Keywords
non-alcoholic fatty liver disease, obesity, steatosis, functional state of the liver, lipids, glycated haemoglobin, C-reactive protein, intima-media thickness
How to Cite
Anokhina, G. (2018). NON-ALCOHOLIC LIVER DISEASE MULTI-SYSTEMIC METABOLITIC DISEASE: PREVENTION AND TREATMENT. The Practitioner, (3), 35-40. Retrieved from https://plr.com.ua/index.php/journal/article/view/30
Abstract
Purpose: evaluation of the effectiveness of diet modification, physical activity, medicinal products Antral, Diaformin and Hepargine in the treatment of patients with non-alcoholic steatohepatitis (NASH). Materials and Methods. 25 patients with NASH associated with obesity aged 28 to 52 years were studied. There were 17 (85%) women and 8 (25%) men. In addition to the generally accepted clinical, laboratory and instrumental studies, body mass index (BMI) and waist circumference (WC) were determined by ultrasound duplex scan measurement of the intima-media thickness (IMT) of the extracranial carotid arteries. Liver function tests, lipid content, glycated haemoglobin, C-reactive protein were determined in the blood. The duration of treatment was 6 months. Results. The examined patients had an abdominal type of obesity: BMI was 34.81±1.25 kg/m2; WC was 115.82±2.31 cm. After the treatment BMI decreased to 30.34±1.37 kg/m2, and WC to 106.17±1.32 cm (p<0.05). Blood ALT, AST, GGTP were increased in patients with NASH. After the treatment, these parameters were normal (p<0.05 for all parameters). Following the treatment, blood TC, LDLC, TG decreased, and the concentration of HDLC, and coefficient of atherogeny decreased from 5.20±0.13 to 3.27±0.09 (p<0.05), the percentage of HbA1c reduced (p<0.05), the content of the C-reactive protein (р<0.05) and IMT decreased from 1.05±0.05 mm to 0.75±0.03 mm. Conclusion. The basic therapy of patients with NASH includes diet and lifestyle modification. Medicinal therapy with Antral, Hepargine and Diaformin, that have anti-inflammatory and metabolic actions, have a positive effect both on the liver and on the vascular wall. The control of the treatment efficacy in patients with NAFLD should include not only traditional blood tests for transaminase activity and lipid content, but HbA1c, C-reactive protein, IMT which are important for prevention of the atherosclerosis progression.
References
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4. Гастроентерологія: Підручник / За ред. Н.В. Харченко та О.Я. Бабака. — К., 2017. — 578 с.
5. Грацианская А.Н. Гепатопротекторы в клинической практике: Прогепар // Фарматека. — 2010. — № 2. — С. 53-57.
6. Граник В.Г., Григорьев Н.Б. Оксид азота (NO). Новый путь к поиску лекарств / Монография. — М., 2004. — С. 222.
7. Грацианская А.Н. Гепатопротекторы в клинической практике: Прогепар // Фарматека. — 2010. — № 2. — С. 53-57.
8. Зуева Н.А. Жировое повреждение печени неалкогольного генеза: причины и терапевтичские подходы // Міжнародний ендокринологічний журнал. — 2009. — № 5 (23).
9. Ильченко Л.Ю. Фармакокоррекция и немедикаментозные методы лечения ожирения у больных неалкогольным стеатогепатитом // Здоров’я України. — 2009. — № 4. — С. 33.
10. Мехтиев С.Н., Гриневич В.Б., Кравчук Ю.А. Неалкогольна жирова хвороба печінки // Лечащий врач. — 2009. — № 10.
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12. Коноплева Л.Ф. Эндотелиальная дисфункция в патогенезе сердечно-сосудистых заболеваний и методы ее коррекции / Л.Ф. Коноплева // Therapia. — 2011. — № 3 (56). — С. 26-30.
13. Мехтиев С.Н., Мехтиева О.А., Зиновьева Е.Н. Неалкогольная жировая болезнь печени в вопросах и ответах. Учебное пособие. — СПб. Изд.: СПбГМУ им. акад. И.П. Павлова, 2011. — С. 56.
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15. Atkinson W., Slow S., Elmslie J., Lever M., Chambers S.T., George P.M. Dietary and supplementary betaine: effects on betaine and homocysteine concentrations in males // Nutr. Metab. Cardiovasc. Dis. — 2009. — Vol. 19 (11). — Р. 767-773.
16. Ballestri Stefano, Amedeo Lonardo, Bonapace Stefano, Byrne Christopher, Loria Paola, Targher Giovanni. Risk of cardiovascular, cardiac and arrhythmic complications in patients with non-alcoholic fatty liver disease // World J. Gastroenterol. — 2014. — Vol. 20 (7). — P. 1724-1745.
17. Bhatia L.S., Curzen N.P., Calder P.C., Byrne C.D. Nonalcoholic fatty liver disease: a new and important cardiovascular risk factor? // Eur. Heart J. — 2012. — Vol. 33. — P. 1190-1200.
18. Bоger R.H. The Pharmacodynamics of L-Arginine // J. Nutr. — 2007 — Vol. 137 — P. 1650-1655.
19. Bode-Bоger S.M. Effect of L-arginine supplementation on NO production in man // European Journal of Clinical Pharmacology — 2006. — Vol. 62, Supplement 13. — P. 91-99.
