Проблема неалкогольної жирової хвороби печінки, метаболічного синдрому та атеросклерозу: від єдності патогенезу до можливості корекції урсодезоксихолевою кислотою
Ключові слова:
неалкогольна жирова хвороба, метаболічний синдром, атеросклероз, кардіоваскулярний ризик, урсодезоксихолева кислотаАнотація
Неалкогольна жирова хвороба печінки (НАЖХП) є однією з найвідоміших патологій печінки, поширеність якої неухильно зростає в світі. Серцево‑судинні захворювання є іншою групою широко поширених захворювань, які мають подібні патофізіологічні механізми з НАЖХП. Серцево‑судинні захворювання і НАЖХП виникають на тлі метаболічного синдрому, системної інсулінорезистентності, окисного стресу, зміни метаболізму ліпідів. Перебіг обох нозологій призводить до розвитку ендотеліальної дисфункції та формування/дестабілізації атеросклеротичних бляшок. Прогресування НАЖХП асоціюється зі збільшенням товщини комплексу інтима — медіа, кальцифікацією коронарних артерій, що супроводжується зростанням ризику розвитку субклінічного і клінічно значущого атеросклерозу. Хворим на НАЖХП властивий високий кардіоваскулярний ризик, максимальне зростання якого слід очікувати у пацієнтів з вираженим фіброзом (F3—F4 за шкалою NAFLD Fibrosis Score). Урсодезоксихолева кислота зменшує виразність системної запальної відповіді та окисного стресу, поліпшує метаболізм ліпідів, посилює гіполіпідемічну дію статинів, зменшує ступінь гіперглікемії та інсулінорезистентності, гальмує утворення атеросклеротичних бляшок, сприяє вазодилатації. Наявність значних плейотропних властивостей у поєднанні з виразною цитопротекторною, холеретичною, антиапоптичною, антихолестатичною, імуномоделювальною активністю дає змогу включати урсодезоксихолеву кислоту в схеми лікування НАЖХП, неалкогольного стеатогепатиту з метою зменшення клінічних виявів атеросклерозу і профілактики прогресування серцево‑судинних захворювань.
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