medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-23-37-48medalphabet-2215Research ArticleСОВРЕМЕННАЯ ПОЛИКЛИНИКАMODERN POLYCLINICЛекарственно-индуцированное поражение печени с холестазом на фоне приема нестероидных противовоспалительных средствNSAID-induced liver damage with cholestasishttps://orcid.org/0000-0001-7168-3636ПереверзевА. П.PereverzevA. P.

Антон Павлович Переверзев, к. м. н., доцент кафедры терапии и полиморбидной патологии

eLibrary SPIN: 4842-3770

Москва

Anton P. Pereverzev, PhD Med, associate professor, Department of Therapy and Polymorbid Pathology

eLibrary SPIN: 4842-3770

Moscow

acchirurg@mail.ruhttps://orcid.org/0000-0002-0795-8225ОстроумоваО. Д.OstroumovaO. D.

Ольга Дмитриевна Остроумова, д. м. н., проф., зав. кафедрой терапии и полиморбидной патологии, проф. кафедры клинической фармакологии и пропедевтики внутренних болезней

eLibrary SPIN: 3910-6585

Москва

Olga D. Ostroumova, DM Sci, prof., head. Department of Therapy and Polymorbid Pathology, prof. Department of Clinical Pharmacology and Propedeutics of Internal Diseases

eLibrary SPIN: 3910-6585

Moscow

ostroumova.olga@mail.ruhttps://orcid.org/0000-0001-8579-7167ГоловинаО. В.GolovinaO. V.

Ольга Владимировна Головина, к. м. н., доцент, доцент кафедры терапии и полиморбидной патологии

Москва

Olga V. Golovina, PhD Med, associate professor of the Department of Therapy and Polymorbid Pathology

Moscow

olenka_golovina@list.ruhttps://orcid.org/0000-0003-3081-602XФилипповаА. В.FilippovaA. V.

Анастасия Витальевна Филиппова, ординатор кафедры терапии и полиморбидной патологии

Москва

Anastasia V. Filippova, Resident of the Department of Therapy and Polymorbid Pathology

Moscow

filippova.96@mail.ruhttps://orcid.org/0000-0002-2923-6450ПавлееваЕ. Е.PavleevaЕ. Е.

Елена Евгеньевна Павлеева, к. м. н. ассистент кафедры пропедевтики внутренних болезней и гастроэнтерологии

Москва

Elena Evgenievna Pavleeva, PhD Med, assistant of the Department of Propedeutics of Internal Diseases and Gastroenterolog

Moscow

pavleeva.elena@mail.ruФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy for Continuing Professional EducationRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И. М. Сеченова» Минздрава РоссииРоссияRussian Medical Academy for Continuing Professional Education; I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет имени А. И. Евдокимова» Минздрава РоссииРоссияMoscow State University of Medicine and Dentistry n. a. A. I. EvdokimovRussian Federation202126092021023Современная поликлиника (3)3748Copyright © Переверзев А.П., Остроумова О.Д., Головина О.В., Филиппова А.В., Павлеева Е.Е., 20212021Переверзев А.П., Остроумова О.Д., Головина О.В., Филиппова А.В., Павлеева Е.Е.Pereverzev A.P., Ostroumova O.D., Golovina O.V., Filippova A.V., Pavleeva Е.Е.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2215

Печень является одним из органов, которые наиболее часто поражаются на фоне приема лекарственных средств (ЛС). Лекарственно­ индуцированное поражение печени с холестазом (ЛИППХ), с одной стороны, редко приводит к смерти по сравнению с гепатоцеллюлярным типом, но, с другой стороны, чаще характеризуется длительным, в ряде случаев хроническим течением. Для данного типа поражения печени характерно повышение активности щелочной фосфатазы (ЩФ) >2 верхних границ нормы (ВГН) или соотношение аланинаминотрансфераза (АЛТ)/ЩФ <2 при хроническом течении. Нестероидные противовоспалительные средства (НПВС) являются одними из наиболее доступных (в том числе без рецепта) и широко используемых в клинической практике ЛС и нередко являются причиной развития ЛИППХ. В данной статье обобщены имеющиеся на момент подготовки статьи доступные данные о распространенности, механизмах развития и особенностях ЛИППХ на фоне приема НПВС. Отдельно выделен раздел, касающийся особенностей ведения таких пациентов. В частности, в соответствии как с отечественными, так и с зарубежными клиническими рекомендациями при лекарственном генезе поражения печени рекомендуется прекратить прием препарата-индуктора и назначить урсодезоксихолевую кислоту (УДХК). Эффективность применения УДХК у пациентов с ЛИППХ, в том числе ассоциированных с приемом НПВС, подтверждена результатами большого числа рандомизированных плацебо-контролируемых клинических исследований. Среди препаратов УДХК, представленных на рынке Российской Федерации, нельзя не обратить внимание на Эксхол® (ЗАО «Канонфарма продакшн»), который биоэквивалентен референтному препарату, производится с соблюдением стандартов GMP на высокотехнологичной производственной базе, что обеспечивает его качество, а доступная цена и большой выбор лекарственных форм позволяют с успехом применять данный препарат в том числе у особых категорий пациентов, например, пациентов пожилого возраста и/или страдающих дисфагией.

