Новые возможности коррекции сахарного диабета 2 типа у пациентов с заболеваниями печени

Заболевания печени у пациентов с сахарным диабетом 2 типа встречаются с большей частотой, чем в общей популяции. Сахарный диабет 2-го типа оказывает негативное влияние на состояние печени, нарушая обмен белков, аминокислот, жиров и других веществ в гепатоцитах, что ведет к развитию  ее хронических заболеваний. Сочетание патологии печени и сахарного диабета является прогностическим фактором осложнений  и летального исхода. Ингибиторы натрий-глюкозного котранспортера 2-го типа (дапаглифлозин, эмпаглифлозин, канаглифлозин) оказывают позитивное влияние  на уменьшение степени жирового гепатоза, снижение концентрации печеночных  ферментов  и активности воспалительного процесса в печени, улучшая гистологическую картину стеатоза и стеатогепатита. Прогрессирование изменений в печени при сахарном диабете 2 типа в виде неалкогольной жировой болезни печени, объединяющей  неалкогольный стеатоз и неалкогольный стеатогепатит, имеющих общие механизмы с синдромом инсулинорезистентности, отражает этапы формирования заболеваний печени, приводящие в итоге к развитию ее цирроза. Проведенные исследования указывают на эффективность натрий-глюкозных котранспортеров 2-го типа у пациентов с циррозом печени. У пациентов с неалкогольной жировой болезнью печени и сахарным диабетом 2 типа при лечении ингибиторами  натрий-глюкозного котранспортера  2-го типа отмечается улучшение гистопатологических характеристик  при проведении биопсии печени. Кроме того, у этих пациентов наблюдалось снижение индекса массы тела, окружности талии, уровня гликемии.  У больных сахарным диабетом 2 типа и неалкогольной жировой болезнью печени, подверженных повышенному  риску развития цирроза печени, при лечении ингибиторами натрий-глюкозного котранспортера 2-го типа наблюдалось клинически значимое снижение уровня аланинаминотранферазы в сыворотке крови. Препараты хорошо переносятся пациентами с заболеваниями печени,  безопасны в применении и могут с успехом использоваться у больных с печеночной недостаточностью.

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