Disorders of carbohydrate metabolism in patients with non-alcoholic steatohepatitis, obesity and chronic obstructive pulmonary disease
Keywords:non-alcoholic steatohepatitis, chronic obstructive pulmonary disease, obesity, antral, policosanol
AbstractBackground. A significant increase in the incidence of non-alcoholic steatohepatitis (NASH) in obese patients with chronic obstructive pulmonary disease (COPD) in the world requires the study of the mechanisms of their mutual aggravation, and correction of the metabolic components of pathogenesis and the consequences of concomitant pathology. The purpose was determination of the state of glycemic parameters, regulation of carbohydrate metabolism and evaluation of the effectiveness of antral and the combination of antral with policosanol use in terms of the effect on the state of glycemia, the degree of insulin resistance in patients with non-alcoholic steatohepatitis against the background of obesity combined with chronic obstructive pulmonary disease. Materials and methods. One hundred and sixty patients were screened and divided into 3 groups. Group I consisted of 35 people with NASH against the background of degree I obesity. Group II includes 90 patients with NASH, degree I obesity and COPD 2–3 D, group III — 35 individuals with COPD 2–3 D. According to the treatment received, group II of patients was divided into 3 subgroups, of which 25 people (subgroup 1t — control one) received NASH therapy (essential phospholipids 300 mg 2 capsules 3 times daily for 60 days) and baseline COPD therapy. Subgroup II (primary, 2t) — 35 patients, in addition to similar COPD therapy, for the treatment of NASH, instead of essential phospholipids, they received antral 200 mg 3 times a day for 60 days. Subgroup III (primary, 3t) — 30 patients, in addition to similar COPD therapy, for the treatment of NASH they received antral 200 mg 3 times daily and, additionally, policosanol 20 mg after the dinner for 60 days. Comparison group consisted of 30 apparently healthy individuals. Results. Before treatment, a slight insignificant increase in the level of fasting glycemia by 10.9 and 14.3 %, respectively (p < 0.05), was established in patients of groups I and II, in the content of postprandial glucose in the blood — by 18.6 and 34.4 % (p < 0.05), while in the patients of group 3, the changes in indicators were insignificant. After treatment, in patients from the subgroups 2t and 3t, a decrease in fasting glucose was 8.9 % (p < 0.05), while in the subgroup 1t, its slight decrease was revealed — 3.4 % (p > 0.05). The content of postprandial blood glucose in patients of all groups decreased, respectively, in the subgroups 1t, 2t and 3t — by 10.6, 21.3 and 21.9 % compared to the data before treatment (p < 0.05). The maximum decrease in the blood insulin content (by 1.9 times) and the degree of insulin resistance (by 46.8 %) was also observed in the subgroup 3t (p < 0.05). Conclusions. The administration of antral for 60 days led to a significant correction of glycemia in NASH patients with obesity and COPD that was accompanied by a significant decrease in insulin levels (p < 0.05), postprandial glucose content and the insulin resistance degree (p < 0.05).
Stepanov YuM, Nedzvetskaya NV, Yagmur VB, Klenina IA, Oshmyanskaya NYu. Noninvasive diagnosis of liver fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterologìa. 2017;51(3):188-95. doi:10.22141/2308-2097.51.3.2017.112635. (in Ukrainian).
Khukhlina OS, Antoniv AA, Mandryk OY, Smandych VS, Matushchak MR. The role of endothelial dysfunction in the progression mechanisms of non-alcoholic steatohepatitis in patients with obesity and chronic kidney disease. Wiad Lek. 2019;72(4):523-526.
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). EASL-EASD-EASO Clinical Practice Guidelines for the Management of Non-Alcoholic Fatty Liver Disease. Obes Facts. 2016;9(2):65-90. doi:10.1159/000443344.
Lonardo A, Mantovani A, Lugari S, Targher G. Epidemiology and pathophysiology of the association between NAFLD and metabolically healthy or metabolically unhealthy obesity. Ann Hepatol. 2020 Jul-Aug;19(4):359-366. doi:10.1016/j.aohep.2020.03.001.
Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015 Aug;149(2):389-97.e10. doi:10.1053/j.gastro.2015.04.043.
Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: A meta-analysis. J Hepatol. 2016 Sep;65(3):589-600. doi:10.1016/j.jhep.2016.05.013.
Italian Association for the Study of the Liver (AISF). AISF position paper on nonalcoholic fatty liver disease (NAFLD): Updates and future directions. Dig Liver Dis. 2017 May;49(5):471-483. doi:10.1016/j.dld.2017.01.147.
Sadikova SI, Tagaeva MH, Dzhalilova SH, Rustamova MT. Chronic liver disease of viral etiology - therapy with modern principles Antral. Bulletin of Medical Association of Uzbekistan. 2015;(2):85-88. (in Russian).
Kuzminov BP, Matysik SI, Zazuliak TS, Mykytchak TI. Evaluation of antral hepatoprotector acute toxicity in alternative test-systems. Environment and health. 2016;(78):43-46. doi:10.32402/dovkil2016.02.043. (in Ukrainian).
Younossi ZM, Blissett D, Blissett R, Henry L, Stepanova M, Younossi Y, Racila A, Hunt S, Beckerman R. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. Hepatology. 2016 Nov;64(5):1577-1586. doi:10.1002/hep.28785.
Fadieienko GD, Kushnir IE, Chernova VM, et al. Nutrigenetic characteristics of patients with nonalcoholic liver disease combined with metabolic syndrome. Modern Gastroenterology. 2018;(104):7-13. doi:10.3978/MG-2018-6-7. (in Uikrainian).
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 Jul;64(1):73-84. doi:10.1002/hep.28431.
Singh S, Khera R, Allen AM, Murad MH, Loomba R. Comparative effectiveness of pharmacological interventions for nonalcoholic steatohepatitis: A systematic review and network meta-analysis. Hepatology. 2015 Nov;62(5):1417-32. doi:10.1002/hep.27999.
How to Cite
Copyright (c) 2020 O.S. Khukhlina, O.Ye. Hrinyuk, A.A. Antoniv, O.V. Kaushanska
This work is licensed under a Creative Commons Attribution 4.0 International License.