Pavlovskyi S. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The purpose of the study is to optmize the treatment of patents with non-alcoholic steatohepatts associated with diabetes type 2 by pathogenetc approach, depending on the specifcs of the course of the disease. Object and methods of research: the study was conducted on 25 patents. Patents’ age was (56.2 ± 2.05) years (control group – 20 healthy individuals). The observaton tme is 1 month. In order to identfy the diagnosis of NASH complex the data of clinical, laboratory, biochemical and instrumental studies were taken into consideraton, according to the standards of examinaton of patents with pathology of organs of the gastrointestnal tract. By the tme of the examinaton, the patents did not receive NASH treatment according to standard procedures. A mandatory diagnostc method was the implementaton of an ultrasound study to determine the size of the partcles of the liver. The biochemical blood test included: determinaton of protein (total protein content, thymol test), lipid (total cholesterol, triglycerides, high, low and very low density lipoprotein), pigmentary metabolism (total bilirubin), enzyme (aspartate aminotransferase, AST), alanine aminotransferase, ALT), alkaline phosphatase, gamma-glutamyltranspeptdase, and glucose levels in the onset of blood; general blood test. The content of adiponectn was determined by the immune enzyme method (ELISA method, analyzer and test system, Mediagnost GmbH, Germany). Determinaton of the content of interleukin-6 (IL-6) was carried out in a supernatant from peripheral blood lymphocytes, which was obtained afer oxygen-free incubaton and centrifugaton, parameters were evaluated using ECLIA (Sobas Roche) and tumor necrosis factor-alpha (FNP-α, immunochemical method with chemiluminescent detecton, Immulite 100, Siemens AG, Germany). The content of C-reactve protein in blood was determined in blood serum using latex turbidimetric method – “Cobas 6000 (with 501 module; Roche Diagnostcs (Switzerland). Treatment of NASH was carried out in accordance with the “Unifed clinical protocol of primary, secondary (specialized) medical aid. Non-alcoholic steatohepatts” (Order of the Ministry of Health of Ukraine dated November 06, 2014, No. 826). In the applicaton of integrated treatment with combined hypoglycemic therapy (diabetes and pioglitazone), the results of treatment showed a signifcant improvement in the subjectve state of patents. Complaints about the feeling of discomfort in the right hypochondrium, general weakness, biterness in the mouth, flatulence, nausea and dizziness have decreased signifcantly. Pain syndrome decreased by 1.4 tmes; dyspepsia syndrome – 1.7 tmes, loss of appette – 1.7 tmes, astenovegetatve syndrome – 1.3 tmes. Objectvely, the subcategory of sclera has decreased by 1.5 tmes; tongue bursts – 2 tmes; liver decrease in 1,3 tmes, pain of the liver during palpaton decreased by 1,4 tmes); the compacton of the liver parenchyma decreased by 1.5 tmes). The cytokine background in patents under the influence of treatment was characterized by the following changes: the level of FNP-α decreased by 1.4; in the II stage – in 1,52 and in the third – in 1,2 tmes. The content of IL-6 decreased in patents with the corresponding stages І, ІІ and ІІІ – in 1,2; in 1.18 and 1.41 tmes. The content of Creactve protein content at stages І, ІІ and ІІ decreased by 1.21; in 1.19 and 1.2 tmes. An increase in the content of adiponectn was found to be 1.44 tmes. In all patents, the cytolysis, mesenchymal-inflammatory syndrome, cytology, hemograms, and lipid metabolism have stabilized, which confrms the positve lipidotrophic effect of the complex effects of diabetes and pioglitazone on the functonal state of hepatocytes, and indicates a decrease in insulin resistance and improved B-cell functon.

non-alcoholic faty liver disease, diabetes mellitus type 2, combinaton therapy, cytokines

