НАРУШЕНИЕ ВСАСЫВАНИЯ И ПЕРСПЕКТИВЫ ПРИМЕНЕНИЯ ЖИРОРАСТВОРИМЫХ ВИТАМИНОВ ПРИ БОЛЕЗНЯХ ПЕЧЕНИ

В обзорной статье рассматриваются вопросы эффективности и тактики назначения жирорастворимых витаминов, как при холестатических, так и нехолестатических болезнях печени, а также водорастворимых витаминов, в частности, витамина С при желчнокаменной болезни. Окислительный стресс, в результате хронического воспаления является одним из основных механизмов преобразования фиброза печени в цирроз. Дисбаланс между продукцией реактивных форм кислорода и антиоксидантной защитой вызывает ряд патофизиологических изменений в печени, в том числе активацию печеночных звездчатых клеток. У носителей I148M мутации в PNPLA3 не наблюдалось уменьшения концентрации в печени витамина А с увеличением тяжести заболевания, но отмечалось снижение уровня циркулирующего ретинил пальмитата и ретинол-связывающего белка. К назначению витамина А при болезнях печени следует подходить с осторожностью. Гипервитаминоз А приводит к ускоренному фиброзу печени и стимулирует канцерогенез. В настоящее время активно изучается возможность использования витамина Е, как антиоксиданта, у больных с неалкогольной жировой болезнью печени. Его присутствие в мембранах фосфолипидного бислоя клеток позволяет предотвратить окисление неферментативных компонентов клеток свободными радикалами. Витамин Е может подавлять профибротические процессы. У пациентов с хроническими холестатическими заболеваниями печени распространена недостаточность витамина K, даже при его назначении, и связана со степенью холестаза и тяжестью заболевания. Гиповитаминоз D при болезнях печени также связан с тяжестью заболевания: коррелирует с выраженностью печеночной недостаточности и инфекционными осложнениями. Витамин D является независимым прогностическим параметром риска смертности у пациентов с циррозом печени.

жирорастворимые витамины, витамины А, D, Е, К, С, болезни печени, холестаз, фиброз, желчнокаменная болезнь, сholelithiasis

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