THE CLINICAL AND BIOCHEMICAL FEATURES OF LIVER‎’‎ FUNCTIONAL STATE IN PATIENTS WITH ISCHEMIC HEART DISEASE IN COMBINATION WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Kazakov Yu. M., Manusha Yu. I., Trybrat T. A., Chekalina N. I., Shut’ S. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

According to WHO, ischemic heart disease (IHD) ranks first among the causes of worldwide mortality. The recent scientific research confirm that the chronic systemic inflammations (CSI) low-intensity have an leading place in occurrence and progression of atherosclerosis, pathogenic basic of it is endothelial disfunction (ED) and dyslipidemia. The hepatocytes is involved in support of lipidic homeostasis. The functional disorders influence on potentiation of dyslipidemia (PD) and respectively development and progressing of IHD. According to modern representations of non-alcoholic fatty liver disease (NAFLD) is considered as a risk factor for cardiovascular disease. The question about formatting of fatty liver infiltration is also quite relevant. NAFLD is a stadium process that provides voluntary livers fatty infiltration with the further progression of diseases like as steatohepatitis, hepatocellular carcinoma or cirrhosis of liver. The increase of prevalence of this comorbidity disease is required a further deep research of features of the functional livers state with the goal of looks for new more effective methods of diagnostic and treatment of IHD in combination with NAFLD. The research have 135 involved patients with IHD: stable angina, І-ІІ of functional class, 0-І of heart failure in combination with NAFLD and 30 healthy persons. At the moment of primary clinical examination of patients with IHD in combination with NAFLD is revealed that patients periodically feel abdominal pain and dyspeptic syndrome with moderate and mild intensity of pain. The feeling of moderate periodical pain and/or feeling of discomfort of right subcostal region is noted by 98 (89%) patients. The dyspeptic syndrome in the form of belching air, feeling of bitterness in the mouth, nausea, bloating is observed in 75 (68%) patients. In 5 (20%) patients with IHD is effected of periodical discomfort in epigastric region of the abdomen, 7 (5,5%) patients have belching, nausea, bloating that connected with chronic comorbid disease of upper gastrointestinal tract. An objective examination showed an increase in liver size in 68 (61.8%) patients with comorbid pathology. The presence of pain during palpation in the area of the right hypochondrium is observed in 35 (31.8%) patients, bloating in the course of the colon in 31 (28%) patients. The increasing livers size isn’t observed in patients with IHD. Slight paint full sensations is observed at the moment of palpation in the area of the right subcostal region by 6 (24%) patients, that can be explained by the presence of other concomitant diseases of the gastrointestinal tract. According to ultrasound liver diagnostics in patients with IHD in combination with NAFLD ultrasound signs of hepatosis are revealed in 110 (100%): increased echostructure, increased echogenic and decreased sound conductivity of the liver, increased liver size (hepatomegaly) is revealed in 68 (61.8%) patients, diagnosed with chronic cholecystitis (sealing the wall of the gallbladder) in 42 (38.2%) and previously performed cholecystectomy in 13 (11.8%). The increasing livers size and echogenicity aren’t observed in patients with IHD. The pulse Doppler of the liver vessels are used with the purpose of estimating livers blood flow. Increasing of blood flow velocity in the portal and hepatic veins in patients with IHD in combination with NAFLD can be a result of possible compaction of the parenchyma of the liver against the background of impaired functional status and the response of vessels to chronic low-intensity vascular inflammation.

functional state of the liver, ischemic heart disease, non-alcoholic fatty liver disease, comorbidity, chronic low-intensity vascular inflammation.