he liver is one of the organs most often affected by medication (MP) intake. Drug-induced liver damage with cholestasis (LIPCH), on the one hand, rarely leads to death in comparison with the hepatocellular type, but, on the other hand, is more often characterized by a long, in some cases chronic course. This type of liver damage is characterized by an increase in the activity of alkaline phosphatase (ALP) > 2 upper limits of normal (ULN) or the ratio of alanine aminotransferase (ALT) / ALP < 2 in chronic course. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most readily available (including over-the-counter) and widely used drugs in clinical practice and are often the cause of LIPCH. This article summarizes the available data at the time of preparation of the article on the prevalence, mechanisms of development and features of LIPPH while taking NSAIDs. A separate section is highlighted on the features of the management of such patients. In particular, in accordance with both domestic and foreign clinical guidelines for the drug genesis of liver damage, it is recommended to stop taking the inducer drug and prescribe ursodeoxycholic acid (UDCA). The efficacy of UDCA in patients with LIPCH, including those associated with the use of NSAIDs, has been confirmed by the results of a large number of randomized placebo-controlled clinical trials. Among the UDCA preparations on the market of the Russian Federation, one cannot fail to pay attention to Exho® (CJSC «Canonpharma Production»), which is bioequivalent to the reference drug, is produced in compliance with GMP standards on a high-tech production base, which ensures its quality, and an affordable price and a large the choice of dosage forms makes it possible to successfully use this drug, including in special categories of patients, for example, elderly patients and/or those suffering from dysphagia.

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Изучение влияния урсодезоксихолевой кислоты на эффективность и безопасность лечения статинами у больных с заболева­ниями печени, желчного пузыря и/или желчевыводящих путей (исследование РАКУРС). Рациональная фармакотерапия в кардиологии. 2014;(10)2:147-52. [Martsevich S. Yu., Kutishenko N. P., Drozdova L. Yu., Lerman O. V., Nevzorova V. A., Reznik I. I. et al. Effect of ursodeoxycholic acid on the efficacy and safety of statin treatment in patients with the diseases of the liver, gallbladder and/or biliary tract (RAKURS study). Rational Pharmacotherapy in Cardiology. 2014;(10)2:147-52. (In Rus.)]Пенкина Т. В., Шикина Е. А., Дичева Д. Т., Березутская О. Е., Головкина Н. Л., Бектемирова Л. Г., Андреев Д. Н., Караулов С. А. Первичный билиарный холангит - новая нозологическая единица в классификации болезней печени (обзор литературы и собственное клиническое наблюдение). Медицинский Совет. 2019;(3):76-82. [Penkina T. V., Shikina E. A., Dicheva D. T., Berezutskaya O. E., Golovkina N. L., Bektemirova L. G., Andreev D. N., Karaulov S. A. Primary biliary cholangitis - a new nosological unit in the classification of liver diseases (literature review and own clinical observation). Meditsinskiy sovet = Medical Council. 2019;(3):76-82. (In Russ.)] https://doi.org/10.21518/2079-701X-2019-3-76-82Пенкина Т. В., Шикина Е. А., Дичева Д. Т., Березутская О. Е., Головкина Н. Л., Бектемирова Л. Г., Андреев Д. Н., Караулов С. А. Первичный билиарный холангит - новая нозологическая единица в классификации болезней печени (обзор литературы и собственное клиническое наблюдение). Медицинский Совет. 2019;(3):76-82. [Penkina T. V., Shikina E. A., Dicheva D. T., Berezutskaya O. E., Golovkina N. L., Bektemirova L. G., Andreev D. N., Karaulov S. A. Primary biliary cholangitis - a new nosological unit in the classification of liver diseases (literature review and own clinical observation). Meditsinskiy sovet = Medical Council. 2019;(3):76-82. (In Russ.)] https://doi.org/10.21518/2079-701X-2019-3-76-82Круглый стол: обсуждение клинических рекомендаций Российской гастро­энтерологической ассоциации по диагностике и лечению функциональных расстройств билиарного тракта. Медицинский Совет. 2018;(12):83-9. [Round table: discussion of the clinical guidelines of the Russian Gastroenterological Association for the diagnosis and treatment of functional disorders of the biliary tract. Medical advice. 2018;(12):83-9. (In Russ.)] https://doi.org/10.21518/2079-701X-2018-12-83-91Круглый стол: обсуждение клинических рекомендаций Российской гастро­энтерологической ассоциации по диагностике и лечению функциональных расстройств билиарного тракта. Медицинский Совет. 2018;(12):83-9. [Round table: discussion of the clinical guidelines of the Russian Gastroenterological Association for the diagnosis and treatment of functional disorders of the biliary tract. Medical advice. 2018;(12):83-9. (In Russ.)] https://doi.org/10.21518/2079-701X-2018-12-83-91

The authors declare that there are no conflicts of interest present.