A nem alkoholos zsírmájbetegség ma a krónikus májbetegség leggyakoribb oka, agresszív formája, a nem alkoholos steatohepatitis fibrosisba, cirrhosisba progrediálhat, és végstádiumú májbetegséghez vezethet. A kórkép gyakran társul obesitassal és 2-es típusú cukorbetegséggel, valamint cardiovascularis és renalis szövődményekkel, ugyanakkor nincs jóváhagyott, specifikus terápiája. Kezelése a kockázati tényezők (obesitas, diabetes, dyslipidaemia) kontrollálásán és az életmód-változtatás, testsúlycsökkentés, kalóriabevitel megszorítása és fizikai aktivitás javaslatán alapul, amit azonban nehéz elérni és fenntartani. A betegség hatékony farmakoterápiájára ezért különösen nagy szükség lenne. A dolgozatban tárgyaljuk azokat a farmakonokat, amelyek az obesitas vagy a diabetes kezelésére elérhetők, és amelyek az előzetes vizsgálatok alapján potenciálisan a nem alkoholos steatohepatitis terápiájában is hasznosíthatók. Jelenleg egyedül az antidiabetikumként ismert pioglitazon és az antioxidáns E-vitamin adása javasolt a nem alkoholos steatohepatitis bizonyos eseteiben. Az említetteken kívül áttekintjük azokat a fejlesztés alatt álló készítményeket, amelyek a nem alkoholos zsírmáj különböző patogenetikai útjait célozzák meg, és specifikusan a steatohepatitis kezelésére szolgálnának. Ezeknek a farmakonoknak a terápiás hatása a májzsírtartalom és a de novo lipogenezis csökkentésén, a farnezoid X-receptor–epesav tengely és a bélmikrobiom módosításán, az oxidatív stressz, a gyulladás és a fibrogenezis gátlásán alapulna. A jövőben feltehetően a különböző támadáspontú farmakonok kombinációi jelentik a nem alkoholos steatohepatitis hatékony terápiáját. A nem alkoholos zsírmájbetegség szisztémás metabolikus kórképnek tekinthető, kezelése ezért a diabetológusok, nefrológusok, kardiológusok és hepatológusok együttműködését igényli. Orv Hetil. 2022; 163(22): 855–862.
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