Diagnostics and treatment of non-alcoholic fatty liver disease: clinical guidelines of the Russian Scientific Liver Society and the Russian gastroenterological association

Ивашкин, В. Т.; Маевская, М. В.; Павлов, Ч. С.; Тихонов, И. Н.; Широкова, Е. Н.; Буеверов, А. О.; Драпкина, О. М.; Шульпекова, Ю. О.; Цуканов, В. В.; Маммаев, С. Н.; Маев, И. В.; Пальгова, Л. К.

doi:10.22416/1382-4376-2016-26-2-24-42

Cited by 87 publications

(7 citation statements)

References 68 publications

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“…В биохимическом анализе крови при НАЖБП «иногда выявляют повышение активности сывороточных трансаминаз (АЛТ и АСТ), гаммаглутамилтрансферазы, щелочной фосфатазы и уровня билирубина». Однако, связь между повышением активности АЛТ и выраженностью воспалительной реакции и фиброза печени не всегда прослеживается [22]. Уровень С-реактивного белка в крови, основного маркера системной воспалительной реакции, повышен не был.…”

Section: Discussionunclassified

Differential diagnosis of unconjugated hyperbilirubinemiadetected after coronary artery stenting

Chepurnenko,

Nasytko,

Shavkuta

2023

jour

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Introduction. An increase in bilirubin and liver enzyme activity may be one of the side effects of statin therapy, often occurring in patients after AMI and coronary artery stenting, or in high and very high risk individuals on high and moderate intensity statin therapy. The frequency of occurrence of increased transaminases and bilirubin is according to different authors. Therefore, in terms of differential diagnosis, the cardiologist should consider Gilbert’s syndrome as a possible cause of hyperbilirubinemia. Description of the clinical case. The article considers a clinical case of differential diagnosis of non-conjugated hyperbilirubinemia detected in a patient after coronary artery stenting. The level of hemoglobin, erythrocytes, reticulocytes did not differ from normal values and did not change over time. This made it possible to exclude the hemolytic genesis of hyperbilirubinemia. Genetic testing was used to establish the homozygous form of Gilbert’s syndrome. However, the presence of fibrotic changes in the liver, an increase in not only unconjugated, but also conjugated bilirubin, hypertriglyceridemia, dyslipidemia, and stenosing atherosclerosis of the coronary arteries did not allow us to state that the patient had only Gilbert’s syndrome. Discussion. According to recent studies, this disease is characterized by a benign course and reduces the risk of developing cardiovascular diseases due to the antioxidant effect of bilirubin. In addition to Gilbert’s syndrome, the patient was diagnosed with an erased form of non-alcoholic fatty liver disease associated with metabolic syndrome. Conclusion. The disease was caused by insulin resistance, a high-calorie diet, excess consumption of saturated fats, refined carbohydrates, and a sedentary lifestyle. The drugs of choice in this case are statins, ezetemibe, and ursodeoxycholic acid. Their appointment allows not only to reduce cardiovascular risk, but also to slow down the further progression of liver fibrosis.

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Section: Discussionunclassified

Differential diagnosis of unconjugated hyperbilirubinemiadetected after coronary artery stenting

Chepurnenko,

Nasytko,

Shavkuta

2023

jour

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“…Ключевые слова: неалкогольная жировая болезнь печени (НАЖБП), жировой гепатоз, амбулаторная помощь В связи с этим НАЖБП рассматривается как печеночный компонент метаболического синдрома (МС) [5,6,7], при наличии которого смертность от сердечно-сосудистых заболеваний увеличивается в 5 раз у женщин и в 2 раза у мужчин [8], а инфаркт миокарда и инсульт встречаются в 3,5 раза чаще [9]. Патогенетической основой составной части МСожирения является инсулинорезистентность (ИР), которая должна выявляться на наиболее раннем этапе с целью осуществления своевременного эффективного лечения основных составляющих МС [10].…”

Section: резюмеunclassified

Clinical improvement of some indicators of the activity of non-alcoholic fatty liver disease after correction of intestinal dysbiosis with dietary fiber

