Метаболически ассоциированная жировая болезнь печени: роль в развитии коморбидных состояний и перспективы терапии

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.

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