В статье освещается одна из наиболее часто встречаемых патологий печени - неалкогольная жировая болезнь печени (НАЖБП), обсуждаются современные концепции этиологии, патогенеза, принципы диагностики и новейшие походы к консервативному и хирургическому лечению данного заболевания. Описывается патофизиология инсулинорезистентности, метаболического синдрома и ряда других клинически-ассоциированных с НАЖБП состояний. Подробно рассматриваются патогенетические аспекты развития фиброза при НАЖБП и описываются современные возможности и ограничения методов визуализации в диагностике степени стеатоза и стадии фиброза печени, ультразвукового исследования и сывороточных маркеров. Обоснованы подходы к обследованию и ведению пациентов с НАЖБП на разных этапах развития заболевания. The article discusses one of the most frequent hepatic pathologies, non-alcoholic fatty liver disease, and current concepts of its etiology, pathogenesis, diagnostic principles, and the latest approaches to conservative and surgical treatment. Pathophysiology of insulin resistance, metabolic syndrome, and other conditions clinically associated with non-alcoholic fatty liver disease are described. The authors deepened the insight into mechanisms of fibrosis development, up-to-date possibilities and limitations of imaging methods in diagnosis of the degree of steatosis and the stage of liver fibrosis, ultrasound, and serum markers. Clinical substantiation of the need to create an algorithm for examining and managing patients with non-alcoholic fatty liver disease at different stages of this condition and early verification of steatosis has an undoubted merit.
Вackground: Non-alcoholic liver disease (NAFLD) is a widely spread disease that needs an effective and safe treatment strategy. One of pharmacological treatments for people with NAFLD is ursodeoxycholic acid (UDCA). The use of UDCA is pathogenetically justified because of its cytoprotective, antiapoptotic, antioxidant, and hypoglycemic properties. Aim: Our meta-analysis (M-A) aimed to assess the benefits and harms of UDCA in people with NAFLD. Material and methods: We identified trials through electronic searches in the Cochrane Hepato-Biliary (CHB) Controlled Trials Register, CENTRAL, MEDLINE, Embase, SCI, LILACS, eLibrary (May 2018). We considered for inclusion randomised clinical trials (RCTs) assessing URSO versus placebo/no intervention in adult participants with NAFLD. We allowed co-interventions in the trial groups if they were similar. We followed Cochrane methodology, CHB Group methodology using Review Manager 5 and Trial Sequential Analysis to perform meta-analysis (M-A), assessed bias risk of the trials, quality of evidence using GRADE. Results: Four RCT, at high bias risk, low quality of evidence, provided data for analysis: 254 participants at different stages of NAFLD received oral UDCA (median of 18 months), 256 ― placebo/no intervention; age 18 to 75 years. We found no evidence of effect on mortality (there were no deaths) and on histological parameters such as steatosis (MD -0.13; CI -0.40−0.13; participants 323; trials 3; I2=43%), fibrosis (MD 0.00; CI -0.00−0.22; participants 323; trials 3; I2=0%), and inflammation (MD -0.05; CI -0.20−0.10; participants 325; trials 3; I2=0%). Also we found no evidence for significant influence of UDCA on occurrence of serious adverse events (RR 1.45, 95% CI 0.65−3.21; participants 292; trials 2; I2=0%), adverse events (RR 1.52, 95% CI 0.73−3.16; participants 510; trials 4; I2=36%) neither with traditional M-A (random-effects), nor with TSA SAE (CI 0.56−2.91; participants 292; trials 2; I2=0%, D2=0%), AE (CI 0.77–2.21; participants 510; trials 4; I2=0%, D2=0%). There was no evidence of effect on cytolysis, but beneficial effect of UDCA on cholestasis (GGTP) (data from two trials only) (р0.0001). We found no data on quality of life. All the trials were funded by the industry. Conclusion: Based on the small number of trials at high risk of bias, low quality, despite the safety profile observed with our M-A, we can neither recommend nor reject the use of UDCA for people with NAFLD. Further trials with low risk of bias and high quality are required to assess the benefits and harms of UDCA.
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