gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2024-1167-3098-1gastro-j-1167Research ArticleОБЗОРЫREVIEWSВнутрипеченочный холестаз при хронических заболеваниях печени и роль адеметионина в его лечении (обзор литературы и резолюция Совета экспертов)Cholestasis in Chronic Liver Disease and the Role of Ademetionine in its Treatment (Literature Review and Expert Panel Resolution)https://orcid.org/0000-0002-8821-6142РайхельсонК. Л.RaikhelsonK. L.

Карина Леонидовна Райхельсон, доктор медицинских наук, профессор

Научно-клинический и образовательный центр гастроэнтерологии и гепатологии

199106; 21-я линия Васильевского острова, 8а; Санкт-Петербург

Karina L. Raikhelson, Dr. Sci. (Med.), Professor

Scientific, Clinical and Educational Center of Gastroenterology and Hepatology

199106; 21st Line of Vasilyevsky Island, 8а; Saint Petersburg

kraikhelson@mail.ruhttps://orcid.org/0000-0002-5041-3466БуеверовА. О.BueverovA. O.

Алексей Олегович Буеверов, доктор медицинских наук, профессор, ведущий научный сотрудник

Институт профессионального образования; кафедра медико-социальной экспертизы, неотложной и поликлинической терапии;  отделение гепатологии

129110;  ул. Щепкина, 61/2; Москва

Aleksey O. Bueverov, Dr. Sci. (Med.), Professor, Leading Researcher

Institute of Professional Education; Department of Medical and Social Expertise, Emergency and Outpatient Therapy; Department of Hepatology

129110; Shchepkina str., 61/2; Moscow

bcl72@yandex.ruhttps://orcid.org/0000-0002-0142-0264КондрашинаЭ. А.KondrashinaE. A.

Элина Александровна Кондрашина, кандидат медицинских наук, доцент

научно-клинический и образовательный центр гастроэнтерологии и гепатологии

199106; 21-я линия Васильевского острова, 8а; Санкт-Петербург

Elina A. Kondrashina, Cand. Sci. (Med.), Associate Professor

Scientific, Clinical and Educational Center of Gastroenterology and Hepatology

199106; 21st Line of Vasilyevsky Island, 8а; Saint Petersburg

elalkon@rambler.ruhttps://orcid.org/0000-0001-8913-140XМаевскаяМ. В.MaevskayaM. V.

Марина Викторовна Маевская, доктор медицинских наук, профессор

119435; ул. Погодинская, 1, стр. 1; Москва

Marina V. Maevskaya, Dr. Sci. (Med.), Professor

119435; Pogodinskaya str., 1, build. 1; Moscow

maevskaya_m_v@staff.sechenov.ruhttps://orcid.org/0000-0002-0944-9811ХлыновИ. Б.KhlynovI. B.

Игорь Борисович Хлынов, доктор медицинских наук, доцент, главныйвнештатный гастроэнтеролог Уральского федерального округа

кафедра факультетской терапии и гериатрии

620028; ул. Репина, 3; Екатеринбург

Igor B. Khlynov, Dr. Sci. (Med.), Associate Professor, Chief Freelance Gastroenterologist of the Ural Federal District

Department of Faculty Therapy and Geriatrics

620028; Repina str., 3; Yekaterinburg

hlinov.doc@yandex.ruhttps://orcid.org/0000-0002-6819-0889ШироковаЕ. Н.ShirokovaE. N.

Елена Николаевна Широкова, доктор медицинских наук, профессор

Институт клинической медицины им. Н.В. Склифосовского; кафедра пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

119435;  ул. Погодинская, 1, стр. 1; Москва

Elena N. Shirokova, Dr. Sci. (Med.), Professor

N.V. Sklifosovsky Institute of Clinical Medicine; Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119435; Pogodinskaya str., 1, build. 1; Moscow

shirokova_e_n@staff.sechenov.ruhttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Владимир Трофимович Ивашкин, доктор медицинских наук, академик РАН, профессор, заведующий кафедрой, директор Клиники

Институт клинической медицины им. Н.В. Склифосовского; кафедра пропедевтики внутренних болезней, гастроэнтерологии и гепатологии; Клиника пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко

119435; ул. Погодинская, 1, стр. 1; Москва

Vladimir T. Ivashkin, Dr. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Head of the Department, Director of Clinic

