gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2021-31-2-7-13gastro-j-548Research ArticleОБЗОРЫREVIEWSПоражение печени при сахарном диабете 1-го типаLiver Damage in Type 1 Diabetes Mellitushttps://orcid.org/0000-0002-5041-3466БуеверовА. О.BueverovA. O.

Буеверов Алексей Олегович — доктор медицинских наук, профессор кафедры медико-социальной экспертизы, неотложной и патогенетической терапии Института профессионального образования ФГАОУ ВО «Первый Московский государственный университет им. И. М. Сеченова» (Сеченовский университет); ведущий научный сотрудник отделения гепатологии ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М. Ф. Владимирского»

129110, Москва, ул. Щепкина, д. 61/2

Aleksey O. Bueverov — Dr. Sci. (Med.), Prof., Chair of Medical and Social Expertise, Emergency and Pathogenetic Therapy, Institute of Professional Education, Sechenov First Moscow State Medical University (Sechenov University); Leading Researcher, Department of Hepatology, Vladimirsky Moscow Regional Research and Clinical Institute

129110, Moscow, Shchepkina str., 61/2

bcl72@yandex.ruhttps://orcid.org/0000-0003-3494-8011ЗиловА. В.ZilovA. V.

Зилов Алексей Вадимович — кандидат медицинских наук, доцент кафедры эндокринологии № 1 Института клинической медицины

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

Aleksey V. Zilov — Cand. Sci. (Med.), Assoc. Prof., Chair of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine

119435, Moscow, Pogodinskaya str., 1, bld. 1

avzilov@hotmail.comФГАОУ ВО «Первый Московский государственный университет им. И. М. Сеченова» (Сеченовский университет) Министерства здравоохранения Российской Федерации; ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М. Ф. Владимирского»РоссияSechenov First Moscow State University (Sechenov University); Vladimirsky Moscow Regional Research and Clinical InstituteRussian FederationФГАОУ ВО «Первый Московский государственный университет им. И. М. Сеченова» (Сеченовский университет) Министерства здравоохранения Российской ФедерацииРоссияSechenov First Moscow State University (Sechenov University)Russian Federation202104052021312713Copyright © Буеверов А.О., Зилов А.В., 20212021Буеверов А.О., Зилов А.В.Bueverov A.O., Zilov 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/548Цель обзора

Цель обзора. Представить данные о распространенности, патогенезе, диагностике и лечении гепатологических осложнений сахарного диабета 1-го типа (СД 1).

Основные положения

Основные положения. СД 1 существенно чаще служит причиной поражения печени, чем традиционно считается. На сегодня у больных СД 1 описано три варианта печеночной патологии: стеатоз, гликогеновая гепатопатия и диабетический гепатосклероз, при этом два последних, по-видимому, являются патогномоничными для этого типа диабета. Патогенез рассматриваемых заболеваний сложен и не до конца изучен. Важным его звеном выступает нефизиологическое поступление инсулина в ткани, особенно в условиях значительных колебаний гликемии, вероятно наличие определенной генетической предрасположенности. Основной метод профилактики и лечения всех рассматриваемых состояний — адекватный гликемический контроль. Представление практикующих врачей о вариантах поражения печени при СД 1 позволяет избежать назначения неоправданных исследований и неэффективных лекарственных препаратов.

Заключение

Заключение. Как эндокринологи, так и интернисты должны быть осведомлены о возможности вовлечения печени в патологический процесс при СД 1, что позволит улучшить результаты лечения пациентов.

Aim

Aim. An up-to-date review of the prevalence, pathogenesis, diagnosis and management of hepatological complications of type 1 diabetes mellitus (T1D).

Key points

Key points. Diabetes type 1 causes a markedly more common liver injury than traditionally assumed. Three types of hepatic damage have been described to date in T1D patients, steatosis, glycogen hepatopathy and diabetic hepatosclerosis, with the latter two apparently pathognomonic of this diabetes type. Their pathogenesis is complex and not fully understood. Its important link is a likely inherited non-physiological insulin supply to the tissue, especially at marked glycaemic fluctuations. An adequate glycaemic control is the main prevention and treatment measure in these conditions. The practitioner’s understanding of liver damage in T1D is an earnest to avoid unnecessary tests and ineffective medications.

Conclusion

Conclusion. Both endocrinologists and internists ought to contemplate the possibility of liver involvement in T1D for improving the patient outcomes.

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