20. Bril F., Bril К. Cusi Management of Nonalcoholic Fatty Liver Disease in Patients With Type 2 Diabetes: A Call to Action // Diabetes Care. — 2017. — Vol. 40 (3). — Р. 419-430.
21. Castro S. Patophysiology of arterial disease / S. Castro // One way S.r.l. — Italy, 2007. — 48 р.
22. Donnelly K.L. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease / K.L. Donnelly, C.I. Smith, S.J. Schwarzenberg [et al.] // J. Clin. Invest. — 2005. — Vol. 115, № 5. — P. 1343-1351. DOI: 10.1172/JCI23621.
23. Eleid M.F. Carotid ultrasound identifies high risk subclinical atherosclerosis in adulrs in with low Framingham risk scores / M.F. Eleid, S.J. Lester, T.L. Wiedenbeck [et al.] // J. Am. Soc. Echocardiogr. — 2010. — Vol. 23 (8). — P. 802-808.
24. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. European Association for the Study of the Liver (EASL) & European Association for the Study of Diabetes (EASD) & European Association for the Study of Obesity (EASO). Diabetologia. DOI: 10.1007/s00125-016-3902-y. Published online: 07 April — 2016.
25. Feng Q., Kalari K., Fridley B.L., Jenkins G., Ji Y., Abo R. Betaine-homocysteine methyltransferase: human liver genotype-phenotype correlation // Mol. Genet. Metab. — 2011. — Vol. 102 (2). — Р. 126-133.
26. Goland S., Shimoni S., Zornitzki T., et al. Cardiac abnormalities as a new manifestation of nonalcoholic fatty liver disease: echocardiographic and tissue Doppler imaging assessment // J. Clin. Gastroenterol. — 2006. — Vol. 40. — R. 949-955.
27. Jiang J., Torok N. Nonalcoholic Steatohepatitis and the Metabolic Syndrome // Metabolic Syndrome and Related Disorders. — 2008. — P. 1-7.
28. Karabay C.Y., Kocabay G., Kalayci A., Colak Y., Oduncu V., Akgun T., Kalkan S., Guler A., Kirma C. Impaired left ventricular mechanics in nonalcoholic fatty liver disease: a speckle-tracking echocardiography study // Eur. J. Gastroenterol. Hepatol. — 2014. — Vol. 26. — R. 325-331.
29. Karajamaki A.J., Patsi O.P., Savolainen M., Kesanie-mi Y.A., Huikuri H., Ukkola O. Non-Alcoholic Fatty Liver Disease as a Predictor of Atrial Fibrillation in Middle-Aged Population (OPERA Study) // PLoS One. — 2015. — Vol. 10. — Р. e0142937.
30. Kim H.C., Kim D., Huh K.B. Association between nonalcoholic fatty liver disease and carotid intima-media thickness according to the presence of metabolic syndrome // Atherosclerosis. — 2009. — Vol. 204. — Р. 521-525.
31. Lee Min-Kyung, Park Hye-Jeong, Jeon Won Seon, et al. Higher association of coronary artery calcification with nonalcoholic fatty liver disease than with abdominal obesity in middle-aged Korean men: the Kangbuk Samsung Health Study // Cardiovascular. Diabetology. — 2015. — Vol. 14. — R88.
32. Lin Y.C., Lo H.M., Chen J.D. Sonographic fatty liver, overweight and ischemic heart disease // World J. Gastroenterol. — 2005. — Vol. 11. — Р. 4838-4842.
33. Mason J.E., Starke R.D., Van Kirk J.E. Gamma-glutamyl transferase: a novel cardiovascular risk biomarker // Prev. Cardiol. — 2010. — Vol. 13 (1). — Р. 36-41.
34. Mellinger J.L., Pencina K.M., Massaro J.M., Hoffmann U., Seshadri S., Fox C.S., O’Donnell C.J., Speliotes E.K. Hepatic steatosis and cardiovascular disease outcomes: An analysis of the Framingham Heart Study // J. Hepatol. — 2015. — Vol. 63. — Р. 470-476.
35. Musso G., Cassader M., Olivetti C., Rosina F., Carbone G., Gambino R. Association of obstructive sleep apnoea with the presence and severity of non-alcoholic fatty liver disease. A systematic review and meta-analysis // Obes. Rev. — 2013. — Vol. 14. — Р. 417-431.
36. Lee J.E., Jacques P.F., Dougherty L., Selhub J., Giovannucci E., Zeisel S.H., Cho E. Are dietary choline and betaine intakes determinants of total homocysteine concentration? // Am. J. Clin. Nutr. — 2010. — Vol. 91 (5). — Р. 1303-1310.
37. Neuschwander-Tetri B.A. Dietary trans-fatty acid induced NASH is normalized following loss of trans-fatty acids from hepatic lipid pools / B.A. Neuschwander-Tetri, D.A. Ford, S. Acharya // Lipids. — 2012. — Vol. 47, № 10. — P. 941-950. DOI: 10.1007/s11745-012-3709-7.
38. Neuschwander-Tetri B.A. Excess cholesterol and fat in the diet: a dangerous liaison for energy expenditure and the liver / B.A. Neuschwander-Tetri, D.Q. Wang // Hepatology. — 2013. — Vol. 57, № 5. — Р. 7-9. DOI: 10.1002/hep.25953.
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