Журнал "Гастроэнтерология" Том 54, №4, 2020
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The features of biochemical markers of liver fibrosis with non-alcoholic steatohepatitis in patients with I–II degree obesity and chronic kidney disease І–ІІІ stage
Авторы: A.A. Antoniv, O.S. Khukhlina
Bukovinian State Medical University, Chernivtsi, Ukraine
Рубрики: Гастроэнтерология
Разделы: Медицинские форумы
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The purpose of the research — to find out the features of biochemical markers of liver fibrosis with non-alcoholic steatohepatitis in patients with I–II degree obesity and chronic kidney disease І–ІІІ stage, to establish the effectiveness of Heparhizine influence on the state of carbohydrate-protein components of the connective tissue of the extracellular matrix of the liver and kidneys.
Material and methods. 98 patients with non-alcoholic steatohepatitis on the background of I–II degree obesity were examined: 52 patients with non-alcoholic steatohepatitis (1st group) (without accompanying chronic kidney disease), 46 patients with non-alcoholic steatohepatitis with a comorbid chronic kidney disease I–III stage (2nd group). The control group consisted of 20 practically healthy persons (PHPs) with the corresponding age and sex. Biopsy of the liver was performed on 32 patients with non-alcoholic steatohepatitis with the accompanying of chronic kidney disease I–III stage, 28 patients with non-alcoholic steatohepatitis without chronic kidney disease. Patients on both groups of non-alcoholic steatohepatitis received Heparhizine treatment (glycyrrhizin 40 mg, glycine 400 mg, L-cysteine hydrochloride 20 mg) (Valartin Pharma) by intravenous administration of 20 ml of the drug for 10 days followed by enteral administration of 2 tablets of Heparhizine (1 tablet: glycyrrhizin 25 mg, glycine — 25 mg, methionine — 25 mg) 3 times a day for 80 days. Patients with non-alcoholic steatohepatitis with a comorbid flow of non-alcoholic steatohepatitis, obesity and chronic kidney disease of the І–ІІІ stage, except heparisin, they received baseline therapy of chronic kidney disease І–ІІІ stage: chronic pyelonephritis (course of antibacterial drugs, uroseptics, cainfron). The examinations were carried out prior to treatment and on the 90th day of treatment.
Results. The study showed that in the case of non-alcoholic steatohepatitis that develops on the background of obesity and chronic kidney disease on the І–ІІІ stage, the presence of fibrotic changes in the liver tissue was established, which according to the biochemical index of fibrosis, exceeds those in patients with non-alcoholic steatohepatitis without comorbidity with kidney pathology. in patients with non-alcoholic steatohepatitis, which was accompanied by obesity, a significant increase in the synthesis of collagen and glycosaminoglycans which was accompanied with an ineffective resorption of newly formed collagen due to inhibition of the collagenolytic activity of blood plasma, due to significant activation of proteinase inhibitors (α2-MG) was observed with a significant imbalance in the system of connective tissue metabolism.
Conclusions. Under the conditions of the comorbidity of non-alcoholic steatohepatitis with chronic kidney disease I–III stage, collagen synthesis and resorption are activated, but the anabolism processes predominate, in spite of the compensatory activation of collagenolysis, a substantial hyperproduction of actinic-phase proteins, fibronectin, glycosaminoglycans, fibroblast growth factor and lead to progressive fibrosis of the liver and disturbance of its functions.