medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-342medsovet-9452Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERСовременные аспекты ведения пациентов с метаболически ассоциированной жировой болезнью печениModern aspects of management of patients with metabolic dysfunction-associated steatotic liver diseasehttps://orcid.org/0000-0002-9980-2294ЦукановВ. В.TsukanovV. V.

Цуканов Владислав Владимирович - д.м.н., профессор, заведующий клиническим отделением патологии пищеварительной системы у взрослых и детей.

660022, Красноярск, ул. Партизана Железняка, д. 3г

Vladislav V. Tsukanov - Dr. Sci. (Med.), Professor, Head of the Clinical Department of the Digestive System Pathology of Adults and Children, Krasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Sciences, Research Institute of Medical Problems of the North.

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

gastro@impn.ruhttps://orcid.org/0000-0002-6481-3196ВасютинА. В.VasyutinA. V.

Васютин Александр Викторович - к.м.н., старший научный сотрудник клинического отделения патологии пищеварительной системы у взрослых и детей.

660022, Красноярск, ул. Партизана Железняка, д. 3г

Alexander V. Vasyutin - Cand. Sci. (Med.), Senior Researcher of the Clinical Department of the Clinical Department of the Digestive System Pathology of Adults and Children, Krasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Sciences, Research Institute of Medical Problems of the North.

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

alexander_vasyutin@mail.ruhttps://orcid.org/0000-0001-7518-1895ТонкихЮ. Л.TonkikhJ. L.

Тонких Юлия Леонгардовна - к.м.н., ведущий научный сотрудник клинического отделения патологии пищеварительной системы взрослых и детей.

660022, Красноярск, ул. Партизана Железняка, д. 3г

Julia L. Tonkikh - Cand. Sci. (Med.), Leading Researcher of the Clinical Department of the Clinical Department of the Digestive System Pathology of Adults and Children, Krasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Sciences, Research Institute of Medical Problems of the North.

3g, Partizan Zheleznyak St., Krasnoyarsk, 660022

tjulia@bk.ruКрасноярский научный центр Сибирского отделения Российской академии наук, обособленное подразделение «Научно-исследовательский институт медицинских проблем Севера»РоссияKrasnoyarsk Science Center of the Siberian Branch of the Russian Academy of Sciences, Research Institute of Medical Problems of the NorthRussian Federation20251710202501596101Copyright © Цуканов В.В., Васютин А.В., Тонких Ю.Л., 20252025Цуканов В.В., Васютин А.В., Тонких Ю.Л.Tsukanov V.V., Vasyutin A.V., Tonkikh J.L.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/9452

В 2023 г. была разработана новая номенклатура и патофизиология, предложены определение и критерии диагностики метаболически ассоциированной жировой болезни печени (МАЖБП). Критериями диагностики МАЖБП было рекомендовано считать наличие стеатоза печени и как минимум 1 из 5 кардиометаболических факторов: 1) индекс Кетле >25; окружность талии >94 см для мужчин и >80 см для женщин; 2) содержание глюкозы натощак >5,6 ммоль/л; 3) артериальное давление >130/85 мм рт. ст.; 4) содержание триглицеридов в крови >1,7 ммоль/л; 5) содержание холестерина липопротеидов высокой плотности в крови <1 ммоль/л. Базовое лечение лиц с МАЖБП включает модификацию диеты, повышение физической активности и снижение веса. В медикаментозной терапии нуждаются преимущественно пациенты с высокой вероятностью прогрессирования заболевания (наличие коморбидных состояний, диагностика стеатогепатита и выраженный фиброз печени). Первым препаратом, который одобрило FDA для лечения метаболически ассоциированного стеатогепатита (МАСГ), был агонист THR-β – ресметиром. Вышеуказанные нововведения обусловили стремление к пересмотру назначения пиоглитазона, метформина, витамина E и препаратов с цитопротективной активностью для лечения МАСГ в новых международных рекомендациях. Вместе с тем российские рекомендации 2024 г. по ведению пациентов с МАЖБП оставляют возможность для применения большой группы лекарственных препаратов для терапии различных фенотипов МАЖБП. В данном обзоре мы обращаем внимание на препараты полиненасыщенных жирных кислот (ПНЖК), одним из представителей которых является Эссенциале форте Н, имеющий широкую доказательную базу. Возможности применения ПНЖК для терапии МАЖБП обсуждаются в рекомендациях Европейской ассоциации по изучению печени 2024 г. и новом международном консенсусе по МАЖБП 2025 г.

In 2023, a new nomenclature and pathophysiology were developed, a definition and diagnostic criteria for MASLD (metabolic dysfunction-associated steatotic liver disease) were proposed. The diagnostic criteria for MASLD were recommended to be the presence of liver steatosis and at least one of five cardiometabolic factors: 1) Quetelet index >25; waist circumference >94 cm for men and >80 cm for women; 2) fasting glucose content >5.6 mmol/l; 3) blood pressure >130/85 mm Hg; 4) blood triglyceride levels >1.7 mmol/l; 5) blood high-density lipoprotein cholesterol < 1 mmol/l. Basic treatment of patients with MASLD includes diet modification, increased physical activity and weight loss. Drug therapy is mainly required for patients with a high probability of disease progression (the presence of comorbid conditions, diagnosis of steatohepatitis and severe liver fibrosis). The first drug approved by the FDA for the treatment of metabolically associated steatohepatitis (MASH) was the THR-β agonist resmetirom. The above innovations have led to a desire to revise the prescription of pioglitazone, metformin, vitamin E and drugs with cytoprotective activity for the treatment of MASH in new international guidelines. At the same time, the 2024 Russian guidelines for the management of patients with MASLD leave room for the use of a large group of drugs for the treatment of various phenotypes of MASLD. In this review, we draw attention to polyunsaturated fatty acid (PUFA) drugs, one of which is Essentiale forte N, which have a broad evidence base. The potential use of PUFAs in the treatment of MASH is discussed in the 2024 European Association for the Study of the Liver guidelines and the new 2025 international consensus on MASH.

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