gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1031Research ArticleГЕПАТОЛОГИЯHEPATOLOGYНовые аспекты неалкогольной жировой болезни печениNew aspects of non-alcoholic fatty liver diseaseЦукановВ. В.TsukanovV. V.

Цуканов Владислав Владимирович — доктор медицинских наук, профессор, руководитель клинического отделения патологии пищеварительной системы у взрослых 

660022, г. Красноярск, ул. Партизана Железняка, д.3-г

Tsukanov Vladislav V — MD, PhD, professor, head of clinical department of digestive diseases in adults,

660022, Krasnoyarsk, Partizana Zheleznyaka street, 3-g.

gastro@impn.ruКаспаровЭ. В.KasparovE. V.

Каспаров Эдуард Вильямович — доктор медицинских наук, профессор, ВРИО директора 

kompleks2009@mail.ruТонкихЮ. Л.TonkikhYu. L.

Тонких Юлия Леонгардовна — кандидат медицинских наук, ведущий научный сотрудник клинического отделения патологии пищеварительной системы у взрослых 

tjulia@bk.ruВасютинА. В.VasyutinA. V.

Васютин Александр Викторович — кандидат медицинских наук, старший научный сотрудник клинического отделения патологии пищеварительной системы у взрослых

alexander@kraslan.ruФедеральное государственное бюджетное научное учреждение «Научно-исследовательский институт медицинских проблем Севера»РоссияFederal State Budgetary Institution «Scientific research institute of medical problems of the North Siberian branch», Russian Academy of Medical ScienceRussian Federation2015290920152543438Copyright © Цуканов В.В., Каспаров Э.В., Тонких Ю.Л., Васютин А.В., 20152015Цуканов В.В., Каспаров Э.В., Тонких Ю.Л., Васютин А.В.Tsukanov V.V., Kasparov E.V., Tonkikh Y.L., Vasyutin A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1031

Цель обзора. Проанализировать современные данные о патогенезе и принципах лечения неалкогольной жировой болезни печени (НАЖБП).Основные положения. В настоящее время быстро развиваются представления о генетических детерминантах и методах диагностики НАЖБП. Лечение этой патологии заключается в применении дозированных физических нагрузок, модификации диеты, снижении массы тела, использовании инсулиновых сенситайзеров, препаратов с цитопротективной активностью и антиоксидантов.Заключение. Стремительное развитие подходов к НАЖБП требует повышенного внимания медицинских специалистов к рассматриваемой проблеме.

The aim of review

The aim of review. To analyze modern data on pathogenesis and principles of treatment of non-alcoholic fatty liver disease (NAFLD).

Key points

Key points. Now concepts on genetic determinants of NAFLD and diagnostics methods develop rapidly. Treatment of NAFLD consists in application of graduated physical activity, diet modification, weight loss, application of insulin sensitizers, cytoprotective agents and antioxidants.

Conclusion

Conclusion. Prompt development of approaches to NAFLD requires enhanced attention of medical experts to this issue.

