lvrachЛечащий ВрачLechaschi Vrach1560-51752687-118110.51793/OS.2024.27.8.001lvrach-1270Research ArticleГАСТРОЭНТЕРОЛОГИЯ. ГЕПАТОЛОГИЯGASTROENTEROLOGY. HEPATOLOGYНеалкогольная жировая болезнь печени и сердечно-сосудистая патология: патогенетические параллелиNon-alcoholic fatty liver disease and cardiovascular pathology: pathogenetic parallelshttps://orcid.org/0000-0003-4391-2889КноррингГ. Ю.KnorringG. Yu.

Кнорринг Герман Юрьевич, к.м.н., доцент кафедры терапии, клинической фармакологии и скорой медицинской помощи лечебного факультета научно-образовательного института клинической медицины имени Н. А. Семашко

127006, Москва, ул. Долгоруковская, 4

German Yu. Knorring, Cand. of Sci. (Med.), Associate Professor of the Department of Therapy, Clinical Pharmacology and Emergency Medicineof the Faculty of Medicineof the N. A. Semashko Scientific and Educational Institute of Clinical Medicine

4 Dolgorukovskaya str., Moscow, 127006

knorring@mail.ruhttps://orcid.org/0000-0002-3125-6282ПахомоваИ. Г.PakhomovaI. G.

Пахомова Инна Григорьевна, к.м.н., доцент кафедры факультетской терапии с клиникой

197341, Санкт-Петербург, ул. Аккуратова 2

Inna G. Pakhomova, Cand. of Sci. (Med.), Associate Professor of the Department of Faculty Therapy with Clinic

2 Akkuratova str., St. Petersburg, 197341

pakhomova-inna@yandex.ruhttps://orcid.org/0000-0003-2487-5509СедякинаЮ. В.SedyakinaYu. V.

Седякина Юлия Владимировна, к.м.н., доцент кафедры терапии, клинической фармакологии и скорой медицинской помощи лечебного факультета научно-образовательного института клинической медицины имени Н. А. Семашко

127006, Москва, ул. Долгоруковская, 4

Yulia V. Sedyakina, Cand. of Sci. (Med.), Associate Professor of the Department of Therapy, Clinical Pharmacology and Emergency Medicineof the Faculty of Medicineof the N. A. Semashko Scientificand Educational Institute of Clinical Medicine

4 Dolgorukovskaya str., Moscow, 127006

sedyakinayulia@gmail.comКурджиеваС. С.KurdzhievaS. S.

Курджиева Светлана Сергеевна, ассистент кафедры терапии, клинической фармакологии и скорой медицинской помощи лечебного факультета научно-образовательного института клинической медицины имени Н. А. Семашко

127006, Москва, ул. Долгоруковская, 4

Svetlana S. Kurdzhieva, Assistant of the Department of Therapy, Clinical Pharmacology and Emergency Medicineof the Faculty of Medicineof the N. A. Semashko Scientific and Educational Institute of Clinical Medicine

4 Dolgorukovskaya str., Moscow, 127006

kafedrakf@mail.ruРоссийский университет медициныРоссияRussian University of MedicineRussian FederationНациональный медицинский исследовательский центр имени В. А. АлмазоваРоссияV. A. Almazov National Medical Research CenterRussian Federation20242408202408814Copyright © Кнорринг Г.Ю., Пахомова И.Г., Седякина Ю.В., Курджиева С.С., 20242024Кнорринг Г.Ю., Пахомова И.Г., Седякина Ю.В., Курджиева С.С.Knorring G.Y., Pakhomova I.G., Sedyakina Y.V., Kurdzhieva S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.lvrach.ru/jour/article/view/1270

