This pathology develops due to the accumulation of excess fats by liver cells - healthy hepatocytes first on outer surface, and then in the internal structures of the organ are gradually replaced by a third-party formation with a loose consistency.

If left untreated, new connective tissue begins to form in places of local liver damage, adhesions, scars form.

The most important negative factor of the above pathological process, as modern medical practice, is a poorly balanced diet, which not only increases body weight and forms the preconditions for a slowdown in lipid metabolism, but also seriously hits the liver.

In turn, a strictly observed diet, even in the presence of complications, can significantly improve the condition of the organ, slow down or even stop the growth of body fat, after which the medications and other methods used conservative therapy complement the healing process.

How to treat fatty liver?

Some patients believe that if fatty hepatosis was discovered by accident, does not cause them discomfort, then it is not necessary to treat it. To some extent, they are right - active treatment of this pathology should be engaged only in cases where there is high risk its progression.

Clear schemes for the treatment of non-alcoholic fatty liver disease have not been developed to date, however, there is still a plan of action for the doctor and the patient suffering from steatosis.

Regarding the need to treat liver steatosis with medicines, there are some disagreements between specialists today. Some believe that it will be more than enough for the patient to normalize his lifestyle and improve nutrition, and the structure of the liver will soon normalize.

According to others, drugs are still indispensable. Still others believe that fatty hepatosis and non-alcoholic steatohepatitis stand side by side, and it is possible to reliably differentiate them from each other only by examining a liver biopsy, and this procedure is not possible in every medical institution.

• metformin;
• thiazolindiones (pioglitazone, rosiglitazone);
• α-lipoic acid;
• cholesterol-lowering drugs (statins, fibrates);
• hepatoprotectors (ursodeoxycholic acid, hepabene, heptral and others).

Metformin

The mechanism of action of this drug is to inhibit the production of glucose by the liver and the resulting decrease in fasting blood glucose (with fatty hepatosis, it can be increased). In addition, it increases the sensitivity of tissues to insulin - the concentration of this hormone decreases, as well as the concentration of free fatty acids and triglycerides. In addition, the result of long-term use of the drug is a decrease in the patient's body weight.

Do not combine metformin with alcohol and heavy physical exertion.

Thiazolindiones (rosiglitazone, pioglitazone)

Yes, these drugs have a pronounced effect of reducing insulin resistance, but their widespread use is limited by the side effects discovered not so long ago. It turned out that glitazones retain water in the body, which is manifested by edema.

They also activate the processes of lipogenesis - the formation of fat, the result of which is an increase in body weight. In addition, it has been proven that against the background of their use, the risk of limb fractures, myocardial infarction and even certain types of cancer increases.

α-lipoic acid (Thiogamma Turbo, Espa-Lipon)

This substance, like metformin, increases the sensitivity of tissues to insulin, and is also powerful antioxidant. It is not contraindicated for use by the elderly and those suffering from cardiovascular diseases and kidney pathology.

Cholesterol-lowering drugs (statins and fibrates)

These drugs do not change the structure of the liver and do not affect the parameters of liver tests, but they are an integral part of the complex therapy of the metabolic syndrome, in which there is often fatty liver hepatosis. They normalize the lipid composition of the blood, preventing the development of atherosclerosis.

Hepatoprotectors

Long-term use of this group of drugs improves metabolism in the liver tissue, normalizing its functions.

This is a drug whose active ingredient is ademetionine. Against the background of taking it in patients, heaviness in the right hypochondrium, nausea, bitterness in the mouth and other manifestations of dyspeptic syndrome disappear, the liver acquires normal sizes, in the presence of non-alcoholic steatohepatitis - the indicators of liver tests - ASAT and ALT - also decrease to normal values.

Gepabene

This is a herbal preparation, which includes extracts of milk thistle and fumes. Silymarin, contained in milk thistle, provides antifibrotic (prevents the replacement of liver cells with connective tissue), protective, membrane stabilizing and anti-inflammatory effects, and also has antioxidant properties.

In persons suffering from the metabolic syndrome associated with non-alcoholic fatty liver disease, while taking this drug, the clinical manifestations of liver pathology disappear.

Ursodeoxycholic acid (Ursofalk, Ursohol)

This is one of the bile acids, not only non-toxic to the human body, but on the contrary, it performs the most important functions in it. It improves metabolism in liver cells, has an immunomodulating effect, and prevents apoptosis (self-destruction of cells).

Against the background of taking drugs containing this substance as a basis, the indicators of liver tests in the blood are normalized and the manifestations of steatosis are reduced, however, the question of whether ursodeoxycholic acid contributes to the normalization of the liver structure has not been studied enough to date.

There are many more hepatoprotectors that can be used for non-alcoholic fatty liver disease, in particular, for fatty hepatosis - it is simply impossible to list all of them. This is Essentiale, and Hepa-Merz, and Antral, and others, others, others.

Concluding the article, we want to repeat that the leading role in the treatment of fatty hepatosis does not belong to drugs, but to lifestyle modifications in combination with proper nutrition. In most cases of pathology, these actions contribute to the normalization of the structure of the liver and the disappearance of unpleasant symptoms of the disease.

The need for the use of drugs for liver steatosis is determined solely by the doctor based on the characteristics of the course of the disease in a particular patient and the results of his examination. You should not self-medicate - if you experience symptoms similar to those of liver disease, please consult a doctor.

For the treatment of fatty hepatosis, the root cause of the disease is determined, and the most effective method of treatment is considered to be a properly selected diet. A special diet can normalize and improve metabolism and cholesterol, normalize the level of glycogen that forms glucose to maintain the functions of other organs, stimulate the production of bile for the proper functioning of the digestive system.