НАЖБПлечениепатогенезNAFLDtreatmentpathogenesisReferencesИвашкин В.Т., Маевская М.В. Липотоксичность и метаболические нарушения при ожирении. Рос журн гастроэнтерол гепатол колопроктол 2012; 22(1):82-6.Ivashkin V.T., Mayevskaya M.V. Lipotoxicity and metabolic disorders at obesity. Ros zhurn gastroenterol gepatol koloproktol 2012; 22(1):82-6.Цуканов В.В., Тонких Ю.Л., Каспаров Э.В. и др. Неалкогольная жировая болезнь печени у взрослого городского населения России (распространенность и факторы риска). Врач 2010; 9:2-6.Tsukanov V.V., Tonkikh Yu. L., Kasparov E.V. et al. Non-alcoholic fatty liver disease in adult urban population of Russia (prevalence and risk factors). Vrach 2010; 9:2-6.Цуканов В.В., Селиверстова Е.В., Догадин С.А. Показатели липидного состава сыворотки крови и желчи при заболеваниях желчевыводящих путей у больных сахарным диабетом. Тер арх 2005; 77(2):15-8.Tsukanov V.V., Selivyorstova Ye.V., Dogadin S.A. Lipid composition of blood serum and bile biliary tract diseases in patients with diabetes. Ther Arkh 2005; 77(2):15-8.Andreone P., Brisc M.C., Chiaramonte M., et al. Silybin conjugated with phosphatidilcholine and vitamin E improves liver damage in patients with NAFLD: the results of a randomized multicentre double-blind vs. placebo trial. J Hepatol 2011; 54(Suppl):330-1.Andreone P., Brisc M.C., Chiaramonte M., et al. Silybin conjugated with phosphatidilcholine and vitamin E improves liver damage in patients with NAFLD: the results of a randomized multicentre double-blind vs. placebo trial. J Hepatol 2011; 54(Suppl):330-1.Anstee Q.M., Day C.P. A lipid to treat non-alcoholic fatty liver disease — the dawn of «liporehabilitation»? J Hepatol 2012; 56(4):987-9.Anstee Q.M., Day C.P. A lipid to treat non-alcoholic fatty liver disease — the dawn of «liporehabilitation»? J Hepatol 2012; 56(4):987-9.Anstee Q.M., Day C.P. The genetics of NAFLD. Nat Rev Gastroenterol Hepatol 2013; 10(11):645-55.Anstee Q.M., Day C.P. The genetics of NAFLD. Nat Rev Gastroenterol Hepatol 2013; 10(11):645-55.Anstee Q.M., Targher G., Day C.P. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol 2013; 10(6):330-44.Anstee Q.M., Targher G., Day C.P. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol 2013; 10(6):330-44.Belfort R., Harrison S.A., Brown K., et al. A placebo controlled trial of pioglitazone in subjects with non-alcoholic steatohepatitis. N Engl J Med 2006; 355(22):2297-307.Belfort R., Harrison S.A., Brown K., et al. A placebo controlled trial of pioglitazone in subjects with non-alcoholic steatohepatitis. N Engl J Med 2006; 355(22):2297-307.Chalasani N., Younossi Z., Lavine J.E., et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142(7):1592- 609.Chalasani N., Younossi Z., Lavine J.E., et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology 2012; 142(7):1592- 609.Chambers J.C., Zhang W., Sehmi J., et al. Genome-wide association study identifies loci influencing concentrations of liver enzymes in plasma. Nat Genet 2011; 43(11):1131-8.Chambers J.C., Zhang W., Sehmi J., et al. Genome-wide association study identifies loci influencing concentrations of liver enzymes in plasma. Nat Genet 2011; 43(11):1131-8.Corrado R.L., Torres D.M., Harrison S.A. Review of treatment options for nonalcoholic fatty liver disease. Med Clin North Am 2014; 98(1):55-72.Corrado R.L., Torres D.M., Harrison S.A. Review of treatment options for nonalcoholic fatty liver disease. Med Clin North Am 2014; 98(1):55-72.De Wit N.J., Afman L.A., Mensink M., et al. Phenotyping the effect of diet on non-alcoholic fatty liver disease. J Hepatol 2012; 57(6):1370-3.De Wit N.J., Afman L.A., Mensink M., et al. Phenotyping the effect of diet on non-alcoholic fatty liver disease. J Hepatol 2012; 57(6):1370-3.Dowman J.K.,Tomlinson J.W.,NewsomeP. N. Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2011; 33(5):525-40.Dowman J.K.,Tomlinson J.W.,NewsomeP. N. Systematic review: the diagnosis and staging of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. Aliment Pharmacol Ther 2011; 33(5):525-40.Ivashkin V.T., Drapkina O.M. The prevalence of nonalcoholic fatty liver disease in Russian Federation. Gut 2009; 58):1207.Ivashkin V.T., Drapkina O.M. The prevalence of nonalcoholic fatty liver disease in Russian Federation. Gut 2009; 58):1207.Jacobs R.L., van der Veen J.N., Vance D.E. Finding the balance: the role of S-adenosylmethionine and phosphatidylcholine metabolism in development of nonalcoholic fatty liver disease. Hepatology 2013; 58(4):1207-9.Jacobs R.L., van der Veen J.N., Vance D.E. Finding the balance: the role of S-adenosylmethionine and phosphatidylcholine metabolism in development of nonalcoholic fatty liver disease. Hepatology 2013; 58(4):1207-9.Kotronen A., Johansson L.E., Johansson L.M., et al. A common variant in PNPLA3, which encodes adiponutrin, is associated with liver fat content in humans. Diabetologia 2009; 52(6):1056-60.Kotronen A., Johansson L.E., Johansson L.M., et al. A common variant in PNPLA3, which encodes adiponutrin, is associated with liver fat content in humans. Diabetologia 2009; 52(6):1056-60.Krawczyk M., Portincasa P. , Lammert F. PNPLA3-associated steatohepatitis: toward a gene-based classification of fatty liver disease. Semin Liver Dis 2013; 33(4):369-79.Krawczyk M., Portincasa P. , Lammert F. PNPLA3-associated steatohepatitis: toward a gene-based classification of fatty liver disease. Semin Liver Dis 2013; 33(4):369-79.Leuschner U.F., Lindenthal B., Herrmann G., et al. High-dose ursodeoxycholic acid therapy for nonalcoholic steatohepatitis: a double-blind, randomized, placebocontrolled trial. Hepatology 2010; 52(2):472-79.Leuschner U.F., Lindenthal B., Herrmann G., et al. High-dose ursodeoxycholic acid therapy for nonalcoholic steatohepatitis: a double-blind, randomized, placebocontrolled trial. Hepatology 2010; 52(2):472-79.Loomba R., Sanyal A. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol 2013; 10(11):686-90.Loomba R., Sanyal A. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol 2013; 10(11):686-90.Nascimbeni F., Pais R., Bellentani S., et al. From NAFLD in clinical practice to answers from guidelines. J Hepatol 2013; 59(4):859-71.Nascimbeni F., Pais R., Bellentani S., et al. From NAFLD in clinical practice to answers from guidelines. J Hepatol 2013; 59(4):859-71.Pan J.J., Fallon M.B. Gender and racial differences in nonalcoholic fatty liver disease. World. J. Hepatol 2014; 6(5):274-83. doi:10.4254/wjh.v6.i5.274. Review.Pan J.J., Fallon M.B. Gender and racial differences in nonalcoholic fatty liver disease. World. J. Hepatol 2014; 6(5):274-83. doi:10.4254/wjh.v6.i5.274. Review.Pathil A., Mueller J., Warth A., et al. Ursodeoxycholyl lysophosphatidylethanolamide improves steatosis and inflammation in murine models of nonalcoholic fatty liver disease. Hepatology 2012; 55(5):1369-78.Pathil A., Mueller J., Warth A., et al. Ursodeoxycholyl lysophosphatidylethanolamide improves steatosis and inflammation in murine models of nonalcoholic fatty liver disease. Hepatology 2012; 55(5):1369-78.Pearlman M., Loomba R. State of the art: treatment of nonalcoholic steatohepatitis. Curr Opin Gastroent 2014; 30(3):223-37.Pearlman M., Loomba R. State of the art: treatment of nonalcoholic steatohepatitis. Curr Opin Gastroent 2014; 30(3):223-37.Rakoski M.O., Singal A.G., Rogers M.A., et al. Metaanalysis: insulin sensitizers for the treatment of nonalcoholic steatohepatitis. Aliment Pharmacol Ther 2010; 32(10):1211-21.Rakoski M.O., Singal A.G., Rogers M.A., et al. Metaanalysis: insulin sensitizers for the treatment of nonalcoholic steatohepatitis. Aliment Pharmacol Ther 2010; 32(10):1211-21.Rinella M.E., Loomba R., Caldwell S.H., et al. Controversies in the diagnosis and management of NAFLD and NASH. Gastroenterol Hepatol (NY) — 2014; 10(4):219- 27.Rinella M.E., Loomba