Получена: 21.02.2024/ Принята: 09.04.2024/Опубликована online: 29.04.2024
УДК: 616.36-004
DOI: 10.53511/pharmkaz.2024.80.59.001
Гульнара Г. Бедельбаева1, Венера С. Рахметова2, Баян Б. Камалова1, Елена Б. Ужегова1, Базарбай Е. Ердаш1
1НАО «Казахский Национальный медицинский университет им. С. Асфендиярова», г. Алматы, Республика Казахстан
2НАО «Медицинский университет Астана», г. Астана, Республика Казахстан
СОВРЕМЕННЫЕ ПРИНЦИПЫ ЛЕЧЕНИЯ ЦИРРОЗА ПЕЧЕНИ И ЕГО ОСЛОЖНЕНИЙ
Актуальность. Цирроз печени становится все более распространенным заболеванием. Оптимальное использование
терапевтических стратегий для предотвращения и мониторинга осложнений цирроза печени имеет решающее
значение для улучшения клинических результатов и прогноза пациентов.
Цель: обзор литературы, посвященный современным принципам лечения цирроза печени и его осложнений.
Методы: проведен описательный обзор литературы, сосредоточив внимание на самых последних достижениях.
Стратегия поиска. Поиск научных публикаций проводился в базах данных доказательной медицины (PubMed,
Scopus, Cochrane Library, Medline), в электронных научных ресурсах (e-Library, CyberLeninka, медицинские сайты
стран ближнего зарубежья), который позволил выявить около 135 литературных источников, 119 из них включены
в данный обзор. Глубина поиска составила 26 лет (1997 – 2023 гг.). Это связано с важностью основополагающих
фундаментальных работ, раскрывающих базовые вопросы принципов лечения цирроза печени.
Критерии включения: результаты современных исследований, выполненных с учетом всех требований
доказательной медицины; данные фундаментальных базовых исследований, проведенных на разнообразных
группах; англо- и русскоязычные публикации.
Критерии исключения: «кейс-репорт»; источники ранее 1997 года, не соответствующие требованиям доказательной
медицины; тезисы.
Результаты: рассмотрены этиологически ориентированные методы лечения, которые могут предотвратить цирроз
печени и его осложнения. К ним относятся противовирусная терапия, психофармакологическая терапия
расстройств, связанных с употреблением алкоголя, а также текущий ландшафт клинических исследований
неалкогольного стеатогепатита. Рассмотрены современные стандарты медицинской помощи и последние
разработки в области лечения печеночной энцефалопатии (ПЭ), асцита и гепаторенального синдрома. Оценены
перспективы и недостатки химиопрофилактической терапии, которая изучалась в клинических и обсервационных
исследованиях и которая может снизить риск гепатоцеллюлярной карциномы и осложнений цирроза печени. Также
описаны методы лечения, направленные на устранение безболевых симптомов цирроза печени, включая зуд,
мышечные спазмы, сексуальную дисфункцию и усталость.
Выводы: Улучшение клинических результатов и эффектов лечения пациентов циррозом печени возможно путем
применения научно обоснованных фармакотерапевтических подходов к профилактике и лечению осложнений
цирроза печени.
Ключевые слова: цирроз печени, осложнения, лечение, химиопрофилактика, безболевые симптомы.
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