If a person has fatty liver hepatosis, a doctor prescribes medication. Hepatosis should not be confused with hepatitis. hepatitis is not inflammatory process which leads to fatty degeneration of the liver. This pathology most often occurs in obese individuals. What are the causes, symptoms and treatment of fatty liver?

Characteristics of the disease

Hepatosis is a chronic noncommunicable disease, which is characterized by organ degeneration, accumulation of lipids in hepatocytes and cell destruction. The liver is an important organ human body. It neutralizes toxic substances and decay products during metabolic processes.

Failure to comply with the prescribed diet and maintaining the same diet leads to the progression of liver changes in the fatty type. Fatty degeneration becomes chronic, its symptoms are partially lubricated, and negative processes gradually develop and worsen.

The next stage of fatty hepatosis will be fibrosis - on the surface and inside the organ there are structural changes, third-party connective tissues are quickly formed, scars and adhesions are formed. After some more time, focal degeneration is replaced by a global lesion of both lobes, hepatocytes are genetically modified and reproduce already damaged cells - cirrhosis is rapidly emerging, on terminal stages leading to the death of the patient.

For citation: Drapkina O.M., Klimenkov A.V., Ivashkin V.T. Can statins be prescribed to patients with liver disease? // RMJ. 2007. No. 2. S. 74

Cardiovascular pathology (ischemic heart and brain disease, occlusive diseases of peripheral arteries) is the most common cause of morbidity, mortality and disability in the population of industrialized countries. All these diseases are based on the same pathological process- atherosclerosis.