Введение. Последними исследованиями и руководствами неалкогольная жировая болезнь печени признается междисциплинарной проблемой на стыке гастроэнтерологии, кардиологии и эндокринологии. Возросший в последние годы интерес к неалкогольной жировой болезни печени как самому распространенному хроническому заболеванию определяет эту патологию как вносящую вклад в развитие и прогрессирование сердечно-сосудистых заболеваний и сахарного диабета 2-го типа. Проведенные исследования последовательно раскрывают сложные механизмы взаимовлияния сосудистой патологии и неалкогольной жировой болезни печени, а также нарушений обмена углеводного и жирового обмена.Цель работы. Обзорная статья рассматривает патогенетические пути влияния неалкогольной жировой болезни печени на развитие и прогрессирование сердечно-сосудистых заболеваний в зависимости от факторов риска и коморбидности. Показана четкая ассоциация неалкогольной жировой болезни печени с ожирением, метаболическим синдромом и сахарным диабетом 2-го типа, а также с сердечно-сосудистыми заболеваниями, что подчеркивает взаимозависимость этих коморбидных состояний.Результаты. В течении неалкогольной жировой болезни печени можно выделить несколько патогенетических механизмов – ударов (толчков), тесно сопряженных с метаболическими нарушениями, влияющими на развитие широкого круга сердечно-сосудистой и эндокринной патологии. Также показано отрицательное влияние неалкогольной жировой болезни печени на развитие, течение и прогноз хронической болезни почек, злокачественных новообразований ряда локализаций, цирроза и рака печени. Однако существуют доказательства того, что контроль и патогенетически обоснованная терапия неалкогольной жировой болезни печени с коррекцией метаболических и сопутствующих сосудистых нарушений способны положительно повлиять на течение как самого заболевания, так и коморбидных состояний. Обсуждаются роль препаратов урсодезоксихолевой кислоты в лечении неалкогольной жировой болезни печени и влияние этой терапии на течение ассоциированных заболеваний и состояний. Отмечено наличие плейотропных эффектов урсодезоксихолевой кислоты в первую очередь на гепатоциты с реализацией антиоксидантного, цитопротективного и антифибротического действия, а также метаболическое действие – гиполипидемический эффект, снижение уровня общего холестерина и липопротеинов низкой плотности, положительное влияние на параметры гликемии.Заключение. Сложные взаимозависимые механизмы развития неалкогольной жировой болезни печени, сосудистой и эндокринной патологии требуют дальнейшего изучения и уточнения, в том числе для разработки новых и оценки имеющихся подходов к ведению пациентов с подобными состояниями и заболеваниями, к числу которых относится и применение урсодезоксихолевой кислоты.

Background. Recent studies and guidelines recognize non-alcoholic fatty liver disease (NAFLD) as an interdisciplinary problem at the intersection of gastroenterology, cardiology and endocrinology. The increased interest in NAFLD in recent years, as the most common chronic disease, identifies this pathology as a participant in the development and progression of cardiovascular diseases and type 2 diabetes mellitus. The studies carried out consistently reveal the complex mechanisms of mutual influence of vascular pathology and NAFLD, as well as carbohydrate and fat metabolism disorders.Objective. The review article examines the pathogenetic pathways of the influence of NAFLD on the development and progression of cardiovascular diseases depending on risk factors and comorbidity. A clear association of NAFLD with obesity, metabolic syndrome and type 2 diabetes, as well as with cardiovascular diseases has been shown, which emphasizes the interdependence of these comorbid conditions.Results. Analysis of the course of NAFLD identifies several pathogenetic mechanisms – shocks (shocks), closely associated with metabolic disorders that affect the development of a wide range of pathologies, cardiovascular and endocrine. The negative impact of NAFLD on the development, course and prognosis of chronic kidney disease, malignant neoplasms of a number of localizations, as well as cirrhosis and liver cancer has also been shown. However, there is evidence that control and pathogenetically based therapy of NAFLD with correction of metabolic and concomitant vascular disorders can positively affect the course of both the disease itself and comorbid conditions. The role of ursodeoxycholic acid (UDCA) drugs in the treatment of NAFLD and the impact of this therapy on the course of associated diseases and conditions are discussed. The presence of pleiotropic effects of UDCA was noted, primarily on hepatocytes with the implementation of antioxidant, cytoprotective and antifibrotic effects, as well as metabolic effects: hypolipidemic effect, reduction in the level of total cholesterol and low-density lipoproteins, and a positive effect of UDCA on glycemic parameters.Conclusion. The complex interdependent mechanisms of the development of NAFLD, vascular and endocrine pathologies require further study and clarification, including the development of new and evaluation of existing approaches to the management of patients with similar conditions and diseases, which include the use of ursodeoxycholic acid.

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