gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-621Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESКлинические рекомендации Российского общества по изучению печени и Российской гастроэнтерологической ассоциации по диагностике и лечению фиброза и цирроза печени и их осложненийClinical Recommendations of the Russian Scientific Liver Society and Russian Gastroenterological Association on Diagnosis and Treatment of Liver Fibrosis, Cirrhosis and Their Complicationshttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Ивашкин Владимир Трофимович — доктор медицинских наук, академик РАН, профессор, заведующий кафедройпропедевтики внутренних болезней, гастроэнтерологии и гепатологии,

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

Vladimir T. Ivashkin — Dr. Sci. (Med.), Full Member of the Russian Academy of Sciences, Prof., Departmental Head,Department of Internal Disease Propaedeutics,

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

ivashkin_v_t@staff.sechenov.ruhttps://orcid.org/0000-0001-8913-140XМаевскаяМ. В.MaevskayaM. V.

Маевская Марина Викторовна  — доктор медицинских наук, профессор,

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

Marina V. Maevskaya  — Dr. Sci. (Med.), Prof.,

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

mvmaevskaya@me.comhttps://orcid.org/0000-0001-5939-1032ЖарковаМ. С.ZharkovaM. S.

Жаркова Мария Сергеевна — кандидат медицинских наук, заведующая отделением гепатологии Клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии им. В.Х. Василенко,

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

Maria S. Zharkova*  — Cand. Sci. (Med.), Head of the Department of Hepatology, Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology,

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

zharkovamaria@mail.ruhttps://orcid.org/0000-0003-1006-3462ЖигаловаС. Б.ZhigalovaS. B.

Жигалова Светлана Борисовна  — доктор медицинских наук, ведущий научный сотрудник лаборатории экстреннойхирургии и портальной гипертензии,

119991, Москва, Абрикосовский пер., д. 2

Svetlana B. Zhigalova — Dr. Sci. (Med.), Leading Researcher, Laboratory of Emergency Surgery and Portal Hypertension,

119991, Moscow, Abrikosovskiy per., 2

Zhigalova06@mail.ruhttps://orcid.org/0000-0002-8268-3129КиценкоЕ. А.KitsenkoE. A.

Киценко Евгений Александрович  — доктор медицинских наук, профессор, ведущий научный сотрудник лабораторииэкстренной хирургии и портальной гипертензии,

119991, Москва, Абрикосовский пер., д. 2

Evgeniy A. Kitsenko — Dr. Sci. (Med.), Prof., Leading Researcher, Laboratory of Emergency Surgery and Portal Hypertension,

119991, Moscow, Abrikosovskiy per., 2

Kitsenko-surgeon@mail.ruhttps://orcid.org/0000-0001-8064-1964МанукьянГ. В.ManukyanG. V.

Манукьян Гарик Ваганович — доктор медицинских наук, профессор, руководитель лаборатории экстренной хирургии и портальной гипертензии,

119991, Москва, Абрикосовский пер., д. 2

Garik V. Manukyan — Dr. Sci. (Med.), Prof., Head of the Laboratory of Emergency Surgery and Portal Hypertension,

119991, Moscow, Abrikosovskiy per., 2

drmanukyan@mail.ruhttps://orcid.org/0000-0003-3362-2968ТрухмановА. С.TrukhmanovA. S.

Трухманов Александр Сергеевич — доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии,

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

Aleksandr S. Trukhmanov — Dr. Sci. (Med.), Prof., Department of Internal Disease Propaedeutics,

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

alexander.trukhmanov@gmail.comhttps://orcid.org/0000-0001-6114-564XМаевИ. В.MaevI. V.

Маев Игорь Вениаминович — доктор медицинских наук, академик РАН, профессор, заведующий кафедрой пропедевтики внутренних болезней и гастроэнтерологии,

127473, г. Москва, ул. Делегатская, д. 20, стр. 1

Igor V. Maev — Dr. Sci. (Med.), Full Member of the Russian Academy of Sciences, Prof., Head of the Chair of Internal Disease Propaedeutics and Gastroenterology,

127473, Moscow, Delegatskaya str., 20, bld. 1

igormaev@rambler.ruhttps://orcid.org/0000-0002-0532-9126ТихоновИ. Н.TikhonovI. N.