Atherosclerosis is one of the most important medical problems of our time. In Europe and North America, the disease, its effects and complications are main reason population mortality. For over 70 years in developed countries there was a progressive increase and aggravation of manifestations of atherosclerosis and their "rejuvenation". Only in the 80s of the last century, thanks to advances in the study of the pathophysiology of atherosclerosis and rationally organized prevention, this trend was somewhat slowed down. However, for Russia, the epidemiological picture still remains almost as alarming as it was in the 1970s. More than half of people die as a result of this disease.
Almost all theories of atherosclerosis recognize that the mechanism of occurrence and progression of this disease is associated with a violation of the interaction of metabolic, neurohumoral and cellular factors blood with the wall of the artery. Most experts are inclined to the so-called "response to damage" theory, according to which four main stages in the formation of atherosclerosis can be distinguished:
. endothelial dysfunction/damage;
. adhesion and diapedesis of monocytes;
. formation of foam cells;
. migration and proliferation of smooth muscle cells.
It has now been established that even before damage to the endothelium, blood components begin to interact with the endothelial surface - this primarily concerns low-density lipoproteins (LDL) and their active component (apolipoproteins). It should be noted that the most atherogenic particles (LDL) are able to penetrate into the subendothelial space, where, being oxidized, they act on endothelial cells. Thus, today they talk about the initial stage of atherosclerosis, as a response to the retention of atherogenic particles.
The main risk factors that play a significant role in endothelial damage are smoking, arterial hypertension (AH) and hypercholesterolemia. It has been shown that with an increase in cholesterol levels of more than 8.5 mmol / l (or above 330 mg / dl), the risk of fatal cardiovascular diseases increases 4 times, when combined with hypertension - 9 times, in the presence of hypercholesterolemia, smoking and hypertension - 16 times. It is these three risk factors that are included in the well-known table (SCORE calculation) adopted by the European Congress of Cardiology, which, in addition to the listed criteria, takes into account gender and age. Based on these data, the coronary risk over 10 years can be calculated for each patient.
In recent years, it has been convincingly shown that lipid-lowering therapy significantly reduces not only the risk of such complications of atherosclerosis as coronary death, myocardial infarction and angina pectoris, but also overall mortality. This was made possible by the use of a new class of lipid-lowering drugs - statins. The discovery and introduction into wide clinical practice of HMG-CoA reductase inhibitors has become one of the most striking events in the field of cardiology in the last decade.
But before talking about statins, it is also necessary to say a few words about lifestyle changes. Unfortunately, most citizens prefer to take pills instead of giving up an unhealthy lifestyle. However, therapeutic lifestyle modification has a significant and usually more pronounced than additive effect in terms of risk reduction. In addition, the efficiency drug therapy the same statins are enhanced by favorable therapeutic lifestyle changes, including diet. In terms of dietary recommendations for lowering LDL cholesterol, clinicians should advise limiting saturated fat to less than 7% of total calories and cholesterol to less than 200 mg/day, as well as plant stanols and sterols and foods with viscous (soluble) fibers. Stanols and sterols are found in certain types of margarine and salad dressings. Sources of soluble fiber include legumes, cereals, beans, various fruits and vegetables. These lifestyle changes, including diet, appear to have positive influence not only on the risk of developing coronary artery disease, but also on some forms of cancer, especially of the large intestine and uterus (possibly breast).
The choice of lipid-lowering drug is determined by the degree of its proven effectiveness according to placebo-controlled studies, safety in long-term use, portability, cost.
For the first time, attempts to reduce cholesterol levels with the help of drugs were made in the 50-60s of the XX century. In those years, the possibilities of using clofibrate, plant sterols and high doses of nicotinic acid for this purpose were actively investigated. Not too high efficiency of these drugs, as well as frequent side effects were the basis for the search for drugs with fundamentally different mechanisms of action. To date, five groups of lipid-lowering agents have been created - fatty acid sequestrants, fibrates, nicotinic acid preparations, antioxidants and statins.
Although several groups of drugs, prescribed by a doctor or sold without a prescription, can beneficially change the lipid spectrum, NCEP III recommends that in almost all patients requiring medical correction lipid levels, use 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitors, or statins, as drugs of first choice.
Inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme-A-reductase have taken a leading place in the treatment of elevated plasma cholesterol levels, primarily due to their pronounced hypolipidemic effect, safety and good tolerability.
The history of statins began in 1976, when a new class of antibiotics, monocalins, was discovered, which is distinguished by its ability to suppress the synthesis of cholesterol in the liver. Subsequently, they were called statins.
The first representatives of this class, which received wide clinical distribution, were derivatives of fungi (“natural” statins) - lovastatin, simvastatin, pravastatin. Somewhat later, synthetic statins were synthesized - fluvastatin, cerivastatin, atorvastatin, rosuvastatin. These drugs began to be actively introduced into wide clinical practice in the 80s after a comprehensive study of their effects. These statins (with the exception of cerivastatin, discontinued in 2001) are currently on the Russian pharmaceutical market.
Statins completely inhibit HMG-CoA reductase, an enzyme that catalyzes the rate-limiting step in cholesterol biosynthesis (Fig. 1). As a result, the concentration of cholesterol in hepatocytes decreases, which increases the expression of LDL receptors in the liver, which remove LDL and its precursors from the circulating blood.
Statins also reduce hepatic synthesis and secretion of apolipoproteins B-100 and lipoproteins with high content triglycerides (TG). The primary mechanism for lowering LDL is to remove it from the blood via LDL receptors; however, a decrease in hepatic lipoprotein production and secretion may explain the fact that atorvastin and simvastatin are able to lower LDL in those patients who have homozygous familial hypercholesterolemia and who do not have functioning LDL receptors. Treatment with statins leads to a significant, stable reduction in total cholesterol by 25-40% and LDL cholesterol by 25-50%, depending on the drug and daily dose, with each doubling of the dose additionally reducing LDL-C by 6-7%. There is also a significant decrease in apoproteins B and E in plasma (by 15-25%). As a result, such important indicator blood plasma atherogenicity, as the ratio of LDL cholesterol / HDL cholesterol, is reduced by almost 50%. The effect of statins on the concentration of triglycerides depends on their initial level: the greatest decrease is observed in patients with the most severe triglyceridemia. With a fixed dose of statins, the maximum lipid effect occurs after 4-8 weeks.
The goal of lipid-lowering therapy in patients with CAD is to lower and maintain low-density lipoprotein (LDL) cholesterol (Cholesterol) below 100 mg/dL (<2,6 ммоль/л) , что может быть достигнуто лишь с помощью средств, способных снижать этот показатель на 20-35% и не вызывающих серьезных побочных действий при длительном применении.
