COMPLEX APPROACH TO TREATMENT OF PATIENTS WITH NON-ALCOHOLIC STEATOGEPATITIS COMBINED WITH DIABETES MELLITUS TYPE 2
About the author:
Pavlovskyі S. A.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Non-alcoholic fatty liver disease (NAFLD) is becoming more and more an important cause of chronic liver disease. In generalizing numerous studies, data were found to confirm the association of NAFLD with type 2 diabetes or metabolic syndrome. Progression from fatty steatohepatosis to NASH occurs in 5-20% of patients with the possibility of developing liver fibrosis / liver cirrhosis. Patients with NASH and fibrosis patients should be identified as they risk mortality. Specific treatment of NASH is currently unavailable. Of importance is the definition of prognosis and optimal treatment of patients with NADH and directed monitoring of the development of hepatocellular carcinoma. Researchers offer complex therapy taking into account the main pathogenetic factors of NASH, which is increasingly combined with type 2 diabetes. The goal is to optimize the treatment of patients with non-alcoholic fatty liver disease combined with type 2 diabetes. The study was conducted on 30 patients with NAFLD – at the stage of NASH. Control group – 20 healthy individuals. In order to identify the diagnosis of NAFLD, the data of clinical, laboratory, biochemical and instrumental studies were taken into account in full compliance with the standards of examination of patients with pathology of the organs of the gastrointestinal tract. The statistical processing of the obtained results was carried out using statistical statistic data package STATISTICA on Pentium-IV personal computer and application of parametric and non-parametric methods for estimating the obtained results. The ultrasound investigation revealed signs of fatty liver dystrophy – steatohepatosis (distal constriction of the signal, diffuse hyperhogenicity of the liver tissue, in comparison with the kidneys, and uncertainty of the contour of the vascular picture). In the refinement of the ultrasonographic picture of the liver, in the set of signs (slight increase in echogenicity, visualization of the wall of the mediums and large caliber veins) in 5 patients (16.7% of cases), I was diagnosed as stage fatty liver disease. Moderate elevation of echogenicity of the liver, visualization of only partial and segmental veins, corresponding to the II stage of hepatatosis, was detected in 15 patients (50.0%) cases. In the 10 patients (33.3%), III stage of fatty hepatosis was visualized. The reliability of the difference in values between independent quantitative values was determined with a normal distribution according to Student’s criterion, and in other cases, using the Mann-Whitney U-criterion. With the use of combined treatment with combined hypoglycaemic (diabetic and pioglitazone) and lipotropic (heptral) therapy, the results of treatment showed a significant improvement in the subjective and objective state of patients. Pain syndrome remained tangible (1.8 times fewer patients than prior to treatment); dyspeptic syndrome – decreased by 1,7 times, appetite decreased – (a decrease of 1,9 times), astenovegetative syndrome – (a decrease of 1,9 times). The applied combined hypoglycemic and lipotropic therapy on the background of basic therapy positively influenced the state of hepatocytes: the activity of ALT decreased to (0.61±0.03) μmol/l, AST (0.52±0.04) μmol/L, alkaline phosphatase – (78.18±2.21) units/l, gammaglutamyltranspeptidase – up to (52.34±1.26). In all patients, cytolysis, mesenchymal-inflammatory syndrome significantly decreased, hemogram rates improved, and lipid and metabolic parameters were stabilized.
non-alcoholic fatty liver disease, diabetes mellitus type 2, complex combined treatment
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 (144), 2018 year, 217-221 pages, index UDK 616.36-003.826