gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2022-32-4-104-140gastro-j-777Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESКлинические рекомендации Российского общества по изучению печени, Российской гастроэнтерологической ассоциации, Российской ассоциации эндокринологов, Российской ассоциации геронтологов и гериатров и Национального общества профилактической кардиологии по диагностике и лечению неалкогольной жировой болезни печениClinical Practice Guidelines of the Russian Scientific Liver Society, Russian Gastroenterological Association, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians and National Society for Preventive Cardiology on Diagnosis and Treatment of Non-Alcoholic Liver Diseasehttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Ивашкин Владимир Трофимович — доктор медицинских наук, академик РАН, профессор, заведующий кафедрой пропедевтики 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/0000-0002-1628-5093КотовскаяЮ. В.KotovskayaYu. V.

Котовская Юлия Викторовна — доктор медицинских наук, профессор, заместитель директора по научной работе

129226, г. Москва, ул. 1-я Леонова, д. 16

Yulia V. Kotovskaya — Dr. Sci. (Med.), Prof. of the Aging Diseases Chair, Deputy Director of Russian Clinical and Research Center of Gerontology129226, Moscow, 1st Leonova str., 16 

kotovskaya_yv@rgnkc.ruhttps://orcid.org/0000-0002-4193-688XТкачеваО. Н.TkachevaO. N.

Ткачева Ольга Николаевна — доктор медицинских наук,профессор, директор

129226, г. Москва, ул. 1-я Леонова, д. 16

Olga N. Tkacheva — Dr. Sci. (Med.), Prof., Head of the Aging Diseases Chair,  Chief consultant gerontologist129226, Moscow, 1st Leonova str., 16 

tkacheva@rgnkc.ruhttps://orcid.org/0000-0002-8520-8702ТрошинаЕ. А.TroshinaE. A.

Трошина Екатерина Анатольевна — доктор медицинскихнаук, профессор, член-корреспондент РАН, заместительдиректора, директор Института клинической эндокринологии

117292, г. Москва, ул. Дмитрия Ульянова, д. 11

Ekaterina A. Troshina — Dr. Sci. (Med.), Prof., Associate Member of the Russian Academy of Sciences, Deputy Director; Head of the Institute of Clinical Endocrinology

17292, Moscow, Dmitriya Ulyanova str., 11 

troshina@inbox.comhttps://orcid.org/0000-0002-5057-127XШестаковаМ. В.ShestakovaM. V.

Шестакова Марина Владимировна — академик РАН, доктор медицинских наук, профессор, заместитель директора,  директор Института диабета117292, г. Москва, ул. Дмитрия Ульянова, д. 11

Marina V. Shestakova — Dr. Sci. (Med.), Full Member of the Russian Academy of Sciences, Prof., Deputy Director; Head of the Institute of Diabetes

117292, Moscow, Dmitriya Ulyanova str., 11 

shestakova.mv@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 — RAS Academician, Dr. Sci. (Med.), Prof., Departmental Head, Department of Internal Disease Propaedeutics and Gastroenterology

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

igormaev@rambler.ruhttps://orcid.org/0000-0002-6244-4294БредерВ. В.BrederV. V.

Бредер Валерий Владимирович — доктор медицинских наук, ведущий научный сотрудник, онкологическое отделение лекарственных методов лечения  (химиотерапевтическое отделение № 17)

115478, г. Москва, Каширское шоссе, д. 23

Valeriy V. Breder — Dr. Sci. (Med.), Chief Researcher, Chemotherapy Department № 17

115478, Moscow, Kashirskoe highway, 23 

vbreder@yandex.ruhttps://orcid.org/0000-0001-5920-5703ГейвандоваН. И.GheivandovaN. I.

Гейвандова Наталья Иогановна — доктор медицинских наук, профессор кафедры госпитальной терапии

355017, г. Ставрополь, ул. Мира, д. 310

Natalia I. Geyvandova — Dr. Sci. (Med.), Prof., Department of Hospital Therapy

355017, Stavropol, Mira str., 310 

ngeyvandova@yandex.ruhttps://orcid.org/0000-0001-8874-4108ДощицинВ. Л.DoshchitsinV. L.