For patients in need of primary prevention whose LDL-C target is below 130 mg/dL (3.36 mmol/L), NCEP III suggests initiating drug therapy concomitantly with therapeutic lifestyle changes. Statins reduce levels of total cholesterol, LDL cholesterol and TG, and also increase HDL cholesterol levels. With regard to HDL cholesterol levels, both of its large fractions, namely 2 and 3, have a protective effect against coronary artery disease. Moreover, in the treatment of mixed dyslipidemia, statins also remain the drugs of first choice. The vast majority of patients (>90%) who will receive therapy will achieve the NCEP-recommended goals with approximately a 35% reduction in LDL-C. In a review of secondary and primary prevention studies in patients randomized to statin groups, there was a 22% reduction in cholesterol levels and a 30% reduction in LDL-C. These positive changes were accompanied by a significant reduction in the risks of myocardial infarction, stroke and vascular mortality, as well as overall mortality.
The uniqueness of this class of drugs also lies not only in the ability to significantly reduce the synthesis of cholesterol (for which they, in fact, were created), but also in the presence of a number of other properties, united under the name of "pleiotropic effects". It is the complexity of the impact on various links in the pathogenesis of cardiovascular diseases that is the basis for the extremely high effectiveness of statins not only for the treatment of dyslipoproteinemia, but also for the prevention and treatment of, in fact, all diseases united in the cardiovascular continuum.
Thus, it has been proven that statins have the ability to restore the function of the endothelium and thereby contribute to the normal vasomotor response of the coronary and peripheral arteries. It should be emphasized that this property of statins is already manifested at low doses and this does not require long periods of treatment. Improving the function of the endothelium against the background of taking statins is realized in two ways: indirectly through the normalization of the blood lipid spectrum and with the help of a direct effect on the endothelium, due to increased vasodilating and a decrease in the activity of vasoconstrictive stimuli in the vascular wall (regardless of the effect on the blood lipid spectrum).
Experiments have shown a positive effect of statins on the barrier function of the endothelium. So, under the influence of simvastatin in animals with hereditary hypercholesterolemia, there was a significant decrease in the penetration of Evans blue stain through the endothelium of the thoracic and abdominal aorta, and the possibility of penetration of oxidized low-density lipoproteins (LDL) through the endothelium also decreased.
The anti-ischemic effect of statins is directly related to the restoration of the normal function of the arterial endothelium. It is expressed in a decrease in angina attacks and signs of myocardial ischemia with physical activity. In patients, the magnitude of S-T segment depression is significantly reduced, the time to the onset of ischemia during a stress test increases, and a significant decrease in peripheral resistance is detected.
Statins are known to indirectly affect the blood coagulation system. Thus, simvastatin, fluvastatin and cerivastatin reduce the expression of tissue factor and the amount of thrombin fragments by human monocytes. They can shift the fibrinolytic balance inside vascular wall towards increased fibrinolytic activity. Statins can also affect platelet function by changing the cholesterol content in the membrane, thereby changing its properties. By affecting endothelial NO production, statins can inhibit platelet aggregation and indirectly increase NO bioavailability, independent of cholesterol levels.
In vitro studies have shown that most statins reduce smooth muscle cell proliferation and migration, which are key processes in atherogenesis, the pathogenesis of restenosis after angioplasty. coronary arteries, occlusion of venous bypasses after coronary artery bypass surgery and graft vasculopathy in patients after heart transplantation.
Recently, the hypothesis about the important role of inflammation and immune reactions of the body in the genesis of atherosclerosis and especially its complications and exacerbations has received more and more confirmation. With this in mind, studies on the effect of statins on inflammation are of particular value. There is experimental and clinical evidence that statins have an inhibitory effect on inflammatory processes, and this effect is due in large part to mechanisms not involved in the lipid-lowering effect of this class of drugs.
And these are just some of the additional effects of statins that are not associated with a direct effect on lipid metabolism.
Thus, "in the face" of statins, doctors received an effective and safe remedy inpatient and outpatient use, which was included in the pharmacopoeial lists of "mandatory" drugs in many countries of the world, and the statins themselves have become one of the most popular and prescribed drugs. A reflection of this attitude towards statins, evidence of the importance of their wider use, has been the phenomenally rapid growth in their use.
Thus, according to the EUROASPIRE I and II studies conducted in 1996 and 2001, in just 5 years, the average frequency of statin prescription in Europe increased 5 times - from 10.5 to 55.3%, respectively.
Unfortunately, the available statistics do not allow us to accurately assess the frequency of statin use by Russian patients. However, even anecdotal evidence suggests an extremely unfavorable situation for this class of drugs. Thus, according to the VALIANT multicenter study, in which Russia also took part, by 2001, only 0.6% of our compatriots who had had acute MI received statin therapy.
Common sense suggests that among the many possible reasons for this phenomenon, three main ones can be distinguished: firstly, the high cost of statins, secondly, the overestimation of the risk of side effects and complications of statin therapy, and thirdly, the formal attitude of doctors and patients to prevention and treatment SDP, as well as underestimation by patients and doctors of the effectiveness of statin use.
Among the alleged reasons for the popularity among Russian doctors and patients is the high cost of statins. The natural way out of this situation is to reduce the cost, which is possible due to the increased use of cheaper generic drugs. Unfortunately, the effectiveness of generic statins does not always match the effectiveness of original drugs. Examples of such a discrepancy are described, they are also in the domestic literature.
What to do? There is only one answer: use only proven generically equivalent statins. Testing the equivalence of drugs is evidence of the integrity of pharmaceutical companies that produce generic drugs. There are not so many examples of such an approach to the issue, but that is why they are more valuable.
We use Vasilip (simvastatin, Krka, Slovenia) in our daily practice for the treatment and prevention of atherosclerosis. There are numerous international and one Russian studies that have proven the high efficacy and safety of this well-known generic when compared with the original. Simvastatin is one of the most studied lipid-lowering drugs. An analysis of its lipid-lowering efficacy indicates the possibility of reducing the level of total cholesterol by 28-36% and LDL cholesterol by 27-48% under the influence of therapy. The lipid-lowering effect is observed already after 3 days of taking the drug, when its stable concentration in the blood plasma is reached. The maximum effect is recorded after 4-8 weeks of therapy. Recommended daily dose the drug is 10-40 mg / day. Often start with a dose of 20 mg / day. Dose adjustment is recommended at intervals of 4 weeks under the control of laboratory parameters (ALT, AST, CPK, total cholesterol and LDL cholesterol). With significant hypercholesterolemia, the daily dose is rarely less than 20 mg / day. Simvastatin is a highly effective drug that provides reliable control of blood lipid levels when administered at a dose of 20-80 mg; target LDL-C levels are achieved in about 9 out of 10 patients according to European (less than 3 mmol/l, or 115 mg/dl) and American (2.6 mmol/l, or 100 mg/dl) standards. The drug provides a significant (42%) reduction in the risk of coronary mortality, by 30% - the risk overall mortality, 34% - the risk of major cardiac complications, 37% - the need for myocardial revascularization. Simvastatin is well tolerated by patients, safe for long-term use (more than 7 years). Myopathy occurred in only 1 of 1399 patients who used the drug at a dose of 20 mg, it was not observed in 822 patients who used 40 mg of the drug per day for more than 5 years.