R., Caldwell S.H., et al. Controversies in the diagnosis and management of NAFLD and NASH. Gastroenterol Hepatol (NY) — 2014; 10(4):219- 27.Romeo S., Kozlitina J., Xing C., et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet 2008; 40(12):1461-5.Romeo S., Kozlitina J., Xing C., et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet 2008; 40(12):1461-5.Safadi R., Konikoff F.M., Mahamid M., et al. The fatty acid-bile acid conjugate aramchol reduces liver fat content in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2014. pii: S1542-3565(14)00673-9. [Epub ahead of print].Safadi R., Konikoff F.M., Mahamid M., et al. The fatty acid-bile acid conjugate aramchol reduces liver fat content in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2014. pii: S1542-3565(14)00673-9. [Epub ahead of print].Sanyal A.J., Abdelmalek M., Suzuki A., et al. No Significant effects of ethyl-eicosapentanoic acid on histologic features of nonalcoholic steatohepatitis in a phase 2 trial. Gastroenterology 2014. pii: S0016- 5085(14)00604-0. doi:10.1053/j.gastro.2014.04.046. [Epub ahead of print]Sanyal A.J., Abdelmalek M., Suzuki A., et al. No Significant effects of ethyl-eicosapentanoic acid on histologic features of nonalcoholic steatohepatitis in a phase 2 trial. Gastroenterology 2014. pii: S0016- 5085(14)00604-0. doi:10.1053/j.gastro.2014.04.046. [Epub ahead of print]Singal A.G., Manjunath H., Yopp A.C., et al. The effect of PNPLA3 on fibrosis progression and development of hepatocellular carcinoma: a meta-analysis. Review. Am J Gastroenterol 2014; 109(3):325-34.Singal A.G., Manjunath H., Yopp A.C., et al. The effect of PNPLA3 on fibrosis progression and development of hepatocellular carcinoma: a meta-analysis. Review. Am J Gastroenterol 2014; 109(3):325-34.Sookoian S., Pirola C.J. Meta-analysis of the influence of I148M variant of patatin-like phospholipase domain containing 3 gene (PNPLA3) on the susceptibility and histological severity of nonalcoholic fatty liver disease. Hepatology 2011; 53(6):1883-94.Sookoian S., Pirola C.J. Meta-analysis of the influence of I148M variant of patatin-like phospholipase domain containing 3 gene (PNPLA3) on the susceptibility and histological severity of nonalcoholic fatty liver disease. Hepatology 2011; 53(6):1883-94.Speliotes E.K., Yerges-Armstrong L.M., Wu J. Genomewide association analysis identifies variants associated with nonalcoholic fatty liver disease that have distinct effects on metabolic traits. PLoS Genet 2011; 7(3): e1001324.Speliotes E.K., Yerges-Armstrong L.M., Wu J. Genomewide association analysis identifies variants associated with nonalcoholic fatty liver disease that have distinct effects on metabolic traits. PLoS Genet 2011; 7(3): e1001324.Valenti L., Dongiovanni P. , Ginanni Corradini S., et al. PNPLA3 I148M variant and hepatocellular carcinoma: a common genetic variant for a rare disease. Dig Liver Dis 2013; 45(8):619-24.Valenti L., Dongiovanni P. , Ginanni Corradini S., et al. PNPLA3 I148M variant and hepatocellular carcinoma: a common genetic variant for a rare disease. Dig Liver Dis 2013; 45(8):619-24.Xiang Z., Chen Y.P. , Ma K.F. The role of ursodeoxycholic acid in non-alcoholic steatohepatitis: a systematic review. BMC Gastroenterol 2013; 13(9):140-52.Xiang Z., Chen Y.P. , Ma K.F. The role of ursodeoxycholic acid in non-alcoholic steatohepatitis: a systematic review. BMC Gastroenterol 2013; 13(9):140-52.Younossi Z.M., Reyes M.J., Mishra A., et al. Systematic review with meta-analysis: non-alcoholic steatohepatitis — a case for personalised treatment based on pathogenic targets. Aliment Pharmacol Ther 2014; 39(1):3-14.Younossi Z.M., Reyes M.J., Mishra A., et al. Systematic review with meta-analysis: non-alcoholic steatohepatitis — a case for personalised treatment based on pathogenic targets. Aliment Pharmacol Ther 2014; 39(1):3-14.

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