EFFICIENCY OF COMPLEX PATHOGENIC APPROACH FOR TREATMENT OF PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS COMBINED WITH TYPE 2 DIABETES MELLITUS

S.  Pavlovskyi

doi:10.32345/USMYJ.2(106).2018.32-36

S. Pavlovskyi Bogomolets National Medical University, Kyiv, Ukraine

DOI: https://doi.org/10.32345/USMYJ.2(106).2018.32-36

Keywords: non-alcoholic steatohepatitis, type 2 diabetes mellitus, treatment

Abstract

Aim is to optimize treatment of non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus. 100 patients with NAFLD in stage of non-alcoholic steatohepatitis (NASH) were enrolled into study. Application of S-adenosylmethionine during the treatment of patients with non-alcoholic fatty liver disease (NAFLD) had high efficacy in the normalization of the functional, biochemical and cytokine profile of the blood. Combination of gliclizide and pioglitazone led to the decrease in the levels of cytolysis and mesenchymal-inflammatory syndromes, stabilization of lipid metabolism. This fact confirms the positive lipotrophic effect of the complex effect of gliclizide and pioglitazone on the functional state of hepatocytes, indicates decrease in insulin resistance and improves cell function. Complex therapy with combination of hypoglycemic and lipotropic drugs (gliclizide, pioglitazone, S-adenosylmethionine) showed good results, confirming the positive complex effect of S-adenosylmethionine, gliclizide and pioglitazone on the functional state of hepatocytes, led to decrease in insulin resistance and production of antiinflammatory effect. Pain syndrome remained significant in 9 patients (30%, 1.8 times less than before treatment); dyspeptic syndrome – in 10 patients (33,3%, decreased by 1,7 times), anorexia – in 10 patients (33,3%, a decrease of 1,9 times), asthenia – in 11 patients (36,7 %, decrease by 1.9 times). Combination of hypoglycemic, lipotropic therapy and basic therapy positively influenced on the state of hepatocytes decreasing activity of ALT, AST, alkaline +phosphatase. USG study showed reduction of the hepatic tissue changes compared to the visualization results before treatment. Particularly important was a significant decrease in the number of patients on the stage 3 of hepatosis having a decrease in the levels of TNF-α, IL-6 and C-reactive protein and increase of adiponectin. According to the results, application of the proposed agents affecting specific pathogenic links of NAFLD is believed to be an effective way to treat NAFLD.

References

Динник Н.В., Свінціцький А.С., Соловйова Г.А., Богомаз ВМ. Метоо модифікації способу життя в пацієнтів із нєалкогольною жировою хворобою печінки. Практикуючий лікар. 2016;5(№):6-8.

Маньковский Б.Н. Тиазолидиндионы (глитазоны) — место в терапии больных сахарным диабетом 2-го типа. Therapia. Український медичний вісник. 2008,1: 22.

Уніфікований клінічний протокол первинної, вторинної (спеціалізованої) медичної допомоги. Неалкогольний стеатогепатит / Наказ Міністерства охорони здоров'я України 06 листопада 2014 року №і 826.

Barb D., Portillo-Sanchez Р, Cusi К. Pharmacological management of nonalcoholic fatty liver disease. Metabolism. 2016 Aug; 65(8): 1183-95.

Bellentani S. The epidemiology of non-alcoholic fatty liver disease. Liver Int. 2017 Jan;37 Suppl 1:81-84.

Federico A., Dallio M., Masarone M., Persico M., Loguercio C. The epidemiology of non-alcoholic fatty liver disease and its connection with cardiovascular disease: role of endothelial dysfunction. Eur Rev Med Pharmacol Sci. 2016 Nov;20(22):4731-4741.

Chalasani N., Younossi Z., Lavine J.E., Diehl A.M., Brunt E.M., Cusi K., et al. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012 Jun;55(6):2005-23.

Gasbarrini G., Vero V., Miele L., Forgione A., Hernandez A.P., Greco A. V. et al. Nonalcoholic fatty liver disease: defining a common problem. Eur Rev Med Pharmacol Sci. 2005 Sep-Oct;9(5):253-9.

Lattuada G., Ragogna F., Perseghin G. Why does NAFLDpredict type 2 diabetes? Curr Diab Rep. 2011 Jun;11(3):167-72.

Rau M., Weiss J., Geier A. Non-alcoholic fatty liver disease (NAFLD). Dtsch Med Wochenschr. 2015 Jul;140(14):1051-5.

Sweet P.H., Khoo T, Nguyen S. Nonalcoholic Fatty Liver Disease. Prim Care. 2017 Dec;44(4):599-607.

Vizzutti E, Arena U, Nobili V., Tarquini R, TrappoliereM., Laffi G. et al. Non-invasive assessment of fibrosis in non-alcoholic fatty liver disease. Ann Hepatol. 2009 Apr-Jun;8(2):89-94.