Reliable protection against ineffective statins can be provided by regular direct and comparative (with original drugs) studies, well covered in the available literature, which have been growing in recent years. It is this path that seems to be the only correct and possible one for generic pharmaceutical companies, and not only for lipid-lowering drugs, but also for all other drugs.
And yet, the main thing is the doctor's ability to convey to the depths of the patient's consciousness an understanding of the real threat to his life and explain why statin therapy is necessary. A good doctor must be a good psychologist.
Among the possible reasons that patients do not take statins, the formal attitude to treatment is the most dangerous, because it causes double harm: it misleads both the doctor and the patient. The doctor should not only formally prescribe statin treatment, but regularly monitor its effectiveness and know that the patient's cholesterol during treatment is kept at the required target level; the patient must not only take pills regularly, but also be sure that they lowered his cholesterol to the normal level he needs and bring him nothing but good. Unfortunately, more often the opposite happens: the doctor formally prescribes a statin, not caring about whether the patient takes it or not; after 1-2 months, the patient stops taking the statin, naively believing that he has "cured" of the disease. As a result, the reputation of a doctor who could not save the patient from a heart attack or stroke suffers, statin is discredited as “a weak drug that is unable to help the patient”, and most importantly, the patient himself suffers, who is the worst in this situation.
The rules of constant and controlled statin use seem simple and obvious, but it is precisely their non-compliance that crosses out all efforts and the very possibility of effective control of atherosclerosis and its complications.
Another one of important reasons the low percentage of statin prescriptions in Russia is an overestimation of the risk of side effects and complications of therapy.
Like any effective and effective drug, statins, if misused, overdosed, or intolerant, can cause complications or have side effects. All of them are well known: first of all, this is an increase in liver enzymes and creatine phosphokinase (CPK), rhabdomyolysis, gastrointestinal disorders and rare cases exacerbations of cholelithiasis, skin manifestations, red blood changes, etc., which are routinely listed in the leaflet when describing the action of any drug. Absolute contraindications to the appointment of statins today are:
- active pathological processes in the liver,
- initially elevated levels of ACT or ALT, three times the upper limit of normal,
- individual intolerance to the drug,
- pregnancy,
- lactation.
Recently, however, the problem of statin safety has become increasingly used as a tool in the competitive struggle of manufacturers. In our country, this approach leads to the opposite effect. After hearing about the side effects of a particular statin, many doctors, without much thought, stopped prescribing statins altogether. Those who, by virtue of conservatism, have not prescribed them before, have received, as they think, a very important weapon against the drugs of this group.
But as numerous effects show, statin treatment is generally well tolerated. The drugs act at the early stages of cholesterol synthesis, and the accumulation of toxic intermediates does not occur. This accounts for the low incidence of side effects of statins. 1-3% of patients stop taking drugs, which is comparable to data in placebo-controlled groups. The professional duty of the doctor is to prevent these complications or notice them in time and take appropriate measures.
We are often asked how to use statins for liver diseases and other concomitant diseases. And on what basis can we give an answer if such patients were not included in the test groups? The way out is known. You cannot learn about many side effects from studies, these data come only from general medical practice. Based on our clinical experience(and in our clinic there are a large number of patients with comorbidities liver), we can state with a high probability sufficient safety of statins in such patients. But, of course, it is necessary to observe more strict control of treatment.
Elevated liver enzymes are the most common side effect of statins. It is observed in 0.5-2% of cases and depends on the dose of the drug. At the same time, other signs of hepatotoxicity have not yet been recorded against the background of statins.
Although liver diseases are on the list of contraindications to the use of statins, cases of worsening of the course of these diseases during their prescription have not yet been described. In patients with hepatitis C and B, who have an increased level of transaminases, the appointment of statins does not lead to a worsening of the course of the disease. Treatment of hyperlipidemia in patients with fatty liver can even reduce the level of transaminases in the blood.
Nevertheless, it is common practice to reduce the dose of the drug when the level of liver enzymes increases more than 3 times the normal value. If such an increase is noted in the initial blood test, one should start with lower doses and monitor enzyme levels more frequently. Sometimes a change in the drug leads to the normalization of the level of liver enzymes.
To ensure the safety of treatment, it is necessary to examine the level of hepatic transaminases before prescribing statins and conduct monthly biochemical monitoring during the dose selection period (the first 2-3 months). During maintenance therapy, biochemical analyzes can be done once every 3-6 months. If ACT or ALT increase no more than 1.5 times the upper limit of normal and are not accompanied by the appearance of clinical symptoms, statin withdrawal is not required. More careful monitoring of the functional state of the liver is necessary in patients who consume a significant amount of alcohol. It should also be remembered that in patients with liver disease, fibrates should not be added to statin therapy.
Thus, “in the person of” statins, doctors received an effective and safe drug for inpatient and outpatient use, which was included in the pharmacopoeial lists of “mandatory” drugs in many countries of the world, and the statins themselves became one of the most popular and prescribed drugs. Currently, the high efficacy of statins in primary (WOSCOPS, APCAPS studies) and secondary (4S, CARE, LIPID) prevention has been proven. coronary disease heart in the aspect of reducing the frequency of cardiovascular complications, total and coronary mortality. Lipid-lowering drugs are essentially pathogenetic anti-atherosclerotic drugs that stabilize atherosclerotic plaque, along with antiplatelet drugs, they should become basic in the ongoing treatment of patients with coronary artery disease. Statins are recommended for all patients with confirmed coronary heart disease or other forms of atherosclerosis in the absence of contraindications or side effects of drugs. For inhibitors of HMG-CoA reductase, by far, there is the greatest amount of strong evidence indicating beneficial changes in lipid profile, including a positive effect on the risk of developing cardiovascular events and the cost of treatment. Increasing the use of statins for primary and secondary prevention could prevent tens of thousands of premature deaths every year. Cautious, controlled administration of statins in patients with liver disease (in their inactive phase) will do more good than harm.

