Эссенциальные фосфолипиды в терапии метаболически ассоциированной жировой болезни печени: от молекулярных механизмов к клинической эффективности (обзор литературы)

Метаболически ассоциированная жировая болезнь печени (МАЖБП) является зонтичным понятием, охватывающим спектр состояний от стеатоза до метаболически ассоциированного стеатогепатита (МАСГ), фиброза и цирроза печени, связанных с системной метаболической дисфункцией. МАЖБП демонстрирует неуклонный рост распространенности и имеет тесную взаимосвязь с сердечно-сосудистой заболеваемостью и смертностью, что делает ее одним из наиболее актуальных хронических неинфекционных заболеваний. В настоящем обзоре проанализированы данные клинических исследований (КИ), посвященных эффективности применения эссенциальных фосфолипидов (ЭФЛ) в качестве средства монотерапии и адъювантной терапии МАЖБП с учетом особенностей их механизмов действия, эффектов и потенциала фармакологического энхансинга. Обзор выполнен в нарративном (несистематическом) формате на основании поиска источников, проведенного в российских и международных специализированных базах данных и регистрах КИ. ЭФЛ и их основной активный компонент – 1,2-дилинолеоилфосфатидилхолин – повышают стабильность и текучесть клеточных мембран, поддерживают трансмембранные процессы, уменьшают выраженность митохондриальной дисфункции и оксидативного стресса, ингибируют липогенез, облегчают эффлюкс желчных кислот, замедляют активацию звездчатых клеток печени, уменьшают локальное воспаление и апоптоз гепатоцитов. Помимо собственной гепатотропной активности, ЭФЛ способны выступать в роли фармакологического энхансера, повышая биодоступность, пролонгируя системную циркуляцию и усиливая эффекты других лекарственных соединений. При использовании в качестве средства монотерапии МАЖБП/МАСГ ЭФЛ оказывают антицитолитический эффект, могут уменьшать стеатоз печени (по данным ультрасонографии) и улучшать показатели липидного спектра, однако имеющиеся доказательства ограничены малой мощностью и погрешностями дизайна КИ. Наибольший интерес представляют возможности применения ЭФЛ в рамках комплексной фармакотерапии МАЖБП у коморбидных пациентов. В КИ подтверждено, что включение ЭФЛ в схемы базисной терапии позволяет повысить ее эффективность в отношении морфологических изменений в печени, маркерных ферментов, показателей липидного обмена, а также качества жизни пациентов.

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