safetyriskБезопасность и риск фармакотерапииSafety and Risk of Pharmacotherapy2312-78212619-1164Federal State Budgetary Institution ‘Scientific Centre for Expert Evaluation of Medicinal Products’ of the Ministry of Health of the Russian Federation (FSBI ‘SCEEMP’)10.30895/2312-7821-2020-8-2-66-76safetyrisk-177Research ArticleОБЗОРЫREVIEWSЛекарственно-ассоциированная жировая болезнь печениDrug-Induced Fatty Liver Diseasehttps://orcid.org/0000-0001-7168-3636ПереверзевА. П.PereverzevA. P.

канд. мед. наук,

ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993

Cand. Sci. (Med.).,

2/1/1 Barrikadnaya St., Moscow 125993

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

д-р мед. наук, профессор,

ул. Баррикадная, д. 2/1, стр. 1, Москва, 125993

Dr. Sci. (Med.), Professor,

2/1/1 Barrikadnaya St., Moscow 125993

ostroumova.olga@mail.ruФедеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation202022052020826676Copyright © Переверзев А.П., Остроумова О.Д., 20202020Переверзев А.П., Остроумова О.Д.Pereverzev A.P., Ostroumova O.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.risksafety.ru/jour/article/view/177

Лекарственно-ассоциированная жировая болезнь печени (ЛЖБП) — это группа осложнений фармакотерапии, распространенность которых составляет около 10% от всех нежелательных реакций. Цель работы — анализ и систематизация данных о лекарственных средствах, применение которых может потенциально приводить к развитию ЛЖБП, а также о патофизиологических механизмах ее развития, способах диагностики, лечения и профилактики. Анализ данных научной литературы показал, что чаще всего данное осложнение возникало при приеме амиодарона, метотрексата, тамоксифена, вальпроевой кислоты и некоторых других лекарственных средств. Установлено, что основными факторами риска развития ЛЖБП являются коморбидность/полиморбидность и митохондриальная дисфункция. Показано, что в связи с отсутствием патогномоничных клинических проявлений ЛЖБП оптимальной тактикой для постановки соответствующего диагноза является тщательный сбор анамнеза, в том числе лекарственного, использование шкал RUCAM и Наранжо, анализ ряда биохимических показателей (аланиновой трансаминазы, аспаргиновой трансаминазы, билирубина, щелочной фосфатазы) крови и при необходимости биопсия печени. При развитии ЛЖБП необходимо по возможности отменить препарат, применение которого ассоциировано с возникновением нежелательной реакции, либо уменьшить его дозу, а также исключить факторы, которые потенциально могут ухудшать состояние пациента. Соблюдение предписаний инструкции по медицинскому применению препаратов, учет сопутствующей патологии и потенциально неблагоприятных межлекарственных взаимодействий, а также проведение регулярного мониторинга состояния пациентов, принимающих лекарственные средства с известными гепатотоксическими эффектами, позволят специалистам практического здравоохранения осуществлять профилактику и своевременно выявлять случаи развития ЛЖБП. 

Drug-induced fatty liver disease (DIFLD) covers a group of adverse drug reactions whose prevalence accounts for about 10% of all adverse reactions. The aim of this review was to analyse and summarise data on medicines that can potentially lead to the development of DIFLD, as well as on the pathophysiological mechanisms of its development, methods of its diagnosis, treatment, and prevention. The analysis of scientifi c literature showed that most often this complication occurred following the use of amiodarone, methotrexate, tamoxifen, valproic acid, and some other medicines. It was demonstrated that the main risk factors for developing DIFLD are comorbidity/polymorbidity and mitochondrial dysfunction. Due to the lack of pathognomonic clinical manifestations of DIFLD the best approach to making diagnosis is to obtain a thorough medical history, including medication history, to use RUCAM and Naranjo scales, to analyse a number of blood chemistry parameters (alanine transaminase, aspartate transaminase, bilirubin, alkaline phosphatase), and, if necessary, to perform liver biopsy. Whenever DIFLD is observed in a patient, it is necessary, if possible, to discontinue the use of the medicine that caused the adverse reaction, or to lower its dose and to exclude the factors that may potentially aff ect the patient’s condition. The following measures will help healthcare professionals to prevent and detect DIFLD in a timely manner: observing the requirements of the patient information leafl et, taking into account any comorbidity and potential adverse drug interactions, as well as regular monitoring of the condition of patients taking medicines with known hepatotoxic eff ects.

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