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Fatty hepatosis of the liver is a disease associated with a violation of metabolic processes occurring directly in the liver parenchyma. The disease is chronic and non-inflammatory in nature, in which normally functioning liver cells (hepatocytes) gradually begin to degenerate into adipose tissue. Hence another name for hepatosis - fatty degeneration liver. This process is reversible, the success of recovery depends on a timely diagnosis. This disease does not require specific treatment. Treatment of liver hepatosis consists in eliminating the causes that caused it and normalizing the functions of the organ. To do this, you need to understand what factors caused this disease.

Possible causes of fatty liver

Physicians did not come to an unambiguous opinion about the causes of hepatosis. However, the occurrence of this disease is most often associated with the following factors:

The risk group includes people with hyperuricemia (an increase in the level of uric acid in the blood), hyperglycemia ( increased concentration blood glucose), hypertriglyceridemia (elevated blood triglycerides), and low HDL (high-density lipoprotein) levels. All these conditions are detected in the biochemical study of blood. Hypertension and central obesity can also provoke the development of hepatosis.

How does hepatosis develop?

This pathological process initially develops slowly. Gradually, lipids (fatty acids) accumulate in the liver cells, most of which are triglycerides (neutral fats). Hepatocytes overflow and die, being replaced by fibrous connective and adipose tissue. The liver does not cope with the function assigned to it, and the disease further develops rapidly. Not only the liver suffers, but also other organs and systems. Sometimes the regenerated tissue is up to half mass fraction Naturally, under such conditions, the body cannot normally cope with its main work. If the disease is not started and the treatment of hepatosis of the liver is started on time, then some time after the elimination of the causes that caused fatty degeneration, the pathological deposition of adipose tissue stops, and eventually disappears altogether. After that, the body begins to function normally.

The diagnosis of "fatty hepatosis of the liver" is made if, after the necessary studies, it is revealed that the content of triglycerides in the liver exceeds 10% of the mass of this organ or more.

Degrees of hepatosis

In total, there are 4 degrees of fatty hepatosis:

1. Zero degree - individual cells or groups of hepatocytes capture small fat droplets.
2. The first degree is focal moderately pronounced degeneration of liver cells into adipose tissue, medium or large droplet obesity of hepatocytes.
3. The second degree is diffuse small-, medium- and large-drop intracellular adiposity of the liver cells.
4. The third degree is large-drop highly pronounced diffuse obesity of hepatocytes, the accumulation of fat not only inside, but also outside the cells with the formation of fatty liver cysts. In such cases, a diagnosis is made - diffuse hepatosis of the liver. The treatment will be long, followed by a period of rehabilitation and maintenance therapy.

Diagnosis of hepatosis

Often this disease is asymptomatic, especially at the very beginning. It is possible to diagnose it using various research methods:

• ultrasound diagnostics;
• dopplerography (study of blood flow);
• CT scan;
• magnetic resonance spectroscopy;
• studies of liver enzymes ALT and AST, they react only in 50% of cases;
• in 20-50% of cases, there is an increase in the level of ferritin.

According to statistics, men aged 40 to 56 most often suffer from fatty degeneration.

Fatty liver hepatosis. Symptoms. Treatment

As mentioned above, the initial stage of this disease can be asymptomatic. Patients do not complain about anything. For example, during preventive examinations, it is sometimes possible to detect hepatosis of the fatty liver. Symptoms, treatment - we'll talk about everything a little lower.

If the disease progresses, the patient may feel discomfort and heaviness in the right hypochondrium. Often patients complain of bitterness in the mouth. On palpation, the doctor may detect an enlarged liver. It will protrude from under the costal arch. Ultrasound diagnostics will show that the liver has increased echogenicity. Also, with fatty degeneration of this organ, this study will indicate a light liver, that is, its tissue will be noticeably lighter than healthy. Dopplerography in this disease will show that there is a deterioration in blood flow. CT scan with fatty hepatosis, it will indicate that the liver has a lower density than the spleen (normally, these two organs have the same density).

For the correct diagnosis of this disease, it is important to exclude viral hepatitis. This is done with the help of serological studies.

Disease pathogenesis

The pathogenesis of fatty liver is not fully understood. Scientists suggest that the development of this disease is based on a violation of the metabolism of lipids (fats) in the body. This may be caused by an imbalance between lipid storage and energy expenditure. Another reason for the development of this disease can be resistance (resistance) to insulin. There is an increase in the transport of fatty acids to hepatocytes - liver cells. The reason for the development of hepatosis may be inhibition (inhibition) of receptors responsible for the production of enzymes that are responsible for proper oxidation and production of fatty acids. This violation leads to the accumulation of fat, including in the tissues of the liver. Also, various toxic and medicinal substances can destroy cell mitochondria and other structures. As a result, there is a violation of the utilization of fatty acids. Next possible reason development of hepatosis - poor bowel function, for example, chronic dysbacteriosis.

Fatty hepatosis of the liver. Treatment. Preparations

The main strategy for the treatment of hepatosis is aimed at eliminating the factors that caused this disease, as well as restoring metabolic processes and improving tissue regeneration and liver detoxification. An important role in the treatment is given to changing the patient's lifestyle and correcting his eating habits. In addition, there is also a drug treatment of hepatosis of the liver. For this, antioxidant and membrane-stabilizing drugs are widely used. All of them are divided into three main groups:

1. Medicines containing essential phospholipids. It is these substances that serve as defenders of liver cells - hepatocytes. This group includes the preparations "Essentiale", "Phosphogliv", "Essliver forte".
2. Sulfoamino acids (drug "Heptral" or "Ademethionine", "Dibicor" or "Taurine" and "Methionine").
3. Medicines, which include extracts from plants (Liv 52, Karsil).

Treatment of fatty hepatosis of the liver with drugs based on artichoke has a good effect. This is the drug "Hofitol", its effectiveness is due to biologically active substances that are part of the artichoke greens. So, the substance cynarin and phenolic acids have a choleretic and hepatoprotective effect. The carotene, ascorbic acid and B vitamins contained in this medicinal plant stabilize metabolic processes.

It responds well to treatment, especially at the initial stage of hepatosis of the liver. Treatment - taurine preparations (Taufon capsules or Dibicor tablets), they should be discussed separately. These funds have several mechanisms of action at once: antioxidant (reduce peroxidation of unsaturated fats) and membrane stabilizing (substance taurine helps to restore hepatocyte membranes). They also improve hepatic blood flow and thereby help dissolve bile acids.

In addition, the treatment of fatty liver disease with drugs containing taurine helps to reduce total blood cholesterol, triglycerides and harmful LDL, while increasing HDL, which protects the body from atherosclerosis, also lowers the activity of ALT and AST enzymes and stabilizes glucose metabolism in body (normalize fasting sugar).

