gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2019-29-1-17-23gastro-j-321Research ArticleОБЗОРЫREVIEWSКлинико-патогенетические параллели неалкогольной жировой болезни печени и желчнокаменной болезниClinical and Pathogenetic Parallels of Nonalcoholic Fatty Liver Disease and Gallstone DiseaseБуеверовА. О.BueverovAleksey O.

доктор медицинских наук, профессор кафедры медико-социальной экспертизы, неотложной и поликлинической терапии Института профессионального образования;

ведущий научный сотрудник МОНИКИ им. М.Ф. Владимирского

117556, г. Москва, ул. Фруктовая, д. 12

Dr. Sci. (Med.), Prof., Department of Medical and Social Expertise, Emergency and Outpatient therapy, Institute of Vocational Education; Leading researcher (MONIKI)

117556, Moscow, Fruktovaya str., 12

bcl72@yandex.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет) Министерства здравоохранения Российской Федерации; Московский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); M.F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)Russian Federation2019290320192911723Copyright © Буеверов А.О., 20192019Буеверов А.О.Bueverov A.O.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/321Цель обзора

Цель обзора: проанализировать накопленные данные по патогенетической связи желчнокаменной болезни (ЖКБ) и неалкогольной жировой болезни печени (НАЖБП), а также оценить влияние холецистэктомии на течение последней.

Основное содержание

Основное содержание. Отношения между ЖКБ и НАЖБП весьма сложные и, по-видимому, взаимоотягощающие. Не вызывает сомнений факт повышенного риска ЖКБ у пациентов с НАЖБП, что связано в первую очередь с общими патогенетическими механизмами. К ним относятся центральная и периферическая инсулинорезистентность, изменение экспрессии транскрипционных факторов (печеночного Х-рецептора, фарнезоидного Х-рецептора) и мембранных рецепторов желчных кислот (TGR5). Одновременно предполагается влияние ЖКБ на течение НАЖБП, хотя патогенетические факторы этой ассоциации пока остаются неизвестными. В последние годы появились убедительные данные о роли холецистэктомии в прогрессировании НАЖБП, что может быть обусловлено развитием синдрома избыточного бактериального роста в тонкой кишке, а также нарушением эндокринного баланса и сигнальной функции желчных кислот.

Заключение

Заключение. Связь НАЖБП, ЖКБ и холецистэктомии комплексная и многогранная; ее дальнейшее изучение открывает перспективы разработки новых методов лечения.

Aim

Aim: to analyze the data that has so far been accumulated on the pathogenetic association of gallstone disease (GD) and non-alcoholic fatty liver disease (NAFLD), as well as to assess the effect of cholecystectomy on the NAFLD course.

Key findings

Key findings. The relationship between GD and NAFLD is very complex and seems to be mutually aggravating. There is no doubt that there is an increased risk of GB in NAFLD patients, which is primarily associated with common pathogenetic mechanisms. These include central and peripheral insulin resistance, changes in the expression of transcription factors (liver X-receptor and farnesoid X-receptor) and the bile acid membrane receptors (TGR5). Conversely, the effect of GD on the NAFLD course is assumed, although the pathogenetic factors of this association are still unknown. In recent years, convincing data has emerged concerning the role of cholecystectomy in the NAFLD progression, which may be connected with the development of small intestinal bacterial overgrowth, as well as with the disruption of the endocrine balance and the signal function of bile acids.

Conclusion

Conclusion. The connection between NAFLD, GD and cholecystectomy is complex and multifaceted. The study of this connection will allow new methods of treatment to be developed.

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