Структура коморбидности, метаболический статус и возможности терапии пациентов амбулаторного профиля с неалкогольной жировой болезнью печени и нормальной массой тела

Введение. В последние годы стали выделять фенотип неалкогольной жировой болезни печени (НАЖБП) у лиц с нормальной массой тела (НМТ), клинические особенности которого мало изучены.

Цель — изучить структуру сопутствующей патологии, компонентный состав тела и метаболический профиль пациентов НАЖБП и НМТ, динамику этих показателей при комбинированной терапии глицирризиновой кислотой и фосфолипидами.

Материалы и методы. Обследовано 69 пациентов с НАЖБП и НМТ. Проводилось ультразвуковое исследование органов брюшной полости, транзиентная эластография печени, определение компонентного состава тела, параметров углеводного и липидного обмена, уровни инсулина, лептина, адипонектина, HbA1c.

Результаты. Исследуемые пациенты имели стеатоз печени 1-й стадии в 72,5 % случаев, 2-й стадии — 27,5 %; фиброз печени 1–3-й стадий — 22,0 %. Сопутствующая патология органов желудочно-кишечного тракта регистрировалась у 48,0 % лиц, артериальная гипертензия — 25,0 %, дислипидемия — 51,0 %; нарушение толерантности к глюкозе в 30,7 % случаев, адипокинового статуса — 46,0 %. Индекс коморбидности составил (0,6±0,2) балла, риск развития острого коронарного синдрома по шкале PROCAM равнялся (29,2±2,6) %.

Заключение. Большинство пациентов с НАЖБП и НМТ имело 1 или более факторов кардиометаболического риска. Прогрессирование НАЖБП ассоциировалось с неблагоприятным метаболическим профилем и повышением риска развития кардиоваскулярной патологии. В результате 3-месячной терапии препаратом «Фосфоглив» в комплексе с немедикаментозными методами достигнуты задачи по регрессу стеатоза, фиброза, улучшению компонентного состава тела и повышение протективных липопротеинов высокой плотности. 

1. Maev IV, Andreev DN, Kucheryavyy YuA. Prevalence of non-alcoholic fat disease liver in Russian Federation: Meta-analysis. Consilium Medicum. 2023;25(5):313–319. (In Russ.). DOI: https://doi.org/10.26442/20751753.2023.5.202155.

2. Drapkina OM, Evstifeeva SE, Shalnova SA, Kutsenko VA, Balanova YuA, Imaeva AE, et al. Prevalence of non-alcoholic fatty liver disease and its association with cardiovascular risk factors (data from Russian epidemiological studies). Cardiovascular Therapy and Prevention. 2025;24(2):4316. (In Russ.). DOI: https://doi.org/10.15829/1728-8800-2025-4316.

3. Dicheva DT, Brekhunets RM, Andreev DN, Lebedeva EG, Berezutskaya OE, Golovkina NL, et al. Prevalence of non-alcoholic fatty liver disease at Moscow multi-speciality hospitals from 2022 to 2024. Medical Council. 2025;(15):149–155. (In Russ.). DOI: https://doi.org/10.21518/ms2025-401.

4. Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): A systematic review. Hepatology. 2023;77(4):1335–1347. DOI: https://doi.org/10.1097/hep.0000000000000004.

5. Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123–133. DOI: https://doi.org/10.1002/hep.29466.

6. Fan R, Wang J, Du J. Association between body mass index and fatty liver risk: A dose-response analysis. Scientific Reports. 2018;8(1):15273. DOI: https://doi.org/10.1038/s41598-018-33419-6.

7. Lazebnik LB. Metabolic associated fatty liver disease. Practical recommendations of the Scientific Society of Gastroenterologists of Russia. Part 1. Experimental and Clinical Gastroenterology. 2024;(10):5–10. (In Russ.). DOI: https://doi.org/10.31146/1682-8658-ecg-230-10-5-10.

8. Tang A, Ng CH, Phang PH, Chan KE, Chin YH, Fu CE, et al. Comparative burden of metabolic dysfunction in lean NAFLD vs non-lean NAFLD — a systematic review and meta-analysis. Clinical Gastroenterology and Hepatology. 2023;21(7):1750–1760.e12. DOI: https://doi.org/10.1016/j.cgh.2022.06.029.

9. DiStefano JK, Gerhard GS. NAFLD in normal weight individuals. Diabetology & Metabolic Syndrome. 2022;14:45. DOI: https://doi.org/10.1186/s13098-022-00814-z.

10. Turkina SV, Tyshchenko I, Titarenko MN. Non-alcoholic fatty liver disease in people with normal body weight. Experimental and Clinical Gastroenterology. 2024;(10):36–48. (In Russ.). DOI: https://doi.org/10.31146/1682-8658-ecg-230-10-36-48.

11. Margariti A, Deutsch M, Manolakopoulos S, Tiniakos D, Papatheodoridis GV. The severity of histologic liver lesions is independent of body mass index in patients with nonalcoholic fatty liver disease. Journal of Clinical Gastroenterology. 2013;47(3):280–286. DOI: https://doi.org/10.1097/mcg.0b013e31826be328.

12. Younes R, Govaere O, Petta S, Miele L, Tiniakos D, Burt A, et al. Caucasian lean subjects with non-alcoholic fatty liver disease share long-term prognosis of non-lean: Time for reappraisal of BMI-driven approach? Gut. 2022;71(2):382–390. DOI: https://doi.org/10.1136/gutjnl-2020-322564.

13. Hagström H, Nasr P, Ekstedt M, Hammar U, Stål P, Hultcrantz R, et al. Risk for development of severe liver disease in lean patients with nonalcoholic fatty liver disease: A long-term follow-up study. Hepatology Communications. 2017;2(1):48–57. DOI: https://doi.org/10.1002/hep4.1124.

