз печени, гепатоцеллюлярная карцинома – ГЦК). Учитывая пандемический  рост МАЖБП и ее  связь с сердечно-сосудистыми  заболеваниями и ожирением, вопрос о том, как правильно курировать пациентов с коморбидной  патологией, чтобы уменьшить риски, является своевременным  и весьма актуальным. Данный обзор  подготовлен с целью систематизации  имеющихся литературных данных в отношении  ассоциации  НАЖБП/МАЖБП и риска  злокачественных  новообразований. Проведен  литературный поиск, представлены  современные эпидемиологические  данные распространенности МАЖБП/НАЖБП в популяции и их осложненных форм. Оценен риск формирования  ГЦК с циррозом  при НАЖБП и без такового. Выяснено, что тяжесть фиброза печени  может быть полезным  предиктором  будущего риска не только неблагоприятных сердечно-сосудистых  событий, но и злокачественных  новообразований различных локализаций  у пациентов с НАЖБП/МАЖБП. Обсуждены возможные мишени, воздействие  на которые представляется полезным для лечения и профилактики прогрессирующих форм заболевания. Одной из возможных терапевтических молекул являются эссенциальные фосфолипиды, которые в настоящее время включены в согласительные документы по курации пациентов с НАЖБП.

The prevalence of non-alcoholic fatty liver disease  (NAFLD) and metabolic  associated liver disease  (MAFLD) is growing world-wide. A new terminology  (MAFLD) allows us not only to focus on the “metabolic” genesis  of this pathology, but also to take into account  other  factors  affecting  damage  to hepatocytes, such as alcohol  consumption in low doses, viral and toxic hepatitis. Currently, obesity is a pathology, that is growing with MAFLD and causes  of various non-communicable diseases. Most deaths in patients with  NAFLD/MAFLD  are  caused,  firstly, by adverse  cardiovascular  events,  secondly, by malignant tumors  of both the digestive  organs  (liver, intestine, esophagus, stomach  and pancreas)  and other  localizations (kidney cancer  in men, breast cancer  in women) and, thirdly, by development of hepatic  complications (cirrhosis, hepatocellular carcinoma  – HCC). Because of the  pandemic  growth  of MAFLD and its association with cardiovascular  diseases  and obesity, the  question about  properly clinical management of patients suffered from comorbid pathology to reduce the risks of deaths  is timely and very relevant. This review has been prepared to systematize the available  literature dates  about association of NAFLD/MAFLD with the malignant tumors. A literature searches were  conducted,  modern  epidemiological dates  about  the  prevalence of NAFLD/MAFLD  in the population and their complicated forms were presented. The risk of HCC formation  both with and without  cirrhosis in NAFLD was assessed.  It was found that  the severity of liver fibrosis can be useful predictor  of the future risk of not only the adverse cardiovascular  events,  but  also  the  malignant tumors  in patients with  NAFLD/MAFLD. Possible  targets  for treatment were discussed,  the  impact  on which is useful  for the  treatment and prevention of progressive  forms of the  disease.  One of the possible  therapeutic molecules is essential phospholipids, which are  currently  included  in the  consent  documents for the managment of patients with NAFLD.

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