ART OF MEDICINE 2017

 

EFFICIENCY OF DIFFEREN-TIATED HEPATOPROTECTIVE THERAPY IN PATIENTS WITH NON-ALCOHOLIC STEATO-HEPATITIS ON THE BACK-GROUND OF STABLE CORO-NARY HEART DISEASE

 

І.І. Vakalyuk, N.G. Virstyuk

          Ivano-Frankivsk National Medical University, Ivano-Frankivsk, ORCID ID: 0000-0002-1019-2726, ORCID ID: 0000-0002-7495-8882 e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

  

Abstract

Abstract. The aim if this research was to study the effect of differentiated hepatoprotective therapy on the liver functional state in patients with non-alcoholic steatohepatitis (NASH) on the background of stable coronary heart disease (CHD). 44 patients with NASH on the background of stable CHD - postinfarction cardiosclerosis were examined. Among them were 32 men and 12 women with average age 65.8 ± 5.3 years. In order to hepatoprotective therapy on the background of basic treatment ademetionin and heparizine were used; the schemes of the use of these drugs depended on the degree of liver fibrosis and the dynamics of enzymes cytolysis activity on the background of complex treatment. The assessment of the therapy effectiveness was carried out every 3 months. It was evaluated the liver functional state and ultrasound examination was conducted. The degree of liver fibrosis was evaluated according to the results of elastography. FIB-4, NFS indexes were calculated, and collagen type IV was determined by immuno-enzymatic method. It was established that the proposed differentiated approach to hepatoprotective therapy with ademetionin and heparizine in patients with NASH on the background of stable CHD, depending on the liver fibrosis stage contributes to improving the functional liver state by the level of enzymes cytolysis activity. Hepatoprotective therapy positively affected on the regression of the liver fibrotic processes by the most significant reduction in the shear wave velocity by the results of elastography, by the level of collagen type IV and FIB-4 index in the sixth month of treatment, that caused the necessity of lengthening the use of hepatoprotective agents according to the scheme up to 9 months of observation.

 

Keywords: nonalcoholic steatohepatitis, stable coronary heart disease, hepatoprotective therapy.

 

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References

1. Kravchenko VV, Sokolov MY, Talayeva TV. Unified Clinical Protocol "Stable coronary heart disease." MOH Ukraine Order #152 [Internet]. 2016 [cited 2016 Feb 03]. Available from: http://webcache.googleusercontent.com/search?q=cache:GtKuYUMf2TEJ:www.moz.gov.ua/ua/portal/dn_20160302_0152.html+&cd=2&hl=uk&ct=clnk&gl=ua

2. Kan`ovs`ka LV, Dudka IV, Dudka TV, Xuxlina OS, Antoniv AA. Patent for utility model #123026 UА Ukraine, MPK (2017.01) А61К 35/00, А61Р 1/16. “Method of treatment and prevention of liver fibrosis progression in patients with non-alcoholic steatohepatitis”. Bulletin #3 from 12.02.2018

3. Xarchenko NV, Lishhy`shy`na OM, Anoxina GA. Adapted clinical guidance, based on the evidence "Non-alcoholic fatty liver disease" [Internet]. 2014. Available from: http://www. moz.gov.ua/docfiles/dod_akn_dn_20140616_2.pdf

4. Xobzej MK, Sirenko YuM, Stepanenko AV. Unified clinical protocol for emergency, primary, secondary (specialized) and tertiary (highly specialized) medical care and medical rehabilitation “Acute coronary syndrome with elevation of segment ST”. MOH Ukraine Order #455 [Internet]. 2014 Available from: http://mtd. dec.gov.ua/images/dodatki/2014_455_GKS/2014_455%20YKPMD_GKS.pdfBiophysics

5. Xobzej MK, Xarchenko NV, Lishhyshyna OM. Unified Clinical Protocol "Non-alcoholic steatohepatitis". MOH Ukraine Order #826 [Internet]. 2014 [cited 2014 Nov 06]. Available from: http://webcache.googleusercontent.com/search?q=cache:rEnIUM5A_q4J:ww.dec.gov.ua/mtd/dodatki/2014_826Gepatyty/2014_826_YKPMD_NSTPT.doc+&cd=1&hl=uk&ct=clnk&gl=ua

6. Yagmur VB. Non-alcoholic fatty liver disease: a modern look at pathogenesis, diagnosis and treatment. Gastr. 2013:3(49):138-147

7. Adams Leon A, Quentin MAnstee. A Fatty Liver May Result in a Broken Heart. J of Hepatology. 2016;65(1):14-16

8. Angulo P, Hui JM, Marchesini G. The NAFLD fibrosis score A noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatol. 2007;45(4):846-854

9. EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388–1402.

10. Ferraioli G, Parekh P, Levitov AB, et al. Shear Wave Elastography for Evaluation of Liver Fibrosis. J of Ultrasound in Medicine. 2014;33(2):197-203

11. Guo T, Chang L, Xiao Y, et al. S-Adenosyl-L-Methionine for the Treatment of Chronic Liver Disease: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(3): e0122124

12. Noureddin M, Mato JM, Lu SC. Nonalcoholic fatty liver disease: Update on pathogenesis, diagnosis, treatment and the role of S-adenosylmethionine. Exp Biol Med. 2015;240(6):809-820

13. Sterling RK, Lissen E, Clumeck N. Development of a simple noninvasive index to predict significant fibrosis patients with HIV/HCV co-infection. Hepatol. 2006;43:1317-1325

14. World Gastroenterology Organization. Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis: World Gastroenterology Organisation Global Guidelines [Internet]. 2012. Available from: http://www.worldgastroenterology.org/NAFLD-NASH.html

15. World Gastroenterology Organization. Obesity: World Gastroenterology Organization Global Guideline [Internet]. 2012. Available from: http://www.worldgastroenterology.org/obesity.html