The substance taurine has some hypotensive effect. Thus, the treatment of liver hepatosis with taurine immediately solves several problems: it eliminates the causes of the disease, helps restore hepatocytes and helps to remove fatty acids.

For a better outflow of bile, the drugs "Allochol" and "Holosas" are used. These are herbal medicines. They reduce the density of bile. Without such drugs effective treatment fatty hepatosis of the liver is impossible.

Previously, vitamin E was often prescribed as an antioxidant for this disease, but studies conducted in 2009 at the University of Tel Aviv proved that it is more harmful to the body than good. The fact is that high doses of this vitamin can provoke the development of diseases. of cardio-vascular system. Vitamin C and selenium are excellent alternatives, and their action is identical to that of vitamin E.

For detoxification of the liver, riboflavin (vitamin B 2) and niacin (vitamin PP and nicotinic acid) are used.

What is hepatosis of the liver, symptoms and drug treatment have been considered, now let's move on to alternative medicine.

Treatment of hepatosis with herbs

Alternative medicine includes, among other things, folk methods of treatment, using infusions and decoctions of medicinal herbs as remedies, and not only. It should be understood that you will have to change your taste habits and lifestyle before treating fatty liver disease. Herbal medicine will help with this.

With this disease, it is useful to add cinnamon as a seasoning to dishes. This spice, added to tea or coffee, will help reduce appetite and the accumulation of fatty liver.

Treatment of hepatosis of the liver with folk remedies includes medicines based on the extract of milk thistle (it also contains the drug "Gepabene"). Decoctions and infusions of milk thistle are also widely used to treat the liver. They render choleretic action and relieve spasms from a tense gallbladder, in addition, they have an antioxidant effect, binding toxic substances and free radicals in the liver tissues, and accelerate the process of regeneration of hepatocytes.

Artichokes are very useful to eat daily with such a diagnosis as hepatosis of the liver. Herbal treatment of this disease includes adding fragrant lemon balm or mint to morning tea. It is not only tasty and fragrant, but also helps to restore damaged cells. Rosehip also promotes the removal of fats from liver cells. It can be brewed in a thermos and drunk throughout the day with or instead of tea.

Turmeric is a flavoring seasoning that will help soften the calculi present in the gallbladder, as well as increase the production of bile and its fluidity, and normalize drainage from the bile ducts. Treatment of hepatosis of the liver with folk remedies is quite effective.

Parsley, dill and lettuce leaves daily use eating them will help restore liver cells and help eliminate harmful fats.

With such a diagnosis as fatty liver hepatosis, treatment with herbs and useful spices can and should be combined with traditional drug treatment. This will help you recover faster and shorten your recovery time.

Treatment of hepatosis of the liver with alternative methods includes the use of useful products to help the body recover.

Diet for hepatitis

With this disease, it is important to understand that recovery is possible only with a change in lifestyle and revision of eating behavior. The best remedy with such a diagnosis as fatty liver hepatosis - a diet. Treatment needs to be supported therapeutic diet № 5.

Its main tasks are as follows:

1. Elimination of factors contributing to the development of the disease.
2. Normalization of hepatocyte function and liver function in general.
3. Stimulation of bile formation and improvement of the drainage functions of the biliary tract.
4. Stimulation of digestion processes and improvement of bowel function.
5. Normalization of the level of total cholesterol and its fractions.

The foundation treatment table#5 is frequent fractional nutrition. Patients with hepatosis should eat at least 5 times a day in small portions. Overeating and hunger are strictly prohibited - these are the main enemies of recovery. The liver must be constantly maintained in good shape, this is ensured frequent receptions food, but you should not overload it, so portions should be small.

The key to recovery from the disease "fatty liver hepatosis" is diet. Treatment will be successful if the patient strictly adheres to the doctor's recommendations.

So, what products can you:

• first courses - vegetable and milk soups, borsch, cabbage soup and soups from cereals, without the use of strong broths;
• side dishes for second courses - lecho, vegetable stews with the addition of onions, cabbage, carrots;
• salads from boiled and fresh vegetables;
• milk porridge, but without salt;
• eggs - no more than 3 pcs. per week and only protein;
• milk products;
• vegetable oil for dressing salads;
• mild cheeses;
• lean fish;
• lean meat;
• chicken meat and turkey;
• bran and bread products from wholemeal flour;
• freshly squeezed juices;
• dried rowanberry and wild rose are recommended to be added to herbal teas.

All dishes must be steamed or baked in the oven. Fried food is prohibited. The patient's menu should be rich in pectin, carbohydrates, fiber and vitamins.

Prohibited Products:

• alcohol - in any form;
• any energy drinks and carbonated drinks;
• high-fat foods;
• fried food;
• strong meat or vegetable broths;
• fatty meat and fish;
• salted, smoked and canned foods;
• egg yolks (they contain a lot of fat);
• fat sour cream and cottage cheese;
• hot spices and seasonings;
• garlic;
• fatty sauces and mayonnaise;
• any sausages (they all contain a lot of fat, even if it is invisible visually);
• cocoa, coffee and strong tea are also undesirable.

With such a diagnosis as hepatosis of the liver, the treatment is a diet. This is the main condition for a successful recovery.

Conclusion

Don't let the disease run its course. With proper treatment, compliance with all the recommendations of the attending physician and the patient's perseverance, the disease will definitely recede.

Fatty liver disease is a pathology that has chronic course and non-inflammatory nature. This pathology consists in the degeneration of liver cells - hepatocytes into fat cells. It is also called fatty degeneration, fatty liver. Such degeneration of the liver is very common today and this is explained malnutrition, and in general the wrong way of life. Therefore, men are more likely to be diagnosed with hepatosis than women.