Krylova,

Lyamin,

Kupaev

2024

ECG

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Relevance. Metabolic disorders in non-alcoholic fatty liver disease play a signifi cant role in the development and progression of cardiovascular diseases, accelerating their occurrence, aggravating their course and outcomes. The occurrence and maintenance of a chronic staged course (from fatty hepatosis and non-alcoholic steatohepatitis to progressive liver fi brosis) of the disease is associated with quantitative and qualitative changes in the composition of the intestinal microfl ora. At the same time, outpatients may consider themselves healthy, which makes it diffi cult to implement a comprehensive treatment program. The peculiarities of the combination of clinical, laboratory and microbiological characteristics of patients with hepatic steatosis require detailed study for the earliest identifi cation of therapeutic targets, diagnostic and prognostic tools and their eff ective correction.Purpose of the study: to determine the clinical, laboratory and microbiological characteristics of patients with non-alcoholic fatty liver disease.Material and methods: clinical, laboratory and microbiological data of outpatients were collected, anthropometric indicators were calculated. Statistical analysis: Microsoft Excel 2010 and StatTech v.3.1.8 (Russia) with assessment for normality of distribution and chi-square test. Diff erences were assessed by nonparametric analysis at a signifi cance level of p<0.05.Results. Patients were assigned to the observation group if they had NAFLD or to the comparison group in it absence. Many patients in the observation group were found to have metabolic syndrome and/or abdominal obesity, accompanied by asthenic syndrome, functional disorders of the biliary tract, and disorders of lipid and carbohydrate metabolism. In the luminal microfl ora of the intestines of patients in the observation group, the presence of representatives of Pseudomonas spp. was signifi cantly more often detected. Correction of microbiological disorders by adding dietary fi ber to the diet provided clinical improvement. Conclusion.In addition to clinical and laboratory data, microbiological characteristics of patients can be used for the earliest diagnosis and eff ective correction of disorders that occur during the development of NAFLD.

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“…Согласно результатам российского исследования DIREG 1 (2007 г), заболеваемость НАЖБП насчитывала 27% [3]. Исследование DIREG 2 (2015 г) продемонстрировало, что распространенность НАЖБП у лиц, обращающихся за амбулаторной помощью, равнялась уже 37,3%, показав прирост на 10% за 7 лет по сравнению с данными DIREG 1 [4]. Выявление пациентов с ранней стадией НАЖБП, а именно со стеатозом печени, безусловно имеет очень важное значение для определения лиц с высоким кардиометаболическим риском, нуждающихся в лечении, направленном на профилактику прогрессирования НАЖБП и сердечно-сосудистых заболеваний (ССЗ) [5,6].…”

Section: Introductionunclassified

Hyperammonemia in patients with stable angina pectoris and nonalcoholic fatty liver disease at the steatosis stage

Zykina,

Simonova

2023

jour

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The aim. To assess the severity of hyperammoniemia in patients with non-alcoholic fatty liver disease at the steatosis stage in conditions of comorbidity with stable angina. Research materials and methods. During the clinical trial, three groups of patients with stable angina were formed. Group I (n = 43) consisted of patients with NAFLD at the stage of hepatic steatosis in combination with obesity and a stable form of CHD. Group II (n = 41) - patients with NAFLD at the stage of hepatic steatosis against the background of normal body weight and stable CHD. Group III (control) (n = 42) - patients with stable angina without NAFLD, with normal body weight. The results of laboratory examination (clinical and biochemical blood tests, lipidograms, insulin levels (calculated by HOMA-IR), glycosylated hemoglobin (HbAlc)) were evaluated; non-invasive markers for the diagnosis of liver injury. Hyperammonemia was evaluated by quantitative rapid ammonia analysis using a Pocket Chem TM BA PA-4140 analyzer. All patients underwent ultrasound of the liver using Philips Epiq 5 (USA). Results. In all patients with stable angina (group I and II), the diagnosis of non-alcoholic fatty liver disease, steatosis stage, was confirmed. The lipid profile of patients in Groups I and II showed more significant hypertriglyceridemia compared to those in the control group, with no statistical difference in Groups I and II. The mean ammonium level in patients with NAFLD in combination with stable CHD (group I, II) was above the threshold and was 87 (57-127.5) and 79 (57-97) μmol/L, respectively, and did not differ significantly (p > 0.05). In patients of group III (without liver disease), the mean values of ammonia in the blood were in the target range. According to the results of correlation analysis, we established the relationship of ammonium with liver enzymes, calculated steatosis indices and basic metabolic indicators. Conclusion. Patients with non-alcoholic fatty liver disease in the steatosis stage with a combination of stable angina have more severe hyperammonemia compared to patients with stable CHD without concomitant liver injury.

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Diagnostics and treatment of non-alcoholic fatty liver disease: clinical guidelines of the Russian Scientific Liver Society and the Russian gastroenterological association

Cited by 87 publications

References 68 publications

Differential diagnosis of unconjugated hyperbilirubinemiadetected after coronary artery stenting

Differential diagnosis of unconjugated hyperbilirubinemiadetected after coronary artery stenting

Clinical improvement of some indicators of the activity of non-alcoholic fatty liver disease after correction of intestinal dysbiosis with dietary fiber

Hyperammonemia in patients with stable angina pectoris and nonalcoholic fatty liver disease at the steatosis stage

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