• Bao Y. The progress of studying the mechanisms of immune cells in the regulation of non-alcoholicfatty liver diseases. Zhonghua Gan Zang Bing Za Zhi. 2017 Jul 20;25(7):553-6.
• Kurbatova IV, Dudanova OP. Features of a necrotic and inflammatory process in different forms of nonalcoholic fatty liver disease. Ter Arkh. 2017;89(2):52-8.
• Coulon S, Francque S, Colle I, Verrijken A, Blomme B, Heindryckx, et al. Evaluation of inflammatory and angiogenic factors in patients with non-alcoholic fatty liver disease. Cytokine. 2012 Aug;59(2):442-9.
• Nelson JE, Handa P, Aouizerat B, Wilson L, Vemulakonda LA, Yeh MM, et al. NASH Clinical Research Network. Increased parenchymal damage and steatohepatitis in Caucasian non-alcoholic fatty liver disease patients with common IL1B and IL6 polymorphisms. Aliment Pharmacol Ther. 2016 Dec;44(11-12):1253-64.
• Polyzos SA, Kountouras J, Polymerou V, Papadimitriou KG, Zavos C, Katsinelos P. Vaspin, resistin, retinol-binding protein-4, interleukin-1α and interleukin-6 in patients with nonalcoholic fatty liver disease. Ann Hepatol. 2016 Sep-Oct;15(5):705-14.
• Das SK, Balakrishnan V. Role of cytokines in the pathogenesis of non-alcoholic Fatty liver disease. Indian J Clin Biochem. 2011 Apr;26(2):202-9.
• Jarrar MH, Baranova A, Collantes R, Ranard B, Stepanova M, Bennett C, et al. Adipokines and cytokines in non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2008 Mar 1;27(5):412-21.
• Polyzos SA, Kountouras J, Mantzoros CS. Adipokines in nonalcoholic fatty liver disease. Metabolism. 2016 Aug;65(8):1062-79.
• Stojsavljević S, Gomerčić Palčić M, Virović Jukić L, Smirčić Duvnjak L, Duvnjak M. Adipokines and proinflammatory cytokines, the key mediators in the pathogenesis of nonalcoholic fatty liver disease. World J Gastroenterol. 2014 Dec 28;20(48):18070-91.
• Fierbinteanu-Braticevici C, Dina I, Petrisor A, Tribus L, Negreanu L, Carstoiu C. Noninvasive investigations for non alcoholic fatty liver disease and liver fibrosis. World J Gastroenterol. 2010 Oct 14;16(38):4784-91.
• Lana JP, Martins LB, Oliveira MC, Menezes-Garcia Z, Yamada LT, Vieira LQ, et al. TNF and IL-18 cytokines may regulate liver fat storage under homeostasis conditions. Appl Physiol Nutr Metab. 2016 Dec;41(12):1295-302.
• Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi) medychnoyi dopomohy. Nealkoholnyy steatohepatyt. Nakaz Ministerstva okhorony zdorovya Ukrayiny № 826. [in Ukrainian].
• Dynnyk NV, Svintsitsʹkyy AS, Solovyova HA, Bohomaz VM. Metod modyfikatsiyi sposobu zhyttya v patsiyentiv iz nealkoholʹnoyu zhyrovoyu khvoroboyu pechinky. Praktykuyuchyy likar. 2016;5:6-8. [in Ukrainian].
• Manʹkovskyy BN. Tyazolydyndyony (hlytazony) – mesto v terapyy bolʹnykh sakharnym dyabetom 2-ho typa. Therapia. Ukrayinsʹkyy medychnyy visnyk. 2008;1:22. [in Russiаn].
• Rizos CV, Kei A, Elisaf MS. The current role of thiazolidinediones in diabetes management. Arch Toxicol. 2016 Aug;90(8):1861-81.
• Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of the metabolic syndrome. Dig Liver Dis. 2015 Mar;47(3):181-90.
• Cusi K, Orsak B, Bril F, Lomonaco R, Hecht J, Ortiz-Lopez C, et al. Long-Term Pioglitazone Treatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus: a Randomized Trial. Ann Intern Med. 2016 Sep 6;165(5):305-15. EVALUATION OF CONTENT OF CITOKINS IN PATIENTS’ BLOOD WITH NON-ALCOHOLIC STEATOHEPATITIS COMBINED WITH DIABETES MELLITUS TYPE 2 UNDER THE INFLUENCE OF COMBINED SUCTIONAL THERAPY

«Bulletin of problems biology and medicine» Issue 1 Part 2 (143), 2018 year, 170-175 pages, index UDK 616.36-003.826

10.29254/2077-4214-2018-1-2-143-170-175