Особенности ведения больных с НАЖБП и саркопенией

С учетом роста заболеваемости неалкогольной жировой болезнью печени (НАЖБП) и демографического старения населения саркопения стала рассматриваться как одно из патологических состояний, участвующих в развитии и прогрессировании НАЖБП. Установлено, что НАЖБП и саркопения связаны с резистентностью к инсулину и атрофией скелетных мышц как органа-мишени инсулина. В патогенезе НАЖБП участвуют воспалительные цитокины с последующим распадом белков скелетных мышц, адипонектин, низкий уровень которого приводит к снижению чувствительности к инсулину, оксидативный стресс с активацией катаболических процессов и развитием атрофии мышц. Прогрессирование саркопении при НАЖБП является прогностическим фактором и увеличивает риск смертности. Саркопения, преиму щественно возникающая за счет снижения мышечной массы, в сочетании с увеличением висцерального жира, достаточно часто приводит к саркопеническому ожирению и при НАЖБП увеличивает риск сердечно-сосудистых заболеваний. Гипераммониемия, аномальная микробиота кишечника, липидные факторы также способствуют развитию саркопении у пациентов с НАЖБП. Учитывая общие патогенетические механизмы, указывающие на двунаправленную связь между саркопенией и НАЖБП, мультидисциплинарный подход к ведению больных с НАЖБП и саркопенией в настоящее время представляется наиболее оптимальным. Современные концептуальные стратегии направлены на раннюю диагностику НАЖБП и саркопении, оздоровление образа жизни таких больных, поиск эффективных лекарств, комплексное персонализированное лечение, профилактику прогрессирования данных заболеваний и их осложнений.

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