Maevskaya M V, Kotovskaya Y V, Ivashkin V T, Tkacheva O N, Troshina E A, Shestakova M V, Breder V V, Geyvandova 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
Sechenov First Moscow State Medical University (Sechenov University).
Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University.
Ter Arkh. 2022 Feb 15;94(2):216-253. doi: 10.26442/00403660.2022.02.201363.
The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine Fund PROFMEDFORUM. The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus, obesity, dyslipidemia, etc.), chronic kidney disease and the risk of developing hepatocellular cancer were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of ursodeoxycholic acid to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.
《国家共识》是在国家多病症研究医学协会、俄罗斯肝脏科学协会、俄罗斯内分泌学家协会、俄罗斯老年医学家和老年病学家协会、国家预防心脏病学协会、促进医学发展专业基金会PROFMEDFORUM的参与下编写而成。这份多学科共识的目的是详细分析非酒精性脂肪性肝病（NAFLD）的病程及主要相关病症。文中给出了NAFLD的定义，描述了其患病率，阐述了诊断其组成部分（如脂肪变性、炎症和纤维化）的方法。分析了NAFLD与多种心血管代谢疾病（动脉高血压、动脉粥样硬化、血栓形成并发症、2型糖尿病、肥胖症、血脂异常等）、慢性肾病以及肝细胞癌发生风险之间的关联。介绍了NAFLD的非药物治疗方法及现代药物治疗机会。探讨了治疗NAFLD的新分子的可能性：核受体激动剂、促炎分子拮抗剂等。描述了目前使用的药物（维生素E、噻唑烷二酮类等）的优点和缺点。特别关注多靶点熊去氧胆酸分子在作为多因素疾病的NAFLD综合治疗中的作用。考虑了其抗炎、抗氧化和细胞保护特性，以及通过调节自噬减少脂肪变性（心血管病理发展的独立危险因素）、减轻炎症和肝纤维化的能力。已证实熊去氧胆酸对葡萄糖和脂质稳态有影响并具有抗癌作用。该共识声明为从业者优化NAFLD及心血管代谢疾病相关常见发病机制环节的诊断和治疗提供了先进的建议。
