ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2022-3-154-165ssmu-4918Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEW AND LECTURESСовременные стратегии таргетной терапии фиброза печениCurrent strategies for targeted therapy of liver fibrosishttps://orcid.org/0000-0001-9809-8015ГарбузенкоД. В.GarbuzenkoD. V.

Гарбузенко Дмитрий Викторович – доктор медицинских наук, профессор, кафедра факультетской хирургии, ЮУГМУ.

454092, Челябинск, ул. Воровского, 64

64, Vorovskogo Str., Chelyabinsk, 454092

garb@inbox.ruЮжно-Уральский государственный медицинский университет (ЮУГМУ)РоссияSouth Ural State Medical University (SUSMU)Russian Federation202215102022213154165Copyright © Гарбузенко Д.В., 20222022Гарбузенко Д.В.Garbuzenko D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/4918

Учитывая, что фиброз печени (ФП) является неблагоприятным событием естественного течения хронических заболеваний печени (ХЗП), скорейшее внедрение и широкое применение методов антифибротической терапии являются актуальной проблемой гепатологии. Цель обзора – описать современные подходы к таргетной терапии ФП.

Для поиска научных статей применялись база данных PubMed, поисковая система Google Scholar, Кокрановские систематические обзоры, научная электронная библиотека eLIBRARY.RU, а также пристатейные списки литературы. Соответствующие цели обзора публикации отбирались за период с 1998 по 2021 г. по терминам «фиброз печени», «патогенез», «лечение». Критерии включения ограничивались таргетной терапией ФП.

Несмотря на растущее число доказательств обратимости ФП, в настоящее время пока не существует каких-либо эффективных или одобренных для клинического применения схем его специфической терапии. Однако, принимая во внимание актуальность вопроса, научные поиски в этом направлении необходимы. Были изучены многочисленные лекарственные средства с хорошим профилем безопасности, которые хотя и предлагались для других целей, способны оказывать позитивное влияние на ФП. Кроме того, ряд отличных от фармакотерапии новаторских подходов вселяют оптимизм относительно успешности решения данной проблемы. Очевидно, что необходимы исследования, сосредоточенные на хорошо охарактеризованных группах пациентов с подтвержденными гистологическими, эластографическими, клиническими и радиологическими показателями. Это достаточно сложная задача, поскольку ключевым моментом будет стратификация риска на основе этнической принадлежности, этиологии и клинического статуса и для достоверной оценки потребуются очень большие размеры выборок. Тем не менее ее решение позволит повысить эффективность лечения пациентов с ХЗП, улучшит прогноз и качество их жизни, а также существенно уменьшит необходимость в трансплантации печени, потребность в которой во всем мире остается чрезвычайно высокой.

Liver fibrosis (LF) is an unfavorable event in the natural course of chronic liver diseases (CLD), therefore, early implementation and widespread use of antifibrotic therapy methods is a pressing issue in hepatology. The aim of the review was to describe current approaches to targeted therapy of LF.

PubMed database, Google Scholar search engine, Cochrane Database of Systematic Reviews, eLIBRARY.RU scientific electronic library, as well as reference lists of articles were used to search for scientific articles. The publications that corresponded to the aim of the study were selected for the period from 1998 to 2021 by the terms “liver fibrosis”, “pathogenesis”, and “treatment”. Inclusion criteria were restricted to targeted therapy of LF.

Despite the growing evidence for reversibility of LF, there are currently no effective or clinically approved regimens for its specific therapy. However, taking into account the relevance of the issue, scientific research in this area is necessary. Multiple drugs with a good safety profile have been studied, which, though intended for other purposes, can have a positive effect on LF. In addition, a number of innovative approaches that differ from pharmacotherapy inspire optimism about finding a solution to this problem. It is obvious that studies focused on well-characterized groups of patients with confirmed histologic, elastography, clinical, and radiological parameters are required. This is a challenging task, since the key point will be stratification of risk based on ethnicity, etiology, and clinical status, and very large samples will be required for a reliable assessment. Nevertheless, the solution will increase efficiency of treatment for patients with CLD, improve their prognosis and quality of life, and significantly reduce the need for liver transplantation, a demand for which remains extremely high worldwide.

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