Современные взгляды на тактику ведения пациентов с саркопенией в сочетании с неалкогольной жировой болезнью печени

Введение. Распространенность саркопении в мире составляет 10% как у мужчин, так и у женщин. В последние годы все больше накапливается сведений о повышенной распространенности саркопении у пациентов с неалкогольной жировой болезнью печени. Известно, что гиподинамия сопровождается уменьшением мышечной массы и влияет на профиль выработки миокинов и на предотвращение дальнейшей потери мышечной массы и накопления внутрипеченочного жира. Секреция миокина иризина индуцируется физической нагрузкой, что, по-видимому, объясняет негативное влияние гиподинамии на стеатоз печени. Существует также связь между физической активностью и выработкой гепатокинов. Кроме того, потеря мышечной силы и отсутствие физической активности является фактором риска более прогрессирующей потери мышечной массы, накопления жира и усугубления воспаления, что приводит к порочному кругу повторяющейся гиподинамии и еще более выраженной саркопении.
Результаты. В обзорной статье приводятся данные о влиянии различных типов физической нагрузки на саркопению. Отдельное внимание уделяется роли миокинов в патогенезе саркопении и современным препаратам — ингибиторам миостатина. Рассматриваются аспекты роли гипераммониемии в патогенезе саркопении и вопросы влияния на данный патогенетический механизм. Описываются аспекты нутритивной поддержки пациентов с саркопенией.

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