gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2021-31-2-14-26gastro-j-543Research ArticleОБЗОРЫREVIEWSЛечение больных с неалкогольной жировой болезнью печeни и сахарным диабетом 2-го типаPatient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitushttps://orcid.org/0000-0003-2592-0906БагрийА. Э.BagriyA. E.

Багрий Андрей Эдуардович — доктор медицинских наук, заведующий кафедрой внутренних болезней № 2

283003, ДНР, Донецк, пр. Ильича, д. 16

Andrey E. Bagriy — Dr. Sci. (Med.), Head of the Chair of Internal Medicine No. 2

283003, Donetsk People’s Republic, Donetsk, Ilyicha ave., 16

bagriyae@mail.ruhttps://orcid.org/0000-0002-0636-5030ЗубовА. Д.ZubovA. D.

Зубов Александр Демьянович — доктор медицинских наук, профессор кафедры внутренних болезней № 2

283003, ДНР, Донецк, пр. Ильича, д. 16

Alexander D. Zubov — Dr. Sci. (Med.), Prof., Chair of Internal Medicine No. 2

283003, Donetsk People’s Republic, Donetsk, Ilyicha ave., 16

amipt@mail.ruhttps://orcid.org/0000-0002-6219-7537ХоменкоМ. В.KhomenkoM. V.

Хоменко Марина Владимировна — кандидат медицинских наук, доцент кафедры терапии ФИПО им. профессора А. И. Дядыка

283003, ДНР, Донецк, пр. Ильича, д. 16

 

Marina V. Khomenko — Cand. Sci. (Med.), Assoc. Prof., Chair of Therapy named after Prof. A. I. Dyadyk, Facultyof Internship and Postgraduate Education

283003, Donetsk People’s Republic, Donetsk, Ilyicha ave., 16

mv.homenko@gmail.comhttps://orcid.org/0000-0001-8625-1406МихайличенкоЕ. С.MikhailichenkoE. S.

Михайличенко Евгения Сергеевна — кандидат медицинских наук, ассистент кафедры внутренних болезней № 2

283003, ДНР, Донецк, пр. Ильича, д. 16

Evgeniya S. Mikhailichenko — Cand. Sci. (Med.), Research Assistant, Chair of Internal Medicine No. 2

283003, Donetsk People’s Republic, Donetsk, Ilyicha ave., 16

klassiki@inbox.ruhttps://orcid.org/0000-0002-0558-9542ПылаеваЕ. А.PylaevaE. A.

Пылаева Екатерина Алексеевна — аспирант кафедры внутренних болезней № 2

283003, ДНР, Донецк, пр. Ильича, д. 16

Ekaterina A. Pylaeva — Postgraduate Student, Chair of Internal Medicine No. 2

283003, Donetsk People’s Republic, Donetsk, Ilyicha ave., 16

ruda.lisitsa@yandex.ruhttps://orcid.org/0000-0002-3830-382XХаустоваН. А.KhaustovaN. A.

Хаустова Наталья Александровна — врач-эндокринолог поликлинического отделения

283001, ДНР, Донецк, ул. Артема, д. 57

Natalia A. Khaustova — Physician (endocrinology), Outpatient Unit

283001, Donetsk People’s Republic, Donetsk, Artema str., 57

docgkb5@yandex.ruhttps://orcid.org/0000-0003-0471-6148БрюховецкаяЕ. В.BryukhovetskayaE. V.

Брюховецкая Елена Владимировна — врач поликлинического отделения

283001, ДНР, Донецк, ул. Артема, д. 57

Elena V. Bryukhovetskaya — Physician, Outpatient Unit

283001, Donetsk People’s Republic, Donetsk, Artema str., 57

elenadonetsk2@gmail.comГосударственная образовательная организация высшего профессионального образования «Донецкий национальный медицинский университет им. М. Горького»УкраинаDonetsk National Medical UniversityUkraineКоммунальное учреждение «Центральная городская клиническая больница № 1 г. Донецка»УкраинаCentral City Clinical Hospital No. 1Ukraine2021160520213121426Copyright © Багрий А.Э., Зубов А.Д., Хоменко М.В., Михайличенко Е.С., Пылаева Е.А., Хаустова Н.А., Брюховецкая Е.В., 20212021Багрий А.Э., Зубов А.Д., Хоменко М.В., Михайличенко Е.С., Пылаева Е.А., Хаустова Н.А., Брюховецкая Е.В.Bagriy A.E., Zubov A.D., Khomenko M.V., Mikhailichenko E.S., Pylaeva E.A., Khaustova N.A., Bryukhovetskaya E.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/543Цель обзора