14. Xu X, Jin J, Liu Y. Performance of FibroScan in grading steatosis and fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Arab Journal of Gastroenterology. 2023;24(4):189–197. DOI: https://doi.org/10.1016/j.ajg.2023.08.003.

15. Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson comorbidity index: A critical review of clinimetric properties. Psychotherapy and Psychosomatics. 2022;91(1):8–35. DOI: https://doi.org/10.1159/000521288.

16. Gulyaeva IL, Bulatova IA, Sobol AA. Analysis of the course of non-alcoholic fatty liver disease in postmenopausal women depending on metabolic comorbidity. Modern Problems of Science and Education. 2024;4. (In Russ.). DOI: https://doi.org/10.17513/spno.33637.

17. Dowman JK, Tomlinson JW, Newsome PN. Pathogenesis of non-alcoholic fatty liver disease. QJM. 2010;103(2):71–83. DOI: https://doi.org/10.1093/qjmed/hcp158.

18. Milner KL, van der Poorten D, Xu A, Bugianesi E, Kench JG, Lam KS, et al. Adipocyte fatty acid binding protein levels relate to inflammation and fibrosis in nonalcoholic fatty liver disease. Hepatology. 2009;49(6):1926– 1934. DOI: https://doi.org/10.1002/hep.22896.

19. Poetsch MS, Strano A, Guan K. Role of leptin in cardiovascular diseases. Frontiers in Endocrinology. 2020;11:354. DOI: https://doi.org/10.3389/fendo.2020.00354.

20. Frühbeck G, Catalán V, Rodríguez A, Ramírez B, Becerril S, Salvador J, et al. Involvement of the leptin-adiponectin axis in inflammation and oxidative stress in the metabolic syndrome. Scientific Reports. 2017;7:6619. DOI: https://doi.org/10.1038/s41598-017-06997-0.

21. Keating SE, Hackett DA, George J, Johnson NA. Exercise and non-alcoholic fatty liver disease: A systematic review and meta-analysis. Journal of Hepatology. 2012;57(1):157–166. DOI: https://doi.org/10.1016/j.jhep.2012.02.023.

22. Hashida R, Kawaguchi T, Bekki M, Omoto M, Matsuse H, Nago T, et al. Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: A systematic review. Journal of Hepatology. 2017;66(1):142–152. DOI: https://doi.org/10.1016/j.jhep.2016.08.023.

23. Smart NA, King N, McFarlane JR, Graham PL, Dieberg G. Effect of exercise training on liver function in adults who are overweight or exhibit fatty liver disease: A systematic review and meta-analysis. British Journal of Sports Medicine. 2018;52(13):834–843. DOI: https://doi.org/10.1136/bjsports-2016-096197.

24. Cheng S, Ge J, Zhao C, Le S, Yang Y, Ke D, et al. Effect of aerobic exercise and diet on liver fat in prediabetic patients with non-alcoholic-fatty-liver-disease: A randomized controlled trial. Scientific Reports. 2017;7:15952. DOI: https://doi.org/10.1038/s41598-017-16159-x.

25. Trovato FM, Martines GF, Brischetto D, Trovato G, Catalano D. Neglected features of lifestyle: Their relevance in non-alcoholic fatty liver disease. World Journal of Hepatology. 2016;8(33):1459–1465. DOI: https://doi.org/10.4254/wjh.v8.i33.1459.

26. El Hadi H, Di Vincenzo A, Vettor R, Rossato M. Cardio-metabolic disorders in non-alcoholic fatty liver disease. International Journal of Molecular Sciences. 2019;20(9):2215. DOI: https://doi.org/10.3390/ijms20092215.

27. Maev IV, Samsonov AA, Palgova LK, Pavlov CS, Shirokova EN, Vovk EI, et al. Effectiveness of phosphatidylcholine as adjunctive therapy in improving liver function tests in patients with non-alcoholic fatty liver disease and metabolic comorbidities: Real-life observational study from Russia. BMJ Оpen Gastroenterology. 2020;7(1):e000368. DOI: https://doi.org/10.1136/bmjgast-2019-000368.

28. Dajani AI, Popovic B. Essential phospholipids for nonalcoholic fatty liver disease associated with metabolic syndrome: A systematic review and network meta-analysis. World Journal of Clinical Cases. 2020;8(21):5235– 5249. DOI: https://doi.org/10.12998/wjcc.v8.i21.5235.

29. Ivashkin VT, Bakulin IG, Bogomolov PO, Matsiyevich MV, Geyvandova NI, Koroy PV, et al. Efficacy and safety of glycyrrhizic acid combined to essential phospholipids (Phosphogliv) at non-alcoholic fatty liver disease: Results of multicenter double blind randomized placebo-controlled post-registration clinical study (IV phase) “Gepard” (PHG-M2/P02–12). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(2):34–43. (In Russ.). DOI: https://doi.org/10.22416/1382-4376-2017-27-2-34-43.

30. Mayev IV, Bueverov AO, Volnukhin AV. Efficacy and safety of a fixed combination of glycyrrhizic acid and essential phospholipids in non-alcoholic fatty and alcoholic liver disease: Results of randomized placebo-controlled trials. Bulletin of the Russian Academy of Medical Sciences. 2021;76(6):596–603. (In Russ.). DOI: https://doi.org/10.15690/vramn1576.

31. Sitnickov IG, Ryzhkina AV, Bokhonov MS. Peculiarities of the lipid metabolism disturbances and their correction with a Phosphogliv preparation at a chronic hepatitis C. Modern Technologies in Medicine. 2009;1:54– 56. (In Russ.). EDN: https://elibrary.ru/KWEBGV.