Тихонов Игорь Николаевич — ассистент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии, врач-гастроэнтеролог отделения гепатологии Клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко,

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

Igor N. Tikhonov — Research Assistant, Chair of Internal Disease Propaedeutics, Gastroenterology and Hepatology; Physician (gastroenterology), Department of Hepatology, Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology,

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

antihbs@gmail.comhttps://orcid.org/0000-0002-3126-141XДееваТ. А.DeevaT. A.

Деева Татьяна Андреевна — кандидат медицинских наук, доцент кафедры биологической химии, 

105043, Москва, ул. 5-я Парковая, д. 21, стр. 1

Tatyana A. Deeva — Cand. Sci. (Med.), Assoc. Prof., Chair of Biological Chemistry,

105043, Moscow, 5-ya Parkovaya str., 21, bld. 1

deeva_t_a@staff.sechenov.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский Университет) Министерства здравоохранения Российской ФедерацииРоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationФБГНУ «Российский научный центр хирургии им. академика Б.В. Петровского»РоссияPetrovsky National Research Centre of SurgeryRussian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Министерства здравоохранения Российской ФедерацииРоссияYevdokimov Moscow State University of Medicine and DentistryRussian Federation20210703202231656102Copyright © Ивашкин В.Т., Маевская М.В., Жаркова М.С., Жигалова С.Б., Киценко Е.А., Манукьян Г.В., Трухманов А.С., Маев И.В., Тихонов И.Н., Деева Т.А., 20222022Ивашкин В.Т., Маевская М.В., Жаркова М.С., Жигалова С.Б., Киценко Е.А., Манукьян Г.В., Трухманов А.С., Маев И.В., Тихонов И.Н., Деева Т.А.Ivashkin V.T., Maevskaya M.V., Zharkova M.S., Zhigalova S.B., Kitsenko E.A., Manukyan G.V., Trukhmanov A.S., Maev I.V., Tikhonov I.N., Deeva T.A.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/621Цель

Цель: в клинических рекомендациях, предназначенных для врачей-гастроэнтерологов, врачей общей практики и врачей-терапевтов, представлены современные методы диагностики и лечения цирроза и фиброза печени.

Основное содержание

Основное содержание. Фиброз печени развивается при формировании соединительной ткани в печени в результате различных хронических заболеваний, включая действие алкоголя, вирусные гепатиты, аутоиммунные заболевания печени, более редкие наследственные заболевания печени. Цирроз печени представляет собой финальную стадию большинства хронических диффузных заболеваний печени. Описаны современные представления о патогенезе фиброза и цирроза печени, правила диагностики, лечения и профилактики основных его осложнений (печеночной энцефалопатии, кровотечения из варикозно расширенных вен пищевода и желудка, острого повреждения почек / гепаторенального синдрома, инфекционных осложнений (в том числе спонтанного бактериального перитонита), гипонатриемии, легочных осложнений и др.).

Заключение

Заключение: при своевременной диагностике цирроза печени и назначении адекватной терапии можно избежать жизнеугрожающих осложнений и улучшить как прогноз пациентов, так и качество их жизни. 

Aim

Aim. Current clinical recommendations are intended to supply gastroenterologists, physicians and general practitioners with modern methods for the diagnosis and treatment of liver cirrhosis and fibrosis.

Key points

Key points. Liver fibrosis develops with connective tissue accumulation in liver in the outcome of various chronic diseases, including alcohol misuse, viral hepatitises, autoimmune and more rare hereditary liver diseases. Liver cirrhosis is the final stage of most chronic diffuse liver diseases. The recommendations present current opinions on pathogenesis of liver fibrosis and cirrhosis, principles of diagnosis, treatment and prevention of their main complications: hepatic encephalopathy, oesophageal and gastric variceal bleeding, acute kidney injury/hepatorenal syndrome, infectious complications (i.a. spontaneous bacterial peritonitis), hyponatraemia, pulmonary complications, etc.

Conclusion

Conclusion. Timely diagnosis and adequate therapy in cirrhosis can prevent life-threatening complications and improve the patients’ prognosis and quality of life. 

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