medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-456medsovet-9568Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYМетаболически ассоциированная жировая болезнь печени: роль в развитии коморбидных состояний и перспективы терапииMetabolic dysfunction-associated steatotic liver disease: Role in the development of comorbid conditions and therapeutic managementhttps://orcid.org/0000-0001-6385-540XДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна, д.м.н., профессор, заведующая кафедрой эндокринологии лечебного факультета Института клинической медицины

117997, Россия, Москва, ул. Островитянова, д. 1 

Tatiana Yu. Demidova, Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology, Faculty of Medicine, Institute of Clinical Medicine

1, Ostrovityanov St., Moscow, 117997, Russia

t.y.demidova@gmail.comhttps://orcid.org/0000-0002-8684-6095ТитоваВ. В.ТitovaV. V.

Титова Виктория Викторовна, ассистент кафедры эндокринологии лечебного факультета Института клинической медицины

117997, Россия, Москва, ул. Островитянова, д. 1 

Victoria V. Тitova, Assistant of the Department of Endocrinology, Faculty of Medicine, Institute of Clinical Medicine

1, Ostrovityanov St., Moscow, 117997, Russia

meteora-vica@mail.ruhttps://orcid.org/0000-0002-9430-0391ЛевицкаяА. Н.LevitskayaA. N.

Левицкая Анастасия Николаевна, ассистент кафедры эндокринологии лечебного факультета Института клинической медицины

117997, Россия, Москва, ул. Островитянова, д. 1 

Anastasiya N. Levitskaya, Assistant of the Department of Endocrinology, Faculty of Medicine, Institute of Clinical Medicine

1, Ostrovityanov St., Moscow, 117997, Russia

levitskaya.anastasiya@internet.ruhttps://orcid.org/0009-0000-6052-0233ГёзалянМ. А.GyozalyanM. A.

Гёзалян Мэри Артуровна, ассистент кафедры эндокринологии лечебного факультета Института клинической медицины

117997, Россия, Москва, ул. Островитянова, д. 1 

Mary A. Gyozalyan, Assistant of the Department of Endocrinology, Faculty of Medicine, Institute of Clinical Medicine

1, Ostrovityanov St., Moscow, 117997, Russia

marygyozalyan26@gmail.comРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202520112025016238–250Copyright © Демидова Т.Ю., Титова В.В., Левицкая А.Н., Гёзалян М.А., 20252025Демидова Т.Ю., Титова В.В., Левицкая А.Н., Гёзалян М.А.Demidova T.Y., Тitova V.V., Levitskaya A.N., Gyozalyan M.A.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/9568

Рост распространенности избыточной массы тела и ожирения приобрел характер глобальной эпидемии, что повлекло за собой увеличение частоты ассоциированных метаболических нарушений. Среди них ведущее место занимает метаболически ассоциированная жировая болезнь печени (МАЖБП), которая признана наиболее распространенной хронической патологией печени в мире, затрагивающей, по различным оценкам, около 38% населения. МАЖБП представляет собой спектр состояний, включающий простой стеатоз, метаболически ассоциированный стеатогепатит, фиброз и цирроз печени. Значимость МАЖБП обусловлена не только ее высокой распространенностью, но и значительным влиянием на общую заболеваемость и смертность. Данное заболевание ассоциировано с повышенным риском развития сахарного диабета 2-го типа, сердечно-сосудистых заболеваний, хронической болезни почек и некоторых видов злокачественных новообразований. При этом основной причиной смерти пациентов с МАЖБП являются не печеночные, а кардиоваскулярные осложнения, что подчеркивает системный характер метаболических нарушений, лежащих в основе патогенеза. Современная диагностика заболевания все больше смещается в сторону использования неинвазивных методов, позволяющих оценить степень стеатоза и фиброза печени, что особенно важно для скрининга и динамического наблюдения в условиях большой распространенности патологии. Терапевтические подходы к МАЖБП продолжают активно развиваться. В то время как модификация образа жизни остается основой лечения, все большую роль приобретает фармакотерапия, включающая как препараты с метаболическим действием, так и гепатотропные средства, например, эссенциальные фосфолипиды. Появление новых лекарственных средств, целенаправленно воздействующих на ключевые звенья патогенеза, открывает возможности для патогенетической терапии и улучшения долгосрочных исходов. Цель данного обзора – анализ современных представлений о диагностике, патогенезе и перспективных направлениях терапии МАЖБП, а также оценка места различных классов лекарственных препаратов, в том числе эссенциальных фосфолипидов, в комплексном ведении пациентов с данным заболеванием.

The rising prevalence of overweight and obesity has grown into a global epidemic, which entailed the increased incidence of associated metabolic disorders. Metabolic dysfunction-associated steatotic liver disease (MASLD) ranks highest among them. It is recognized as the most common chronic liver disease worldwide, affecting approximately 38% of the global population, by various estimates. MASLD represents a range of conditions including simple steatosis, metabolically associated steatohepatitis, fibrosis, and cirrhosis. The significance of MASLD is caused by not only its high prevalence, but also by its essential impact on overall morbidity and mortality rates. This disease is associated with an increased risk of developing type 2 diabetes, cardiovascular disease, chronic kidney disease, and certain malignancies. Moreover, the leading cause of death in patients with MASLD is not liver-related but cardiovascular complications, which emphasises the systemic nature of the metabolic abnormalities underlying its pathogenesis. Modern diagnostic techniques of the disease are increasingly shifting towards noninvasive methods allowing to evaluate the severity of steatosis and liver fibrosis, which is particularly important for screening and case follow-up in settings where the disease affects a large number of people. MASLD management strategies remain under active development. While lifestyle modification remains the mainstay of treatment, the drug therapy, including both metabolic agents and hepatotropic drugs such as essential phospholipids, continually gains in importance. The emergence of new drugs that specifically target the key components of pathogenesis opens up potential for pathogenetic therapy and improvement of long-term outcomes. This review is aimed to analyse the present-day ideas of the diagnosis, pathogenesis, and promising directions of MASLD treatment, as well as to assess the role of different classes of drugs, including essential phospholipids, in the comprehensive management of patients with this disease.

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