Цель обзора: характеристика современных немедикаментозных и лекарственных подходов в лечении лиц с неалкогольной жировой болезнью печени (НАЖБП) в сочетании с сахарным диабетом 2-го типа (СД 2).

Основные положения

Основные положения. НАЖБП ассоциирована с повышенным сердечно-сосудистым риском (вследствие ассоциации с «метаболическим» синдромом) и риском развития цирроза печени, а также гепатоцеллюлярной карциномы. При сочетании с СД 2 макро- и микрососудистые осложнения диабета влекут за собой увеличение общей смертности. Важнейшее место в лечении таких больных занимает комбинация изменений образа жизни и рациональных медикаментозных подходов с достижением целевых уровней гликозилированного гемоглобина, холестерина липопротеидов низкой плотности, систолического и диастолического артериального давления. Снижение массы тела на 5–7 % и более (благодаря ограничению калоража пищи или бариатрическим хирургическим вмешательствам) способствует отчетливому снижению количества жира в печени и даже обратному развитию стеатогепатита; дозированные физические нагрузки оказывают такое действие даже при отсутствии значимой динамики массы тела. Критически важно сведение к минимуму употребления алкоголя и отказ от курения. При НАЖБП с умеренными фибротическими изменениями важнейшее значение приобретает медикаментозная терапия с гепатотропными эффектами. Она включает сахароснижающие средства (метформин, тиазолидиндионы, агонисты рецепторов глюкагоно-подобного пептида-1, ингибиторы натрий-глюкозного котранспортера-2), препараты желчных кислот (в частности, 24-норурсодезоксихолевая кислота), агонисты фарнезоидных Х-рецепторов (обетихолевая кислота, тропифексор), статины, ацетилсалициловую кислоту. Эффективность комбинаций вышеуказанных препаратов превышает таковую для отдельных ее компонентов.

Заключение

Заключение. Лечение сочетания НАЖБП и СД 2 требует тесного сотрудничества специалистов разного профиля: гепатолога/гастроэнтеролога, эндокринолога и кардиолога. Эта мультидисциплинарная проблема может быть решена путем настойчивого воплощения рекомендаций по изменению образа жизни и назначению рациональных медикаментозных подходов, включающих доказанный гепатопротекторный эффект.

Aim

Aim. A current overview of non-pharmacological and drug-based approaches to non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus (T2D).

Key points

Key points. NAFLD is associated with an increased cardiovascular risk (due to association with “metabolic syndrome”) and the risks of liver cirrhosis and hepatocellular carcinoma. Macro- and microvascular complications in T2D comorbidity entail a higher overall mortality. A conjunction of lifestyle change and rational medication strategies to reach the target levels of glycosylated haemoglobin, low-density lipoprotein cholesterol, systolic and diastolic blood pressure is key in management of such patients. A body weight loss by 5–7 % or more (through caloric restriction or a bariatric surgery) promotes a marked reduction in liver fat and even reversal of steatohepatitis. Metered exercise exerts this effect even at insignificant weight loss. Minimising alcohol consumption and smoking is critical. A hepatotropic drug therapy is most essential in moderate fibrotic NAFLD. It includes antidiabetic agents (metformin, thiazolidinediones, glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter-2 inhibitors), bile acid preparations (e.g., 24-nor-ursodeoxycholic acid), farnesoid X receptor agonists (obeticholic acid, tropifexor), statins, acetylsalicylic acid. Combinations are superior to individual-drug schemes.

Conclusion

Conclusion. The management of combined NAFLD-T2D requires a close inter-specialty involvement from hepatology, gastroenterology, endocrinology and cardiology. This interdisciplinary problem can be tackled through persuasive lifestyle recommendations and choosing rational medication strategies with a proved hepatoprotective efficacy.

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