What is fatty liver disease? In this disease, disorders occur at the cellular level, namely, metabolic processes are disturbed. Further, dystrophic processes in the parenchyma of the organ and hepatomegaly are added. Violation of metabolic processes is the accumulation of lipids in normal hepatocytes, and more often it is the accumulation of lipids and triglycerides. Organ degradation occurs, as normal hepatocytes are quickly replaced by fibrous tissue. Diffuse changes in the liver by the type of fatty hepatosis lead to the fact that the liver ceases to function as before.

stages

Symptoms and treatment of fatty liver disease depend on the stage of the lesion. There are 3 stages:

1. I - this is when there are rudiments of foci of fat cells. The lesion is minor and this stage is asymptomatic.
2. II is already a massive defeat. At this stage, there is already a connective fibrous tissue between the affected cells.
3. III - an irreversible position in which there are strips of fibrous tissue in the liver. They have fibroblasts, which later degenerate into fibrosis.

Causes

The causes of fatty hepatosis are the effects of various negative factors. For example, these are drugs alcoholic drinks, narcotic substances, fatty foods. With the accumulation of toxins in the liver, the body begins to process them into simple fats, thereby neutralizing the process of poisoning. Also fats get in excess with food.

You can also note the following reasons:

Symptoms

On the initial stage the violation does not manifest itself in any way, and in the course of development, the symptoms of fatty liver hepatosis will become brighter. Especially pronounced signs of the disease become at stage 3.

Signs of fatty liver:

• discomfort and feeling of heaviness in the right hypochondrium (with hepatomegaly);
• pronounced dysbacteriosis;
• change in the condition of the skin, namely the skin becomes dull;
• deterioration in visual acuity;
• bouts of nausea and vomiting;
• flatulence;
• loss of appetite.

Quite often, hepatosis of the liver has symptoms similar to liver failure. At the first stage, this is a general malaise, drowsiness, weakness, a complete lack of appetite, and speech becomes monotonous and coordination is disturbed.

The second stage is characterized by manifestations of jaundice, swelling, indigestion, and ascites (dropsy in the abdominal cavity) often develops. In the third stage, the symptoms are serious and conditions such as coma, convulsions, fainting may occur. Since at this stage all internal organs are already changing.

Diagnostics

In order to understand how to treat fatty liver hepatosis, you need to conduct a correct diagnosis. The main diagnostic methods are:

Treatment of fatty hepatosis of the liver

With fatty liver disease, it is important to understand that this condition is very serious and, if left untreated, can be fatal. If diffuse changes in the organ have reached their maximum, then the disease cannot be completely cured. Treatment should be started earlier and then it can be carried out at home.

Principles of treatment:

• cessation of toxic effects on the liver (taking certain medications, alcohol, drugs);
• drug treatment of fatty liver hepatosis (traditional treatment);
• diet food (table No. 5);
• treatment of fatty hepatosis of the liver with folk remedies;
• with this pathology, herbal medicines are necessarily prescribed.

Medication treatment

Treatment of fatty liver disease with drugs consists in taking hepatoprotectors, statins, antioxidants, antidiabetic drugs and drugs that promote metabolism.

Hepatoprotectors are very important in the restoration of the liver. They help restore hepatocyte membranes and improve energy metabolism in cells. These are such tablets as Karsil, Essentiale. You also need to take choleretic drugs to reduce or prevent stagnant processes.

Statins are also very important, as these drugs eliminate dyslipidemia. These drugs help reduce the level of unhealthy low-density fats. Antioxidants help to quickly regress hepatosis.

How to cure fatty liver disease? Anti-diabetic drugs are needed because blood sugar often rises with fatty liver. At the same time, insulin sensitizers are prescribed. They act at the cellular level, increasing the sensitivity of tissues to insulin.

How to treat the disease can only be decided by a doctor, according to the diagnostic indicators. Medical therapy and necessarily complex.

Folk remedies

With fatty liver hepatosis, treatment with folk remedies is necessary. This treatment can be done at home. But it is imperative that the attending physician correct and control it. At the initial stage of the disease, such treatment is effective.

For the treatment of fatty hepatosis, milk thistle (thistle) is used. Since it has hepatoprotective and antioxidant, choleretic, anti-inflammatory properties, it prevents and slows down the formation of fibrous tissue. Milk thistle contains silymarin. It is this pomace that is often included in herbal preparations. For example, Gepabene, Karsil, Legalon, Silimar.

Also useful for liver damage are:

• calamus root;
• plantain leaves;
• horsetail;
• succession;
• dill (dill infusion);
• immortelle;
• birch leaves;
• ginger.

Treatment and diet

Diet for fatty liver hepatosis is a necessary measure. Sometimes, when diagnosing the first stage of the disease, doctors prescribe only strict adherence to the diet table number 5. In other cases, proper nutrition for fatty liver is prescribed along with medication.

Table number 5 - what is it? This diet is to reduce the intake of fats from food and increase the intake of animal protein. At the same time, you can eat:

• lean meat and fish in baked or boiled form. But soups meat broth completely prohibited;
• steamed, boiled or baked vegetables;
• no more than 1 boiled egg per day;
• oatmeal, buckwheat, rice, semolina;
• lean dairy products: cottage cheese, kefir, yogurt.

Table number 5 is required for get well soon from fatty liver disease. A diet for fatty liver helps to stop the development of the disease, and, accordingly, hepatocytes are restored.

Forecasts

Can fatty liver be cured? This is possible with an asymptomatic form, when the situation has not yet been aggravated by a disorder in the functioning of other organs and systems. Very unfavorable forecasts when symptoms persist for a long time. This may indicate the development of hepatic complications - cirrhosis. In this case, it is contraindicated to treat fatty liver hepatosis with folk remedies, and even more so at home.