1. Handzyuk VA. Analiz zakhvoryuvanosti na ishemichnu khvorobu sertsya v Ukrayini. Ukrayinsʹkyy kardiolohichnyy zhurnal. 2014;3:45-52. [in Ukrainian].
2. Amosova KM, Stremenyuk OT, Andryeyev YeV. Rolʹ endotelialʹnoyi dysfunktsiyi ta systemnoho imunnoho zapalennya u vynyknenni ishemiyi miokarda pry fizychnomu navantazhenni u khvorykh z hemodynamichno neznachushchym aterosklerozom vintsevykh arteriy sertsya. Ukrayinsʹkyy kardiolohichnyy zhurnal. 2011;4:14-9. [in Ukrainian].
3. Manusha YuI, Kazakov YuM, Trybrat ТА, Ischeykin KE. Peculiarities of system inflammation of low intensity in patients with stable ischemic heart disease in combination with non-alcoholic fatty liver disease. The Medical and ecological problems. 2019;23(3-4):3-6.
4. Chekalina NI. Vzayemozvʺyazky pokaznykiv systemnoho zapalennya, lipidnoho spektru krovi ta strukturno-funktsionalʹnoho stanu sertsya pry stabilʹniy ishemichniy khvorobi sertsya. Visnyk problem biolohiyi i medytsyny. 2017;3.1(137):251-7. [in Ukrainian].
5. Babushkyna YV, Serheeva AS, Pyvovarov YuY, Kurylʹskaya TE, Koryakyna LB. Strukturnye y funktsyonalʹnye osobennosty sosudystoho éndotelyya. Kardyolohyya. 2015;2:82-6. [in Russian].
6. Kolesnykova EV, Kurynnaya EH. Vlyyanye steatoza pecheny na vyrazhennostʹ dyslypydemyy. Ukrayinsʹkyy terapevtychnyy zhurnal. 2012;1:14- 20. [in Russian].
7. Yahmur VB. Nealkoholʹna zhyrova khvoroba pechinky: pohlyad na patohenez, diahnostyku ta likuvannya. Hastroenterolohiya. 2013;3(49):138- 47. [in Ukrainian].
8. Bashta HV, Tkachuk SO, Lapovetsʹ LYe. Osoblyvosti lipidnoho obminu u khvorykh na ishemichnu khvorobu sertsya i suputnʹoyu nealkoholʹnoyu zhyrovoyu khvoroboyu pechinky. Visnyk problem biolohiyi i medytsyny. 2013;4(2):70-3. [in Ukrainian].
9. Virstyuk NH, Vakalyuk II. Otsinka prohresuvannya fibrozu pechinky u khvorykh na stabilʹnu ishemichnu khvorobu sertsya na tli nealkoholʹnoyi zhyrovoyi khvoroby pechinky. Suchasna hastroenterolohiya. 2017;1(93):38-42. [in Ukrainian].
10. Loboda OM, Krasyuk IV, Alyeksyeyeva VV. Vzayemozv’yazok protsesiv perekysnoho okyslennya lipidiv ta khronichnoho zapalennya z aterosklerotychnymy zminamy sudyn ta pokaznykamy endotelialʹnoyi dysfunktsiyi u khvorykh na KhKhN II-IV stadiy. Ukrayinsʹkyy zhurnal nefrolohiyi ta dializu. 2015;1:13-20. [in Ukrainian].
11. Kolesnykova EV. Sovremennyy patsyent s zabolevanyem pecheny y patolohyey serdechno-sosudystoy systemy: kakoy vybor sdelatʹ? Suchasna hastroenterolohiya. 2014;2(76):85-94. [in Russian].
12. Fadeenko HD, Solomentseva TA, Dovhanyuk YÉ, Sytnyk KA. Rannye pryznaky ateroskleroza u bolʹnykh s nealkoholʹnoy zhyrovoy boleznʹyu pecheny. Suchasna hastroenterolohiya. 2014;4(78):32-6. [in Russian].
13. Fadyeyenko HD, Chernyshov VA. Komorbidna patolohiya, shcho vplyvaye na sertsevo-sudynnyy ryzyk u postinfarktnykh khvorykh. Ukrayinsʹkyy terapevtychnyy zhurnal. 2014;2:10-20. [in Ukrainian].
14. Cardiovascular risk across the histological spectrum and the clinical manifestations of non-alcoholic fatty liver disease: An update. World J Gastroenterol. 2015;21:6820-34.
15. Bueverov AO. Mnoholykyy steatohepatyt. Klynycheskye perspektyvy hastroénterolohyy, hepatolohyy. 2012;3:3-9. [in Russian].
16. Skybchyk VA, Voytovych MO. Nealkoholʹna zhyrova khvoroba pechinky: suchasna diahnostyka. Hepatolohiya. 2015;1:52-6. [in Ukrainian].
17. Unifikovanyy klinichnyy protokol «Stabilʹna ishemichna khvoroba sertsya». Nakaz MOZ Ukrayiny № 152 vid 02.03.2016 r. [in Ukrainian].
18. Unifikovanyy klinichnyy protokol «Nealkoholʹnyy steatohepatyt». Nakaz MOZ Ukrayiny № 826 vid 06.11.2014 r. [in Ukrainian].
19. Tangney C, Rasmussen HE. Polyphenols, inflammation, andcardiovascular disease. Curr. Atheroscler. Rep. 2013;15(5):324.

«Bulletin of problems biology and medicine» Issue 3 (152), 2019 year, 118-121 pages, index UDK 616.36 – 003.826 – 06:616.127 – 005.4] – 092

10.29254/2077-4214-2019-3-152-118-121