medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-462medsovet-8023Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYВлияние тиазолидиндионов на печень: от гепатотоксичности до терапевтического эффектаThe effect of thiazolidinediones on the liver: from hepatotoxicity to therapeutic effecthttps://orcid.org/0000-0001-9253-8075СуплотоваЛ. А.SuplotovaL. A.

Суплотова Людмила Александровна - д.м.н., профессор, заведующая курсом эндокринологии кафедры терапии.

625023, Тюмень, ул. Одесская, д. 54; Scopus Author ID: 0000-0001-9253-8075; Researcher ID: J-3596-2014

Lyudmila A. Suplotova - Dr. Sci. (Med.), Professor, Head of the Endocrinology Course of the Institute of CPD with the Courses of Endocrinology, Functional and Ultrasound Diagnostics.

54, Odesskaya St., Tyumen, 625023; Scopus Author ID: 00000001-9253-8075; Researcher ID J-3596-2014

suplotovala@mail.ruhttps://orcid.org/0000-0002-6138-5659КаплинаЛ. В.KaplinaL. V.

Каплина Луиза Викторовна - клинический ординатор курса эндокринологии кафедры терапии.

625023, Тюмень, ул. Одесская, д. 54

Luiza V. Kaplina - Clinical Resident of the Endocrinology Course of the Institute of CPD with the Courses of Endocrinology, Functional and Ultrasound Diagnostics.

54, Odesskaya St., Tyumen, 625023

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

Душина Татьяна Сергеевна - ассистент кафедры клинической лабораторной диагностики.

625023, Тюмень, ул. Одесская, д. 54

Tatyana S. Dushina - Assistant of the Department the Course Clinical and Laboratory Diagnostics.

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.

625023, Тюмень, ул. Одесская, д. 54

Olga B. Makarova - Cand. Sci. (Med.), Associate Professor, Associate Professor of the Endocrinology Course of the Institute of CPD with the Courses of Endocrinology, Functional and Ultrasound Diagnostics.

54, Odesskaya St., Tyumen, 625023

dr.makarova@yahoo.comТюменский государственный медицинский университетРоссияTyumen State Medical UniversityRussian Federation202320012024023234242Copyright © Суплотова Л.А., Каплина Л.В., Душина Т.С., Макарова О.Б., 20242024Суплотова Л.А., Каплина Л.В., Душина Т.С., Макарова О.Б.Suplotova L.A., Kaplina L.V., 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/8023

Тиазолидиндионы (ТЗД) – группа сахароснижающих препаратов, применяемых для лечения сахарного диабета (СД) 2-го типа. ТЗД являются синтетическими лигандами PPAR-γ-рецепторов, активируемых пролифератором пероксисом. При соединении ТЗД с PPAR-γ-рецепторами запускается транскрипция генов, регулирующих углеводный и липидный обмен. ТЗД обладают протективными свой ствами в отношении β-клетки поджелудочной железы, т. к. уменьшают глюкозо-и липотоксичность. Данные препараты уменьшают инсулинорезистентность, положительно влияют на метаболизм жиров. Этот эффект позволяет применять одного из представителей класса в лечении неалкогольной жировой болезни печени (НАЖБП), что подтверждают клинические рекомендации разных стран. СД2 и НАЖБП – заболевания, тесно связанные друг с другом общими патогенетическими закономерностями. При их сочетании у пациентов наблюдается высокий риск развития неалкогольного стеатогепатита, цирроза печени и гепатоцеллюлярной карциномы, а также ухудшение течения сахарного диабета. Долгие годы препараты класса «тиазолидиндионы» оставались в тени вследствие негативного опыта применения конкретных представителей – гепатотоксичного троглитазона и увеличивающего риски развития сердечно-сосудистых осложнений росиглитазона. Забытым остался представитель класса пиоглитазон, обладающий множеством доказанных положительных эффектов на сердечно-сосудистую систему, липидный обмен и течение НАЖБП. Необходимо выяснить, является ли гепатотоксичность на самом деле класс-эффектом ТЗД или же частным эффектом конкретных препаратов. Проведен литературный поиск информации за период с 1982 по 2023 г. в электронных базах PubMed, Elibrary.ru. В данной статье будут рассматриваться историческое развитие класса ТЗД, исследования в области эффектов пиоглитазона на печень.

Thiazolidinediones (TDD) are a group of hypoglycemic drugs used for the treatment of type 2 diabetes mellitus (DM). TDD are synthetic ligands of PPAR-γ-receptors activated by the proliferator peroxisome. When TDD is combined with PPAR-γ-receptors, transcription of genes regulating carbohydrate and lipid metabolism is triggered. TDD has protective properties against pancreatic β-cells, as it reduces glucose and lipotoxicity. These drugs reduce insulin resistance, have a positive effect on fat metabolism. This effect makes it possible to use one of the representatives of the class in the treatment of non-alcoholic fatty liver disease (NAFLD), which is confirmed by clinical recommendations from different countries. Type 2 diabetes and NAFLD are diseases closely related to each other by common pathogenetic patterns. When combined, patients have a high risk of developing non-alcoholic steatohepatitis, cirrhosis of the liver and hepatocellular carcinoma, as well as worsening of the course of diabetes mellitus. For many years, drugs of the thiazolidinedione class remained in the shadows due to the negative experience of using specific representatives – hepatotoxic troglitazone and increasing the risk of cardiovascular complications of rosiglitazone. The representative of the pioglitazone class, which has many proven positive effects on the cardiovascular system, lipid metabolism and the course of NAFLD, remained forgotten. It is necessary to find out whether hepatotoxicity is actually a class-effect of TDD or a particular effect of specific drugs. A literary search for information for the period from 1982 to 2023 was carried out in PubMed electronic databases, Elibrary.ru. This article will consider: the historical development of the TDD class, research in the field of the effects of pioglitazone on the liver.

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