medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-414medsovet-8626Research ArticleСАХАРНЫЙ ДИАБЕТDIABETES MELLITUSСовременные аспекты терапии метаболически ассоциированной жировой болезни печени у пациентов с сахарным диабетом 2-го типаModern aspects of therapy of metabolic associated liver disease in patients with type 2 diabetes mellitushttps://orcid.org/0000-0003-0027-1786БулгаковаС. В.BulgakovaS. V.

Булгакова Светлана Викторовна, д.м.н., доцент, заведующая кафедрой эндокринологии и гериатрии

443099, Самара, ул. Чапаевская, д. 89

Svetlana V. Bulgakova, Dr. Sci. (Med.), Associate Professor, Head of Department of Endocrinology and Geriatrics

89, Chapaevskaya St., Samara, 443099

osteoporosis63@gmail.comhttps://orcid.org/0000-0001-6678-6411ДолгихЮ. А.DolgikhYu. A.

Долгих Юлия Александровна, к.м.н., ассистент кафедры эндокринологии и гериатрии

443099, Самара, ул. Чапаевская, д. 89

Yulia A. Dolgikh, Cand. Sci. (Med.), Assistant of Professor of Department of Endocrinology and Geriatrics

89, Chapaevskaya St., Samara, 443099

yu.a.dolgikh@samsmu.ruhttps://orcid.org/0000-0001-8827-4919ШароноваЛ. А.SharonovaL. A.

Шаронова Людмила Александровна, к.м.н., доцент кафедры эндокринологии и гериатрии

443099, Самара, ул. Чапаевская, д. 89

Lyudmila A. Sharonova, Cand. Sci. (Med.), Associate Professor of Department of Endocrinology and Geriatrcs

89, Chapaevskaya St., Samara, 443099

 

l.a.sharonova@samsmu.ruhttps://orcid.org/0000-0002-5754-1057КосареваО. В.KosarevaO. V.

Косарева Ольга Владиславовна, к.м.н., доцент кафедры эндокринологии и гериатрии

443099, Самара, ул. Чапаевская, д. 89

Olga V. Kosareva, Cand. Sci. (Med.), Associate Professor of Department of Endocrinology and Geriatrics

89, Chapaevskaya St., Samara, 443099

o.v.kosareva@samsmu.ruhttps://orcid.org/0000-0003-0097-7252ТреневаЕ. В.TrenevaE. V.

Тренева Екатерина Вячеславовна, к.м.н., доцент кафедры эндокринологии и гериатрии

443099, Самара, ул. Чапаевская, д. 89

Ekaterina V. Treneva, Cand. Sci. (Med.), Associate Professor of Department of Endocrinology and Geriatrics

89, Chapaevskaya St., Samara, 443099

eka1006@yandex.ruhttps://orcid.org/0009-0004-6243-6528МерзловаП. Я.MerzlovaP. Ya.

Мерзлова Полина Ярославовна, ассистент кафедры эндокринологии и гериатрии

443099, Самара, ул. Чапаевская, д. 89

Polina Ya. Merzlova, Assistant of Department of Endocrinology and Geriatri

89, Chapaevskaya St., Samara, 443099

p.ya.merzlova@samsmu.ruhttps://orcid.org/0000-0003-4114-5233КурмаевД. П.KurmayevD. P.

Курмаев Дмитрий Петрович, к.м.н., ассистент кафедры эндокринологии и гериатрии

443099, Самара, ул. Чапаевская, д. 89

Dmitriy P. Kurmayev, Cand. Sci. (Med.), Assistant of Department of Endocrinology and Geriatr

89, Chapaevskaya St., Samara, 443099

geriatry@mail.ruСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation202401112024016184192Copyright © Булгакова С.В., Долгих Ю.А., Шаронова Л.А., Косарева О.В., Тренева Е.В., Мерзлова П.Я., Курмаев Д.П., 20242024Булгакова С.В., Долгих Ю.А., Шаронова Л.А., Косарева О.В., Тренева Е.В., Мерзлова П.Я., Курмаев Д.П.Bulgakova S.V., Dolgikh Y.A., Sharonova L.A., Kosareva O.V., Treneva E.V., Merzlova P.Y., Kurmayev D.P.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/8626

