В статье отражены современные литературные данные по эпидемиологии и факторам риска неалкогольной жировой болезни печени (НАЖБП). Важным аспектом является описание современных взглядов сочетанного поражения гепатобилиарного тракта и тонкой кишки. Особая роль в развитии НАЖБП отводится нарушениям кишечной микробиоты. Показано значение энтерогепатической циркуляции желчных кислот в развитии заболеваний кишечника и печени. Представляется актуальным дальнейшее изучение коморбидности развития НАЖБП и энтеропатии для разработки патогенетически обоснованной терапии.
The article reflects current literature data on the epidemiology and risk factors of non-alcoholic fatty liver disease. An important aspect is the description of the modern views of combined lesions of the hepatobiliary tract and small intestine. Disorders of the intestinal microbiota play a special role in the development of non-alcoholic fatty liver disease. The value of enterohepatic circulation of bile acids in the development of intestinal and liver diseases was shown. It seems relevant to further study the comorbidity of the development of non-alcoholic fatty liver disease and enteropathy for the development of pathogenetically substantiated therapy.
Keywords: non-alcoholic fatty liver disease, small intestine, bacterial overgrowth syndrome, bile acids, lipopolysaccharide.
Список литературы
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3. De Alwis NM, Day CP. Nonalcoholic fatty liver disease: the mist gradually clears. J Hepatol. 2008;48(1):104-12. doi: 10.1016/j.jhep.2008.01.009
4. Lazo M, Hernaez R, Bonekamp S, Kamel IR, Brancati FL, Guallar E, Clark JM. Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 2011;343:6891. doi: 10.1136/bmj.d6891
5. Tacuma Y, Nouso Y. Nonalcoholic steatohepatitis associated hepatocellular carcinoma: our case series and literature review. Wld J Gastroenterol. 2010;16(12):1436-41. doi: 10.3748/wjg.v16.i12.1436
6. Waly RS, Yangde Z, Yuxiang C. Hepatocellular carcinoma: focus of different aspects of management. ISRN Oncol. 2012;2012:1-12. doi: 10.5402/2012/421673
7. White DL, Kanwal F, El-Serag HB. Association between nonalcoholic fatty liver disease and risk for hepatocellular cancer, based on systematic review. Clin Gastroenterol Hepatol. 2012;10:1342. doi: 10.1016/ j.cgh.2012.10.001
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10. McCullough AJ. The epidemiology and risk factors of NASH. Hepatology. 2013;58(5):1644-54. doi: 10.1002/9780470987438.ch3
11. Duvnjak M, Lerotic I, Barsic N. Patogenesis and management issues for non-alcoholik fatty liver disease. World J Gastroenterol. 2007;13(34):4539-50. doi: 10.3748/wjg.v13.i34.4539
12. Atabek ME. Non-alcoholic fatty liver disease and metabolic syndrome in obese children. J Gastroenterol. 2011;17(39):4445. doi: 10.3748/wjg.v17.i39.4445
13. Ahmed A, Perumpail RB, Harrison SA. Hige prevalence of hepatic fibrosis in the setting of coexisting diabetes and hepatic steatosis: A case for selective screening in the general population? Hepatology. 2016;63(1):20-2. doi: 10.1002/hep.28277
14. Gerskowitch VP, Hodge J, Hull RAD, Shankley NP, Kalindjian SB, McEwen J, Black JW. Unexpected relationship between plasma protein binding and the pharmacodynamics of 2-NAP, a CCK1-receptor antagonist. Br J Clin Pharmacol. 2007;63(5):618-22. doi: 10.1111/j.1365-2125.2006.02789.x
15. Williamson RM, Price JF, Glance S, Perry E, Nee LD, Hayes PC, et al. Prevalence of and risk factors for hepatic steatosis and nonalcoholic fatty liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes Care. 2011;34:1139-44. doi: 10.2337/dc10-2229
16. Doycheva I, Cui J, Nguyen P, Costa EA, Hooker J, Hoffich H, Bettencourt R, Brouha S, Sirlin CB, Loomba R. Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE. Aliment Pharmacol Ther. 2015;43(1):83-95. doi: 10.1111/apt.13405
17. Ekstedt M, Hagstrom H, Nasr P, Fredrikson M, Kechagias S, Hultcrantz R. Fibrosis Stage is the strongest predictor for disease-specific mortality in NAFLD After Up to 33 Years of Follow-Up. Hepatology. 2015;61(5):1547-54. doi: 10.1016/j.jhep.2015.11.004
18. Ertle J, Dechene A, Sowa JP, Penndorf V, Herzer K, Kaiser G, Schlaak JF, Gerken G, Syn WK, Canbay A. Non-alcoholic fatty liver disease progress tu hepatocellular carcinoma in the absence of apparent cirrhosis. Int J Cancer. 2011;128:2436-43. doi: 10.1002/ijc.25797
19. Loomba R, Sanyal AJ. The global NAFLD epidemic. Nat Rev Gastroenterol Hepatol. 2013;10:686-90. doi: 10.1038/nrgastro.2013.171
20. Michelotti GA, Machado MV. NAFLD, NASH and liver cancer. Nat Rev Gastroenterol Hepatol. 2013;10:656-60. doi: 10.1038/nrgastro.2013.183
21. Stickel F, Hellerbrand С. Non-alcoholic fatty liver disease as a risk factor for hepatocellular carcinoma: mechanisms and implications. Gut. 2010;59:1303-7. doi: 10.1136/gut.2009.199661
22. [Podymova SD. Liver disease: a guide for physicians. 5th ed. Moscow: MIA, 2018 (In Russ.)].
23. Younossi ZM, Koenig AB, Abdelatif DA, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease – Meta-analytic assement of prevalence, incidence and outcomes. Hepatology. 2016;64(1):73-84. doi: 10.1002/hep.28431
24. Copaci I, Mindrut E, Micu L, Hortopan M, Voiculescu M. Can disease progression in non-alcoholic steatohepatitis be stopped? J Hepatol. 2009;50(1):S358. doi: 10.1016/s0168-8278(09)60989-2
25. Miura K, Ohnishi H. Role of gut microbiota and Toll-like receptors in nonalcoholic fatty liver disease. World J Gastroenterol. 2014;20(23):7381-91. doi: 10.3748/wjg.v20.i23.7381
26. Rolfe LD. Interactions among microorganisms of the indigenous intestinal flora and their influence on the host. Rev Infect Dis. 1984;6(1):73-9. doi: 10.1093/clinids/6.Supplement_1.S73
27. Mouzaki M, Comelli EM, Arendt BM, Bonengel J, Fang SK, Fischer SE, McGilvray ID, Allard JP. Intestinal microbiota in patients with nonalcoholic fatty liver disease. Hepatology. 2013;58:120-7. doi: 10.1002/hep.26319
28. Zhu L, Baker SS, Gill C, Liu W, Alkhouri R, et al. Characterization of gut microbiomes in nonalcoholic steatohepatitis (NASH) patients: A connection between endogenous alcohol and NASH. Hepatology. 2012;57:601-9. doi: 10.1002/hep.26093
29. Erejuwa OO, Sulaiman SA, Wahab MSW. Modulation of gut microbiota in the management of metabolic disorders: the prospects and challenges. Int J Mol Sci. 2014;15:4158-88. doi: 10.3390/ijms15034158
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Авторы
Я.М. Вахрушев, Е.В. Сучкова, А.П. Лукашевич
ФГБОУ ВО «Ижевская государственная медицинская академия» Минздрава России, Ижевск, Россия