N.V. Sklifosovsky Institute of Clinical Medicine; Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology; V.Kh. Vasilenko Clinicof Internal Diseases Propedeutics, Gastroenterology and Hepatology

119435; Pogodinskaya str., 1, build. 1; Moscow

ФБГОУ ВО «Санкт-Петербургский государственный университет»РоссияSaint Petersburg State UniversityRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский Университет) Министерства здравоохранения Российской Федерации»; ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»РоссияI.M. Sechenov First Moscow State University (Sechenov University); M.F. Vladimirsky Moscow Regional Research and Clinical InstituteRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский Университет) Министерства здравоохранения Российской Федерации»РоссияI.M. Sechenov First Moscow State University (Sechenov University)Russian FederationФГБОУ ВО «Уральский государственный медицинский университет»РоссияUral State Medical UniversityRussian Federation2024230520243442033Copyright © Райхельсон К.Л., Буеверов А.О., Кондрашина Э.А., Маевская М.В., Хлынов И.Б., Широкова Е.Н., Ивашкин В.Т., 20242024Райхельсон К.Л., Буеверов А.О., Кондрашина Э.А., Маевская М.В., Хлынов И.Б., Широкова Е.Н., Ивашкин В.Т.Raikhelson K.L., Bueverov A.O., Kondrashina E.A., Maevskaya M.V., Khlynov I.B., Shirokova E.N., Ivashkin V.T.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/1167   Цель

   Цель: проанализировать принципы диагностики и лечения внутрипеченочного холестаза при хронических заболеваниях печени, представить данные об эффективности адеметионина в лечении хронических заболеваний печени с внутрипеченочным холестазом и материалы совещания экспертов, состоявшегося в 2023 г.

   Основные положения

   Основные положения. В ходе совещания экспертов были обсуждены проблемы диагностики и лечения внутрипеченочного холестаза при различных хронических заболеваниях печени, уточнена эффективность адеметионина, определены оптимальные схемы его приема. Оценена актуальность существующего алгоритма диагностики холестаза в реальной клинической практике. Продемонстрирована эффективность адеметионина в лечении различных заболеваний печени, протекающих с внутрипеченочным холестазом (холестатические формы лекарственных поражений печени, алкогольная болезнь печени, неалкогольная болезнь печени, первичный билиарный холангит), проявляющаяся уменьшением клинических и лабораторных признаков холестаза. Уточнены антихолестатические механизмы действия адеметионина, которые заключаются в нормализации текучести мембран гепатоцитов, регуляции активности Nrf2, ключевого фактора транскрипции, подавлении перекисного окисления липидов и обусловленного им повреждения гепатоцитов и холангиоцитов. Рассмотрены оптимальные схемы назначения адеметионина для различных клинических ситуаций.

   Выводы

   Выводы. Адеметионин является эффективным препаратом, который благодаря плейотропному действию и благоприятному профилю безопасности может применяться при различных хронических заболеваниях печени, сопровождающихся холестазом, в том числе в составе комплексной терапии.

   Aim

   Aim: to analyse the principles of diagnosis and treatment of intrahepatic cholestasis in chronic liver diseases, to present data on the effectiveness of ademetionine in the treatment of chronic liver diseases with intrahepatic cholestasis and the materials of the Expert Meeting held in 2023.

   Key points

   Key points. During the Expert Meeting, the problems of diagnostics and treatment of intrahepatic cholestasis in various chronic liver diseases were discussed, the effectiveness of ademetionine was clarified, and optimal regimens for its administration were determined. The relevance of the existing algorithm for diagnosing cholestasis in real clinical practice was assessed. The effectiveness of ademetionine in the treatment of various liver diseases occurring with intrahepatic cholestasis (cholestatic forms of drug-induced liver damage, alcoholic liver disease, non-alcoholic liver disease, primary biliary cholangitis) was demonstrated, manifested by a decrease in clinical and laboratory signs of cholestasis. The anticholestatic mechanisms of ademetionine action were clarified, which consist in normalizing the fluidity of hepatocyte membranes, regulating the activity of Nrf2, a key transcription factor, suppressing lipid peroxidation and the resulting damage to hepatocytes and cholangiocytes. Optimal regimens for prescribing ademetionine for various clinical situations were considered.

   Conclusions

   Conclusions. Ademetionine is an effective drug that, due to its pleiotropic action and favourable safety profile, can be used in various chronic liver diseases accompanied by cholestasis, including as a part of the complex therapy.

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