Метаболически ассоциированная жировая болезнь печени (МАЖБП) является на данный момент самым распространенным заболеванием печени. Основными факторами риска ее развития являются нерациональное питание, малоподвижный образ жизни и ожирение. МАЖБП ассоциируется с различными кардиометаболическими состояниями – нарушением липидного обмена, сердечно-сосудистой патологией и нарушениями углеводного обмена. Ассоциация МАЖБП и сахарного диабета (СД) 2-го типа является распространенной среди пациентов, т. к. эти заболевания имеют общее звено патогенеза – инсулинорезистентность. Сочетание этих заболеваний оказывает обоюдное негативное влияние друг на друга и увеличивает риски возникновения сердечно-сосудистых заболеваний, госпитализаций, а также риски прогрессирования фиброза печени. Поэтому выявление МАЖБП и ее лечение при СД 2-го типа крайне важны для улучшения прогноза пациента. Диагностика МАЖБП включает лабораторные и инструментальные методы исследования. «Золотым стандартом» диагностики считается биопсия печени, но в связи с тем, что данный метод является инвазивным, то он используется редко и только для дифференциальной диагностики МАЖБП с другими патологиями печени. Наиболее доступным инструментальным методом выявления стеатоза печени является ультразвуковое исследование. Лечение МАЖБП в первую очередь предполагает изменение образа жизни (рациональное питание с ограничением простых углеводов и животных жиров, адекватные физические нагрузки) и снижение массы тела. Также определенное положительное влияние на МАЖБП могут оказывать сахароснижающие препараты, применяемые для лечения СД 2-го типа (метформин, пиоглитазон, агонисты глюкагоноподобного пептида-1). Важным компонентом лечения МАЖБП являются также эссенциальные фосфолипиды, которые оказывают мембраностабилизирующий, антиоксидантный и антифибротический эффекты. Ряд отечественных и зарубежных исследований показал высокую эффективность эссенциальных фосфолипидов как в отношении биохимических показателей у пациентов с сочетанием СД 2-го типа и МАЖБП, так и в отношении ультразвуковых признаков, улучшая функцию и структуру печени при МАЖБП, а также замедляя прогрессирование фиброза печени.

Metabolic associated fatty liver disease (MAFLD) is currently the most common liver disease. The main risk factors for its development are poor nutrition, sedentary lifestyle and obesity. MAFLD is associated with various cardiometabolic conditions – lipid metabolism disorders, cardiovascular pathology and carbohydrate metabolism disorders. The association of MAFLD and type 2 diabetes mellitus (DM) is common among patients, since these diseases have a common pathogenesis link – insulin resistance. The combination of these diseases has a mutual negative effect on each other and increases the risks of cardiovascular diseases, hospitalizations, as well as the risks of liver fibrosis progression. Therefore, the detection of MAFLD and its treatment in type 2 DM are extremely important to improve the patient’s prognosis. Diagnostics of MAFLD includes laboratory and instrumental research methods. The “gold standard” of diagnostics is considered to be liver biopsy, but due to the fact that this method is invasive, it is rarely used and only for differential diagnostics of MAFLD with other liver pathologies. The most accessible instrumental method for detecting liver steatosis is ultrasound. Treatment of MAFLD primarily involves lifestyle changes (rational nutrition with limitation of simple carbohydrates and animal fats, adequate physical activity) and weight loss. Also, hypoglycemic drugs used to treat type 2 diabetes (metformin, pioglitazone, glucagon-like peptide-1 agonists) can have a certain positive effect on MAFLD. Essential phospholipids, which have membrane-stabilizing, antioxidant and antifibrotic effects, are also an important component of MAFLD treatment. A number of domestic and foreign studies have shown the high efficiency of Essential Phospholipids both in relation to biochemical parameters in patients with a combination of type 2 diabetes and MAFLD, and in relation to ultrasound signs, improving the function and structure of the liver in MAFLD, as well as slowing the progression of liver fibrosis.

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