ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet12758ometendo-12758Research ArticleНаучные обзорыReviewsНеалкогольная жировая болезнь печени и сахарный диабет 2 типа: проблема сопряженности и этапности развитияNon-alcoholic fatty liver disease and type 2 diabetes mellitus: the problem of conjunction and phasinghttps://orcid.org/0000-0003-0217-9246КиселеваЕ. В.KiselevaE. V.

 Киселева Елизавета Владимировна

 Россия, 117997, Москва, ул. Островитянова, д. 1

Elizaveta V. Kiseleva

1 Ostrovityanova street, 117997 Moscow, Russia

elizakiseleva10@gmail.comДемидоваТ. Ю.DemidovaT. Y.

Демидова Татьяна Юльевна, д.м.н., профессор; eLibrary SPIN: 9600-9796; Scopus Author ID: 7003771623 

Москва

Tatiana Yu. Demidova, MD, PhD, Professor

Moscow

t.y.demidova@gmail.comРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical University (RNRMU)Russian Federation202123082021183313319Copyright © Киселева Е.В., Демидова Т.Ю., 20212021Киселева Е.В., Демидова Т.Ю.Kiseleva E.V., Demidova T.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/12758

Широкая распространенность неалкогольной жировой болезни печени (НАЖБП) и сахарного диабета 2 типа (СД2), а также их взаимосвязи определяет необходимость прицельного рассмотрения данной патологии с целью оптимизации подходов к диагностике и лечению пациентов с НАЖБП и СД2. Являясь компонентами метаболического синдрома, эти два заболевания во многом имеют схожие механизмы развития и прогрессирования, синергично повышая риск неблагоприятных исходов у коморбидных пациентов. Несмотря на общность патофизиологических механизмов, актуальным остается вопрос о последовательности развития НАЖБП и СД2.

По результатам анализа литературы выделено две основных теории: алиментарная и метаболическая. Согласно алиментарной теории, первичным звеном патогенеза выступают ожирение и сопряженное с ним избыточное накопление свободных жирных кислот и триглицеридов в печени, приводящее впоследствии к инсулинорезистентности и развитию СД2. В противоположность этому, в метаболической теории в качестве первичного удара рассматривается сопутствующая диабету инсулинорезистентность, которая независимо от ожирения создает предпосылки для повреждения печени. Помимо этого, в обзоре уделено особое внимание рассмотрению новой концепции — метаболически ассоциированной жировой болезни печени (МАЖБП), рассматриваемой в качестве печеночного компонента метаболического синдрома. В рамках данной концепции выделяют различные клинические фенотипы НАЖБП, определяющие путь, по которому развиваются рассматриваемые заболевания. В заключение в обзоре обсуждается патогенетически обоснованная терапия, акцент в которой сделан на преодоление инсулинорезистентности, коррекцию атерогенной дислипидемии и восстановление структуры и функции клеток печени.

The widespread prevalence of non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM), as well as their combination, determines the need for a targeted analysis of this pathology in order to optimize approaches to the diagnosis and treatment of patients with NAFLD and T2DM. As components of the metabolic syndrome, these two diseases have largely similar mechanisms of development and progression, simultaneously increasing the risk of adverse outcomes in comorbid patients. Despite the common pathophysiological mechanisms, the question of the development of NAFLD and T2DM remains significant.

Upon conducting literature analysis, two main theories have been identified: alimentary and metabolic. According to the alimentary theory, the primary link in the pathogenesis is obesity and the associated excessive accumulation of free fatty acids and triglycerides in the liver, which subsequently leads to insulin resistance and the development of T2DM. In contrast, the metabolic theory considers diabetes-related insulin resistance as the first hit, which, regardless of obesity, creates preconditions for liver damage. In addition, the review focuses on the consideration of the new concept of Metabolic associated fatty liver disease (MAFLD) as a hepatic manifestation of the metabolic syndrome and considers the clinical phenotypes identified within this pathology. In conclusion, pathogenically based treatment goals in patients with NAFLD and T2DM are overcoming insulin resistance, correcting atherogenic dyslipidemia, and restoring the structures and functions of liver cells.

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The authors declare that there are no conflicts of interest present.