Принципы диагностики и лечения алкоголь-индуцированного фиброза печени

Связанные со злоупотреблением алкоголем заболевания печени являются одной из ведущих причин смерти во всем мире прежде всего вследствие осложнений цирроза печени (ЦП). Раннее выявление алкоголь-индуцированного фиброза печени (ФП) представляет собой сложную задачу, поскольку нередко алкогольная болезнь печени (АБП) клинически проявляет себя лишь на поздних стадиях. Учитывая, что страдают ей далеко не все алкоголики, широкое применение биопсии печени для верификации диагноза не целесообразно. Несмотря на разнообразие предложенных неинвазивных методов оценки тяжести ФП у пациентов с АБП, ни один из них не имеет достаточной валидации и поэтому не может быть рекомендован для широкой клинической практики. При этом наиболее хорошо изученная транзиентная эластография из-за неоптимальной специфичности оказалась эффективной только для исключения клинически значимого ФП или ЦП. Единственным проверенным подходом к лечению АБП служит стойкое и полное воздержание от алкоголя. Если принципы ведения пациентов с тяжелыми формами острого гепатита остаются неизменными с 1970-х гг. и основаны главным образом на использовании кортикостероидов, то утвержденные клиническими рекомендациями схемы антифибротической терапии АБП в настоящее время отсутствуют. Вместе с тем современные достижения  в понимании патофизиологических механизмов  этого  заболевания послужили толчком к разработке путей решения проблемы. В частности, обеспечение эубиоза кишечника может быть важной целью профилактики и лечения алкоголь-индуцированного ФП. Для подтверждения этой и других гипотез, связанных с антифибротической терапией АБП, и принятия их в качестве стандарта оказания медицинской помощи необходимы рандомизированные контролируемые мультицентровые исследования с участием большого числа пациентов.

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