Роль адипоцитокинов в развитии неалкогольной жировой болезни печени у детей и подростков

За последние 20 лет доля детей и подростков с избыточной массой тела и ожирением значительно увеличилась в большинстве стран. Ожирение представляет собой основной кардиометаболический риск и тесно связано с сопутствующими заболеваниями, такими как гипертония, гиперлипидемия, гиперинсулинемия, диабет 2-го типа и неалкогольная жировая болезнь печени (НАЖБП). Существует много неопределенности в отношении диагностики метаболического синдрома у детей, в основном из-за различных и противоречивых предложенных определений. Распространенность метаболического синдрома значительно различалась у детей (от 6 до 39%) в зависимости от применяемых критериев определения. В соответствии с этими определениями только 2% детей соответствовали всем критериям метаболического синдрома. В течение последнего десятилетия исследования показали, что параллельно с увеличением распространенности ожирения в педиатрической популяции НАЖБП стала наиболее распространенной формой заболевания печени в детском возрасте. При НАЖБП воспалительные цитокины/адипокины и другие факторы приводят к стеатогепатиту и/или фиброзу. Недавно было идентифицировано несколько адипоцитокинов и воспалительных цитокинов со значительной положительной (лептин, хемерин, васпин, TNF-α, IL-6 и IL-8) или отрицательной (адипонектин) связью с метаболическими факторами риска. Некоторые из них можно рассматривать как патофизиологические факторы, связывающие ожирение и его осложнения, такие как резистентность к инсулину и НАЖБП. Однако данные о других адипоцитокинах и их роли в метаболизме остаются спорными и частично неизвестными, особенно в отношении их роли в детском возрасте (резистин, NAMPT, FGF-21, A-FABP, RBP4, липокалин-2, оментин-1, вчСРБ). Адипоцитокины являются новым и действенным инструментом не только для диагностики и стратификации НАЖБП и метаболического синдрома, но и как потенциальная терапевтическая мишень. Адипоцитокиновая терапия требует дальнейшего изучения у всех больных с метаболическим синдромом и НАЖБП, особенно у детей и подростков.

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