medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-343medsovet-8574Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERМетаболически ассоциированная жировая болезнь печени и лекарственные поражения: патогенетические аспекты, лечение и профилактикаMetabolic dysfunction-associated steatotic liver disease and drug-induced injuries: Pathogenetic aspects, treatment and preventionhttps://orcid.org/0000-0002-3125-6282ПахомоваИ. Г.PakhomovaI. G.

Пахомова Инна Григорьевна, к.м.н., доцент кафедры факультетской терапии с клиникой

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Inna G. Pakhomova, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy with Clinic

2, Akkuratov St., St Petersburg, 197341

pakhomova-inna@yandex.ruНациональный медицинский исследовательский центр имени В.А. АлмазоваРоссияAlmazov National Medical Research CenterRussian Federation20241610202401570–78Copyright © Пахомова И.Г., 20242024Пахомова И.Г.Pakhomova I.G.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/8574

Метаболически ассоциированная жировая болезнь печени, или ассоциированная с метаболической дисфункцией стеатозная болезнь печени, является широко распространенным хроническим заболеванием, характеризующимся повышенной аккумуляцией жира в печени, в основе которой лежит дисфункция обмена веществ. При возникновении данного заболевания важное значение имеют кардиометаболические факторы: дислипидемия, нарушение углеводного обмена, инсулинорезистентность, которые нарастают по мере прогрессирования метаболически ассоциированной жировой болезни печени и чаще всего способствуют развитию сердечно-сосудистой патологии. В настоящее время метаболически ассоциированная жировая болезнь печени является мультисистемным заболеванием, ассоциированным с ожирением, сахарным диабетом 2-го типа, сердечно-сосудистыми заболеваниями, хронической болезнью почек, онкологией и т. д. Данным заболеванием чаще всего страдают коморбидные пациенты, которые принимают немалое количество лекарственных препаратов. За последние десятилетия было выявлено много препаратов, которые потенциально могут вызывать стеатогепатит у предрасположенных к нему людей. Спектр лекарственных средств, обладаю щих гепатотоксичностью, достаточно большой: известно более 300 препаратов, способных вызывать лекарственное поражение печени. Вместе с тем истинная распространенность лекарственного поражения печени остается неизвестной, поскольку не всегда представляется возможным определить истинную причину поражения печени или конкретный лекарственный препарат. В связи с этим актуальным остается вопрос о тактике ведения пациентов с метаболически ассоциированной жировой болезнью печени и ее лекарственным поражением, особенно когда речь идет о необходимости приема препаратов, являющихся жизненно необходимыми для пациента. В статье представлен обзор литературы по этиопатогенетическим, клиническим и диагностическим аспектам метаболически ассоциированной жировой болезни печени и в сочетании с лекарственным поражением печени, особенностям ведения коморбидных пациентов. Рассматриваются терапевтические подходы с акцентом на комплексное ведение (немедикаментозное и фармакотерапия). Эффективным в терапии таких пациентов может быть назначение препаратов эссенциальных фосфолипидов.

Metabolic-associated fatty liver disease or metabolic dysfunction-associated steatotic liver disease is a common chronic disease  characterized by increased fat accumulation in the liver and underlying metabolic dysfunction. In the occurrence of this disease, cardiometabolic factors are important: dyslipidemia, impaired carbohydrate metabolism, insulin resistance, which increase as metabolic dysfunction- associated steatotic liver progresses and most often contribute to the development of cardiovascular pathology. Currently, metabolic dysfunction-associated steatotic liver is a multisystem disease associated with obesity, type 2 diabetes, cardiovascular diseases, chronic kidney disease, oncology, etc. Metabolic dysfunction- associated steatotic liver most often affects comorbid patients who take a considerable number of medications. Over the past decades, many drugs have been identified that have the potential to cause steatohepatitis in susceptible individuals. The range of drugs that have hepatotoxicity is quite large. More than 300 drugs are known to cause drug-induced liver injury. However, the true prevalence of drug-induced liver injury remains unknown, since it is not always possible to determine the true cause of liver damage or a specific drug. In this regard, the issue of management tactics for patients with metabolic dysfunction-associated steatotic liver and drug-induced liver injury remains relevant, especially when it comes to the need to take medications that are vital for the patient. The article provides a review of the literature on the etiopathogenetic, clinical and diagnostic aspects of both metabolic dysfunction-associated steatotic liver and in combination with drug-induced liver injury, features of the management of comorbid patients with metabolic dysfunction-associated steatotic liver and drug-induced liver injury. Therapeutic approaches are reviewed with an emphasis on comprehensive management (non-pharmacological and pharmacotherapy). Prescribing essential phospholipids may be effective in the treatment of such patients.

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