gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2023-33-2-79-86gastro-j-830Research ArticleНАЦИОНАЛЬНАЯ ШКОЛА ГАСТРОЭНТЕРОЛОГИИ, ГЕПАТОЛОГИИNATIONAL COLLEGE OF GASTROENTEROLOGY, HEPATOLOGYВнутрипеченочный холестаз при неалкогольной жировой болезни печени: патогенез и роль адеметионина в терапииIntrahepatic Cholestasis in Non-Alcoholic Fatty Liver Disease: Pathogenesis and Role of Ademetionine in Treatmenthttps://orcid.org/0000-0002-6819-0889ШироковаЕ. Н.ShirokovaYe. N.

Широкова Елена Николаевна — доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии.

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

Yelena N. Shirokova — Dr. Sci. (Med.), professor at the Chair of internal diseases propedeutics, gastroenterology and hepatology at the Sechenov First Moscow state medical university (Sechenov University).

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

elshirokova@yandex.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 Federation2023280420233327986Copyright © Широкова Е.Н., 20232023Широкова Е.Н.Shirokova Y.N.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/830Цель исследования

Цель исследования: рассмотреть особенности патогенеза внутрипеченочного холестаза (ВПХ) при неалкогольной жировой болезни печени (НАЖБП), а также место адеметионина в терапии данного состояния. Основные положения. НАЖБП — самое частое хроническое диффузное заболевание печени с неуклонной тенденцией к росту в связи с увеличением числа людей с избыточной массой тела, ожирением и метаболической дисрегуляцией. В 30 % случаев у больных НАЖБП выявляют сопутствующий внутрипеченочный холестаз (ВПХ), который ассоциирован с более активным течением болезни и возможным ухудшением прогноза этих пациентов. Существенную роль в развитии НАЖБП в настоящее время отводят нарушению метаболизма в жировой ткани и гепатоцитах, дисбиозу кишечника и наследственным факторам. У пациентов с НАЖБП большинство случаев ВПХ связано с функциональным холестазом. ВПХ при НАЖБП ассоциирован с повышением риска фиброза печени и смерти от всех причин. Адеметионин при заболеваниях печени способен восстанавливать активность процессов трансметилирования, а также улучшать реологические свойства мембран гепатоцитов. Терапия адеметионином у пациентов с ВПХ была ассоциирована с уменьшением концентрации билирубина в сыворотке, а также активности печеночных трансаминаз и щелочной фосфатазы, на этом фоне отмечали снижение выраженности клинических признаков, включая кожный зуд. Учитывая клиническую эффективность адеметионина при ВПХ на фоне НАЖБП, применение препарата включено в национальные клинические рекомендации.

Заключение

Заключение. Применение адеметионина у пациентов с НАЖБП и сопутствующим ВПХ патогенетически обосновано и может быть эффективным в клинической практике.

Aim

Aim: to evaluate features of intrahepatic cholestasis (IHC) pathogenesis in non-alcoholic fatty liver disease (NAFLD), as well as role of ademetionine in treatment of this condition.

Key statements

Key statements. NAFLD is the most frequent chronic diffuse liver disease. Increase in proportion of people with excess weight, obesity, and metabolic dysregulation leads to higher rates of NAFLD. Concomitant IHC is present in 30 % of NAFLD patients, while it is associated with more active disease course and possible worsening of prognosis. Impairment of adipocyte and hepatocyte metabolism, gut dysbiosis, and inherent factors are recognized as significant factors for NAFLD development. In NAFLD patients most of IHC cases are related to functional cholestasis. IHC in NAFLD is associated with increased risks of fibrosis and all-cause death. Ademetionine may restore transmethylation and improve rheologic properties of hepatocyte membranes in liver disease. In IHC patients treatment with ademetionine led to decreased serum bilirubin concentrations, as well as lowering of the liver transaminases' and alkaline phosphatase activities. At the same time improvement of symptoms severity, including itching, was noted. Taking into account the efficacy of ademetionine in IHC in NAFLD patients, its' use was included in the national clinical guidelines.

Conclusion

Conclusion. Use of ademetionine in NAFLD with concomitant IHC is feasible from pathogenesis perspective and may be effective in clinical practice.

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