ФАРМАКОЭПИДЕМИОЛОГИЧЕСКОЕ ИЗУЧЕНИЕ ЭФФЕКТИВНОСТИ КОРРЕКЦИИ ГИПЕРГЛИКЕМИИ БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ 2 ТИПА С ПОРАЖЕНИЯМИ ПЕЧЕНИ САХАРОСНИЖАЮЩЕЙ ТЕРАПИЕЙ И ЛЕКАРСТВЕННЫМИ ПРЕПАРАТАМИ ЭССЕНЦИАЛЬНЫХ ФОСФОЛИПИДОВ

Abstract

The aim of the study is to study the possibility of improving the effectiveness of hyperglycemia treatment among patients with type 2 diabetes mellitus by correcting the structural-functional state of the liver using essential phospholipid preparations. Materials and methods. The cohort retrospective study examined the medical histories of 1050 patients with type 2 diabetes mellitus, among whom 205 had liver complications. Diagnosis of steatohepatitis among patients with type 2 diabetes mellitus was verified based on increased activity of hepatic transaminases and serum bilirubin concentration. Metabolic syndrome was verified according to 3 criteria: abdominal obesity, dyslipidemia and arterial hypertension. Fatty hepatosis was diagnosed based on an ultrasound study. Three times during the course of treatment of the patients the glycemic profile was studied. Patients were divided into study groups: type 2 diabetes mellitus without liver diseases (control); type 2 diabetes mellitus with liver disease (chronic persistent hepatitis, chronic steatohepatitis) received standard diabetes reduction therapy; type 2 diabetes mellitus with the same liver pathology, which was additionally prescribed essential phospholipid drugs (essentiale forte intravenously 10 ml/day and per os at 500 mg; essliver - per os 500 mg (1 cap) 3 times/day). Statistical methods : calculating the value of the average, the error of the average, the reliability of the differences according to the Student criterion, the percentage of differences between groups. Pharmacoepidemiological methods evaluated the hazard ratio and the odds ratio of the therapeutic effect of essential phospholipids. Results . Patients with liver lesions make up 19.5 % among patients with type 2 diabetes mellitus. Among them, patients with fatty hepatosis account for 3.3 %; with steatohepatitis - 3 %; with metabolic syndrome in combination with fatty hepatosis and steatohepatitis - 14.3 %. More than a 4-fold increase in relative chance and a 2-fold increase in relative risk of hypoglycemic effect in type 2 diabetes mellitus and hepatic steatosis is likely due to the fat-lysis and membranotropic effects of essential phospholipids on the liver. 1.7-fold increase in relative chance and 1.5-fold increase in relative risk of hypoglycemic effect in type 2 diabetes mellitus and steatohepatitis appears to be due to choleretic effect of essential phospholipids.