Мелатонин в патогенезе и лечении метаболических заболеваний печени

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Наиболее распространенной хронической патологией печени являются метаболические нарушения, которые приводят к развитию так называемой неалкогольной жировой болезни печени (с 2020 г. введено новое название — метаболически ассоциированная жировая болезнь печени) с последующим ее прогрессированием от стеатоза, стеатогепатита и фиброза до цирроза и гепатоцеллюлярной карциномы. Заболевание чаще встречается в развитых странах и, по некоторым оценкам, наблюдается у 1/3 населения планеты. Метаболически ассоциированная жировая болезнь печени признана во всем мире основной причиной хронических заболеваний печени, которые у пациентов часто протекают бессимптомно и диагностируются случайно. Как правило наблюдается коморбидность заболевания с ожирением, сахарным диабетом 2-го типа, дислипидемией, атеросклерозом и другой сердечно-сосудистой патологией. Среди многочисленных патогенетических факторов можно отметить окислительный стресс с последующим апоптозом гепатоцитов, резистентность к инсулину, цитокиновый дисбаланс, митохондриальную дисфункцию, нарушение аутофагии и другие нарушения, которые провоцируют развитие воспалительных процессов. Сложный патогенез заболевания остается не изучен до конца, а выдвинутые в настоящее время гипотезы не могут полностью прояснить взаимосвязи между отдельными патогенетическими механизмами заболевания. Достаточно сложной представляется и проблема лечения метаболически ассоциированной жировой болезни, которая направлена на устранение инсулинорезистентности, гепатопротекцию и купирование рисков прогрессирования сопутствующей патологии. До сих пор не было разработано единых специфических медикаментозных стратегий для ее лечения. Именно с фармакотерапевтических позиций в последние годы привлекает к себе внимание мелатонин, у которого показана способность устранять большинство проявлений метаболического синдрома. В обзоре обобщены экспериментальные данные и результаты клинического опыта использования мелатонина (индольное соединение, синтезирующееся в эпифизе) для коррекции метаболических нарушений функции печени. Мелатонин способен контролировать многие физиологические функции в печеночной ткани как за счет влияния на собственные специфические рецепторы, так и за счет вмешательства во внутриклеточные процессы, обеспечивая модулирующий эффект. В экспериментальных условиях на различных видах животных доказано выраженное гепатопротективное действие вещества при моделировании печеночной патологии. Существенным преимуществом мелатонина является наличие у него способности устранять нарушения в эмоциональной сфере, характерные для любой хронической патологии (тревожность, депрессивность, бессонница). Полученные факты уже позволили начать внедрение мелатонина в клиническую практику и предполагают расширение спектра использования его в гепатологии.

Об авторах

Карэн Борисович Ованесов

Северо-Западный государственный медицинский университет им. И.И. Мечникова

Автор, ответственный за переписку.
Email: ovanesov2007@mail.ru
ORCID iD: 0000-0001-7325-8027
SPIN-код: 1598-9971

д-р мед. наук

Россия, Санкт-Петербург

Наталья Валерьевна Бакулина

Северо-Западный государственный медицинский университет им. И.И. Мечникова

Email: Natalya.Bakulina@szgmu.ru
ORCID iD: 0000-0003-4075-4096
SPIN-код: 9503-8950

д-р мед. наук, профессор

Россия, Санкт-Петербург

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