Rozwój metabolicznego stłuszczenia wątroby podczas farmakoterapii zaburzeń psychicznych – przegląd literatury
DOI:
https://doi.org/10.2478/cpp-2022-0013Słowa kluczowe:
insulinooporność, leki przeciwpsychotyczne, metaboliczne stłuszczenie wątroby, niealkoholowe stłuszczenie wątroby, zespół metabolicznyAbstrakt
Wstęp. Metaboliczna stłuszczeniowa choroba wątroby (Metabolic-associated Fatty Liver Disease, MAFLD) jest pojęciem wprowadzonym dla niealkoholowej stłuszczeniowej choroby wątroby (Non-alcoholic Fatty Liver Disease, NAFLD), które podkreśla jej związek ze składowymi zespołu metabolicznego (Metabolic Syndrome, MetS). MAFLD staje się istotnym klinicznie problemem ze względu na swój coraz większy udział w patogenezie kryptogennej marskości wątroby.
Materiał i metody. Powstała praca jest przeglądem najistotniejszych informacji na temat ryzyka rozwoju MAFLD w kontekście stosowania poszczególnych grup leków psychotropowych. Przedstawiono epidemiologię, ze szczególnym zwróceniem uwagi na populację osób leczonych psychiatrycznie, patofizjologię oraz doniesienia naukowe analizujące wpływ poszczególnych leków psychotropowych na rozwój MAFLD.
Wyniki. Lekami, które w największym stopniu mogą mieć wpływ na rozwój MAFLD są atypowe leki przeciwpsychotyczne, szczególnie olanzapina, oraz stabilizatory nastroju -głównie kwas walproinowy. Ich działanie jest pośrednie i polega na dysregulacji gospodarki węglowodanowej i lipidowej organizmu.
Wnioski. Populacja osób leczonych psychiatrycznie jest szczególnie narażona na rozwój MAFLD. U podłoża tego zaburzenia leży sama specyfika chorób psychicznych, nieprawidłowe żywienie, niski poziom aktywności fizycznej, czy skłonność do uzależnień. Również negatywny wpływ stosowanych leków psychotropowych na metabolizm ustrojowy przyczynia się pośrednio do rozwoju MAFLD. W celu prewencji stłuszczenia wątroby należy regularnie kontrolować parametry metaboliczne i wątrobowe, a także poddawać pacjentów przesiewowemu badaniu USG wątroby. Istotne są również działania profilaktyczne ze strony specjalistów, obejmujące edukację pacjentów i uwrażliwianie ich na prawidłowy styl życia.
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