clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.37489/2588-0519-2020-3-61-74clinvest-508Research ArticleБЕЗОПАСНОСТЬ ЛЕКАРСТВDRUG SAFETYХолестатический вариант лекарственно-индуцированного поражения печениDrug-induced liver damage with cholestasishttps://orcid.org/0000-0001-7168-3636ПереверзевА. П.PereverzevA. P.

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

Москва

Pereverzev Anton P. - PhD in Medicine, Associate Professor, Department of Therapy and Polymorbid Pathology

Moscow

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

Остроумова Ольга Дмитриевна - д. м. н., профессор, зав. кафедрой терапии и полимор-бидной патологии

Москва

Ostroumova Olga D. - Dr. Sci. in Medicine, Professor, Head of the Department of Therapy and Polymorbid Pathology

Moscow

https://orcid.org/0000-0001-5801-3742КочетковА. И.KochetkovA. I.

Кочетков Алексей Иванович - к. м. н., доцент, доцент кафедры терапии и полимор-бидной патологии

Москва

Kochetkov Aleksei I. - PhD in Medicine, Associate Professor, Department of Therapy and Polymorbid Pathology

Moscow

ФГБОУДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияFSBEI DPO Russian Medical Academy of Continuing Professional Education of the Ministry of Health of the Russian FederationRussian Federation202026092020036174Copyright © Переверзев А.П., Остроумова О.Д., Кочетков А.И., 20202020Переверзев А.П., Остроумова О.Д., Кочетков А.И.Pereverzev A.P., Ostroumova O.D., Kochetkov A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/508

Печень является основным органом ответственным за биотрансформацию и элиминацию лекарственных препаратов (ЛП) из организма, а потому её функция нередко нарушается на фоне приёма ЛП. В данной статье авторы информируют специалистов практического здравоохранения об особенностях токсического лекарственно-индуцированного поражения печени с холестазом (ЛИППХ), вызванного приёмом ЛС. Чаще всего такое поражение печени протекает вследствие приёма некоторых антибактериальных препаратов, препаратов стероидной структуры, барбитуратов и ряда других ЛП. ЛИППХ не имеет патогномоничных клинических проявлений. В научной литературе описаны как бессимптомное повышение «печёночных» ферментов, так и развитие острой печёночной недостаточности. Важными методами диагностики являются сбор анамнеза (особенно лекарственного), анализ биохимических показателей крови, данные лучевых методов диагностики. В случае выявления у пациента ЛИППХ необходимо, по возможности, отменить подозреваемый ЛП. Универсальные препараты, рекомендованные для медикаментозной терапии ЛИППХ отсутствуют, однако показано положительное влияние адеметионина и урсодезоксихолевой кислоты. Специфических мер профилактики ЛИППХ нет, поэтому специалистам практического здравоохранения и пациентам с высоким риском развития ЛИППХ можно рекомендовать соблюдать предписания инструкции по медицинскому применению ЛП, оптимизировать фармакотерапию, бороться с полипрагмазией, регулярно мониторировать уровень печёночных ферментов и другие мероприятия.

The liver is the main organ responsible for the biotransformation and elimination of drugs, and therefore its function is often impaired by different medications. In this article, the authors inform practical health care professionals about the possible liver damage with cholestasis caused by drugs (DILI). Most often, DILI is caused some antibacterial drugs, steroids, barbiturates and some other drugs. DILI has no pathognomonic clinical manifestations. tte scientific literature describes both an asymptomatic increase of “liver” enzymes and the development of acute liver failure. Important diagnostic methods are the collection of anamnesis (especially the medicinal one), analysis of blood biochemical tests, and data from visual diagnostic methods. If the patient has DILI, it is necessary, whenever possible, to stop intake of a drug. ttere are no specific drugs recommended for pharmacotherapy of DILI but there is some the positive effect of ademetionine and ursodeoxycholic acid. ttere are no specific preventive measures for DILI. Healthcare practitioners are recommended not to use drugs off-label, optimize pharmacotherapy and fight with polypharmacy, monitore biochemical tests regularly etc.

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