Неалкогольна жирова хвороба печінки та серцево-судинний ризик. Огляд літератури
DOI:
https://doi.org/10.30978/UTJ2024-2-66Ключові слова:
неалкогольна жирова хвороба печінки, серцево-судинний ризик, субклінічний атеросклероз, неалкогольний стеатогепатитАнотація
Наведено дані досліджень щодо асоціації неалкогольної жирової хвороби печінки (НАЖХП) із серцево‑судинними захворюваннями, які зумовлюють основну тяжкість прогнозу в цій популяції хворих. Це вказує на те, що НАЖХП слід розглядати як значущий чинник ризику фатальних і несмертельних серцево‑судинних подій унаслідок її тісного зв’язку з розвитком атеросклерозу та тяжкістю перебігу ішемічної хвороби серця. Наголошено, що такі чинники НАЖХП, як інсулінорезистентність і дисліпідемія, яка має виразний атерогенний характер, розвиток прооксидантного стресу, дисбалансу адипокінів і цитокінів можуть спричинити поширене атеросклеротичне ураження судин і серця аж до розвитку гострого коронарного синдрому. Звернено увагу на здатність НАЖХП потенціювати розвиток гіперкоагулянтних станів із наступним тромбоутворенням, що додатково спричиняє розвиток гострих станів. Наведено дані щодо участі кишкової мікробіоти, яка має характерні зміни у пацієнтів із НАЖХП, у потенціюванні розвитку серцево‑судинних захворювань. Описано результати досліджень щодо впливу ендотоксину на розвиток запальних процесів, ендотеліальної дисфункції, аритмій, дисфункції міокарда та гіперкоагуляційних станів. Багатьма дослідниками представлені переконливі дані, які підтверджують зв’язок НАЖХП із субклінічним атеросклерозом. Цей зв’язок насамперед опосередкований фіброзом печінки, як і серцево‑судинний ризик при атеросклерозі, що має клінічні вияви. Також наведено дані про обтяження перебігу ішемічної хвороби серця в разі коморбідності з НАЖХП. Зазначено, що для запобігання прогресуванню серцево‑судинних захворювань у пацієнтів із НАЖХП слід проводити ранній моніторинг серцево‑судинного ризику та пріоритетне лікування НАЖХП на ранніх стадіях до розвитку фіброзу або з метою зупинити його прогресування, що може ефективно знизити подальший серцево‑судинний ризик і має важливе значення для пацієнтів із субклінічним атеросклерозом. На думку авторів, подальші дослідження в цьому напрямі є актуальними і пріоритетними, оскільки сприятимуть розробці ефективних підходів до лікування та усунення серцево‑судинних чинників ризику в пацієнтів із НАЖХП.
Посилання
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