Дощицин Владимир Леонидович — доктор медицинских наук, профессор кафедры кардиологии ФДПО

117997, г. Москва, ул. Островитянова, д. 1

Vladimir L. Doshchitsin — Dr. Sci. (Med.), Prof., Department of Cardiology

117997, Moscow, Ostrovityanova str., 1 

vlad.dos@mail.ruhttps://orcid.org/0000-0001-7891-6850ДудинскаяЕ. Н.DudinskayaE. N.

Дудинская Екатерина Наильевна — кандидат медицинских наук, заведующая лабораторией возрастных метаболических эндокринных нарушений

129226, г. Москва, ул. 1-я Леонова, д. 16

Ekaterina N. Dudinskaya — Cand. Sci. (Med.), Head of the Laboratory of Age-related Metabolic Endocrinological Disorders, Aging Diseases Chair

129226, Moscow, 1st Leonova str., 16 

katharina.gin@gmail.comhttps://orcid.org/0000-0002-6220-4397ЕршоваЕ. В.ErshovaE. V.

Ершова Екатерина Владимировна — кандидат медицинских наук, ведущий научный сотрудник отделения терапевтической эндокринологии

117292, г. Москва, ул. Дмитрия Ульянова, д. 11

Ekaterina V. Ershova — Cand. Sci. (Med.), Chief Researcher, Department of Therapeutic Endocrinology

117292, Moscow, Dmitriya Ulyanova str., 11 

yu99pol06@rambler.ruhttps://orcid.org/0000-0001-7510-6553КодзоеваХ. Б.KodzoevaKh. B.

Кодзоева Хава Багаудиновна — аспирант кафедры  пропедевтики внутренних болезней, гастроэнтерологии и  гепатологии Института клинической медицины им. Н.В. Склифосовского119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Khava B. Kodzoeva — PhD student, Department of Internal Disease Propaedeutics

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

kod_eva@bk.ruhttps://orcid.org/0000-0002-6624-2374КомшиловаК. А.KomshilovaK. A.

Комшилова Ксения Андреевна — кандидат медицинских наук, врач-эндокринолог отделения терапевтической эндокринологии

117292, г. Москва, ул. Дмитрия Ульянова, д. 11

Kseniya A. Komshilova — Cand. Sci. (Med.), endocrinologist, Department of  Therapeutic Endocrinology

117292, Moscow, Dmitriya Ulyanova str., 11 

kom-ksusha@rambler.ruhttps://orcid.org/0000-0002-5538-9418КорочанскаяН. В.KorochanskayaN. V.

Корочанская Наталья Всеволодовна — доктор медицинских наук, профессор кафедры хирургии № 3 ФПК и ППС

350063, г. Краснодар, ул. Митрофана Седина, д. 4

Natalia V. Korochanskaya — Dr. Sci. (Med.), Head of the Gastroenterology Centre, Prof., Chair of Surgery No. 3; Chief Gastroenterologist of the Ministry of Health of the Krasnodar Territory

350063, Krasnodar, Mitrofana Sedina str., 4 

nvk-gastro@mail.ruhttps://orcid.org/0000-0001-5825-3287МайоровА. Ю.MayorovA. Yu.

Майоров Александр Юрьевич — доктор медицинских наук,заведующий отделением прогнозирования и инноваций диабета, профессор кафедры диабетологии и диетологии

117292, г. Москва, ул. Дмитрия Ульянова, д. 11

Alexander Yu. Mayorov — Dr. Sci. (Med.), Head of the Department of Prognosing and Diabetes Innovation, Prof., Chair of Diabetology and Dietology

117292, Moscow, Dmitriya Ulyanova str., 11 

https://orcid.org/0000-0002-5371-8708МишинаЕ. Е.MishinaE. E.

Мишина Екатерина Евгеньевна — научный сотрудник отделения прогнозирования и инноваций диабета

117292, г. Москва, ул. Дмитрия Ульянова, д. 11

Ekaterina E. Mishina — Researcher, Department of Prognosing and Diabetes Innovation

117292, Moscow, Dmitriya Ulyanova str., 11 

eka-mi@rambler.ruhttps://orcid.org/0000-0002-1210-2528НадинскаяМ. Ю.NadinskayaM. Yu.

