Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya7127010.26442/00403660.2021.04.200755ReviewsОбзорыReview ArticleMixed steatohepatitis: more questions than answers (part 2)Стеатогепатиты смешанного генеза: больше вопросов, чем ответов (часть 2)https://orcid.org/0000-0002-8821-6142RaikhelsonKarina L.РайхельсонКарина Леонидовна
Russian Federation

д.м.н., проф., Научно-клинический и образовательный центр гастроэнтерологии и гепатологии

kraikhelson@mail.ruhttps://orcid.org/0000-0002-0142-0264KondrashinaElina A.КондрашинаЭлина Александровна
Russian Federation

к.м.н., доц. , Научно-клинический и образовательный центр гастроэнтерологии и гепатологии

kraikhelson@mail.ruhttps://orcid.org/0000-0002-7590-8932PazenkoEkaterina V.ПазенкоЕкатерина Владимировна
Russian Federation

мл. науч. сотр. Научно-клинического и образовательного центра гастроэнтерологии и гепатологии

kraikhelson@mail.ruSaint Petersburg State UniversityФГБОУ ВО «Санкт-Петербургский государственный университет»150420219345165200306202103062021Copyright ©; 2021, Consilium MedicumCopyright ©; 2021, ООО "Консилиум Медикум"2021Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/71270

In this review, we discussed the epidemiological and pathogenetic aspects of mixed steatohepatitis (SH), developed due to non-alcoholic fatty liver disease, metabolic associated fatty liver disease, drug-induced liver injury. We discussed the mechanisms of the mutually aggravating influence of etiological factors. Drugs can cause steatosis and SH, as well as contribute to the progressive course of existing SH, primarily of metabolic origin. The issues of interaction of pathogenetic factors, peculiarities of diagnostics and perspectives of pathogenetic and symptomatic treatment are considered. Therapy of mixed SH is based on avoidance of hepatotoxic drugs and lifestyle modification, medications with demonstrated efficacy (such as ademetionine) in certain SH might be used.

В обзоре обсуждаются эпидемиологические и патогенетические аспекты сочетания стеатогепатитов (СГ) смешанного генеза, обусловленных неалкогольной жировой болезнью печени (метаболически ассоциированная жировая болезнь печени), алкогольной болезнью печени, лекарственным поражением печени. Проанализированы патогенетические механизмы взаимоотягчающего влияния этиологических факторов. Лекарственные средства могут вызывать стеатоз и СГ, а также способствовать прогрессирующему течению уже имеющегося СГ, прежде всего метаболического характера. Рассмотрены вопросы взаимодействия патогенетических факторов, особенности диагностики и перспективные возможности патогенетического и симптоматического лечения. Основой терапии СГ смешанного генеза являются отмена гепатотоксических лекарственных препаратов и модификация образа жизни, в качестве медикаментозного лечения следует использовать препараты, показавшие свою эффективность при отдельных вариантах СГ (такие как адеметионин).

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