Надинская Мария Юрьевна — кандидат медицинских наук,доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского

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

Maria Yu. Nadinskaia — Cand. Sci. (Med.), Assoc. Prof., Department of  Propaedeutics of Internal Diseases

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

marianad@rambler.ruhttps://orcid.org/0000-0003-1699-0881НикитинИ. Г.NikitinI. G.

Никитин Игорь Геннадьевич — доктор медицинских наук, профессор, заведующий кафедрой госпитальной терапии № 2 лечебного факультета; директор ФГАУ НМИЦ «Лечебно-реабилитационный центр»

117997, г. Москва, ул. Островитянова, д. 1 

Igor G. Nikitin — Dr. Sci. (Med.), Prof., Departmental Head, Department of Internal Disese No. 2; Director of the Medical and Rehabilitation Center117997, Moscow, Ostrovityanova str., 1 

igor.nikitin.64@mail.ruhttps://orcid.org/0000-0002-4165-804XПогосоваН. В.PogosovaN. V.

Погосова Нана Вачиковна — доктор медицинских наук, профессор, заместитель генерального директора по научно-аналитической работе и профилактической кардиологии

121552, г. Москва, ул. 3-я Черепковская, д. 15а, стр. 1

Nana V. Pogosova — Dr. Sci. (Med.), Prof., Deputy of General Director of scientific-analytical work

121552, Moscow, 3rd Cherepkovskaya str., 15a, bld.1 

nanapogosova@gmail.comhttps://orcid.org/0000-0001-9536-8307ТарзимановаА. И.TarzimanovaA. I.

Тарзиманова Аида Ильгизовна — доктор медицинских наук,профессор кафедры факультетской терапии № 2

119048, г. Москва, ул. Ефремова, д. 24

Aida I. Tarzimanova — Dr. Sci. (Med.), Prof., Department of Faculty Therapy No. 2

119048, Moscow, Efremova str., 24 

tarzimanova@mail.ruhttps://orcid.org/0000-0002-3433-0142ШамхаловаМ. Ш.ShamkhalovaM. Sh.

Шахмалова Минара Шахмаловна — доктор медицинских наук, заведующая отделением диабетической болезни почек и посттрансплантационной реабилитации

117292, г. Москва, ул. Дмитрия Ульянова, д. 11

Minara Sh. Shamkhalova — Dr. Sci. (Med.), Head of the Department of Diabetic Kidney Disease and Post-transplant rehabilitation

117292, Moscow, Dmitriya Ulyanova str., 11 

shamkhalova@mail.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский Университет) Министерства здравоохранения Российской ФедерацииРоссияI.M. Sechenov First Moscow State Medical UniversityRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» (Сеченовский Университет) Министерства здравоохранения Российской ФедерацииРоссияSechenov First Moscow State Medical UniversityRussian FederationОСП «Российский геронтологический научно-клинический центр» ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияRussian Gerontology Research and Clinical Centre, Pirogov Russian National Research Medical UniversityRussian FederationФГБУ «Национальный медицинский исследовательский центр эндокринологии» Министерства здравоохранения Российской ФедерацииРоссияEndocrinology Research CentreRussian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Министерства здравоохранения Российской ФедерацииРоссияYevdokimov Moscow State University of Medicine and DentistryRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Министерства здравоохранения Российской ФедерацииРоссияBlokhin National Medical Research Center of OncologyRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияStavropol Regional Clinical Center of Specialized Medical CareRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияPirogov Russian National Research Medical UniversityRussian FederationФГБОУ ВО «Кубанский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKuban State Medical UniversityRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияPirogov Russian National Research Medical UniversitRussian FederationФГБУ «Национальный медицинский исследовательский центр кардиологии им. академика Е.И. Чазова» Министерства здравоохранения Российской ФедерацииРоссияNational Medical Research Center of CardiologyRussian Federation202230092022324104140Copyright © Ивашкин В.Т., Маевская М.В., Жаркова М.С., Котовская Ю.В., Ткачева О.Н., Трошина Е.А., Шестакова М.В., Маев И.В., Бредер В.В., Гейвандова Н.И., Дощицин В.Л., Дудинская Е.Н., Ершова Е.В., Кодзоева Х.Б., Комшилова К.А., Корочанская Н.В., Майоров А.Ю., Мишина Е.Е., Надинская М.Ю., Никитин И.Г., Погосова Н.В., Тарзиманова А.И., Шамхалова М.Ш., 20222022Ивашкин В.Т., Маевская М.В., Жаркова М.С., Котовская Ю.В., Ткачева О.Н., Трошина Е.А., Шестакова М.В., Маев И.В., Бредер В.В., Гейвандова Н.И., Дощицин В.Л., Дудинская Е.Н., Ершова Е.В., Кодзоева Х.Б., Комшилова К.А., Корочанская Н.В., Майоров А.Ю., Мишина Е.Е., Надинская М.Ю., Никитин И.Г., Погосова Н.В., Тарзиманова А.И., Шамхалова М.Ш.Ivashkin V.T., Maevskaya M.V., Zharkova M.S., Kotovskaya Y.V., Tkacheva O.N., Troshina E.A., Shestakova M.V., Maev I.V., Breder V.V., Gheivandova N.I., Doshchitsin V.L., Dudinskaya E.N., Ershova E.V., Kodzoeva K.B., Komshilova K.A., Korochanskaya N.V., Mayorov A.Y., Mishina E.E., Nadinskaya M.Y., Nikitin I.G., Pogosova N.V., Tarzimanova A.I., Shamkhalova M.S.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/777

Цель: в клинических рекомендациях, предназначенных для врачей общей практики, врачей-терапевтов, врачей-гастроэнтерологов, врачей-кардиологов, врачей-эндокринологов, представлены современные методы диагностики и лечения неалкогольной жировой болезни печени.Основное содержание. Неалкогольная жировая болезнь печени — самое частое хроническое заболевание печени, при котором более 5 % гепатоцитов аккумулирует жир, представлено двумя гистологическими формами: стеатоз и неалкогольный стеатогепатит. В клинических рекомендациях описаны современные представления о патогенезе неалкогольной жировой болезни печени как мультисистемного заболевания, методы инвазивной и неинвазивной диагностики стеатоза и фиброза печени, принципы немедикаментозного лечения и фармакотерапии неалкогольной жировой болезни печени и ассоциированных с ней состояний. Представлены осложнения неалкогольной жировой болезни печени, такие как усугубление кардиометаболических рисков, развитие гепатоцеллюлярного рака, прогрессия фиброза печени до стадии цирроза.Заключение. При своевременной диагностике неалкогольной жировой болезни печени и ассоциированных коморбидных состояний, грамотном междисциплинарном ведении этих пациентов можно избежать прогрессии заболевания печени и уменьшить кардиометаболические риски, улучшить жизненный прогноз пациентов.

Aim: present clinical guidelines, aimed at general practitioners, gastroenterologists, cardiologists, endocrinologists, comprise up-to-date methods of diagnosis and treatment of non-alcoholic fatty liver disease.Key points. Nonalcoholic fatty liver disease, the most wide-spread chronic liver disease, is characterized by accumulation of fat by more than 5 % of hepatocytes and presented by two histological forms: steatosis and nonalcoholic steatohepatitis. Clinical guidelines provide current views on pathogenesis of nonalcoholic fatty liver disease as a multisystem disease, methods of invasive and noninvasive diagnosis of steatosis and liver fibrosis, principles of nondrug treatment and pharmacotherapy of nonalcoholic fatty liver disease and associated conditions. Complications of nonalcoholic fatty liver disease include aggravation of cardiometabolic risks, development of hepatocellular cancer, progression of liver fibrosis to cirrhotic stage.Conclusion. Progression of liver disease can be avoided, cardiometabolic risks can be reduced and patients' prognosis — improved by the timely recognition of diagnosis of nonalcoholic fatty liver disease and associated comorbidities and competent multidisciplinary management of these patients.

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