Ефективність адеметіоніну при лікуванні пацієнтів з неалкогольною жировою хворобою печінки

Abstract

Nonalcoholic fatty liver disease is the most common liver disease in the world, showing a variety of histopathological findings ranging from simple steatosis to nonalcoholic steatohepatitis and cirrhosis. Patients with nonalcoholic fatty liver disease have the potential to develop fibrosis and cirrhosis leading to portal hypertension, liver decompensation, and even hepatocellular carcinoma. Nonalcoholic fatty liver disease can be differentiated from simple steatosis by liver biopsy and is diagnosed when all of the following three criteria are met: macrovesicular fatty change of hepatocytes, inflammatory cell infiltration, and ballooning degeneration of hepatocytes. Lipid accumulation in hepatocytes can lead to inflammation within them. Accordingly, significant fibrosis can cause cirrhosis over a period of 10-20 years, but the pathophysiology is not well understood yet. However, liver biopsy is invasive, has drawbacks such as sampling error and cost, and it is not applicable for all patients. Also, there was a greater interest in science and practical medicine in the use of non-invasive methods for diagnosing the stages of nonalcoholic fatty liver disease. Primed on clinical and scientific data, non-invasive markers of liver fibrosis have to be highly sensitive and specific in identifying the early stages of liver fibrosis. The purpose of the work was to determine the effect of S-adenosylmethionine (ademetionine) on the stage of liver fibrosis, the level of pentraxin-3, C-reactive protein and metabolic parameters in patients with comorbide course of non-alcoholic fatty liver disease and arterial hypertension. Results and discussion. On the 61st day from the start of ademetionine use, there was a tendency to a decrease in the number of patients with comorbid course of non-alcoholic fatty liver disease and arterial hypertension in the stage of liver fibrosis F1 and F2 and an increase in the F0 stage. In addition, a significant decrease in the indicators of systemic inflammation (pentraxin-3, C-reactive protein) was achieved (p <0.05). The patients with comorbid course of non-alcoholic fatty liver disease and arterial hypertension also had a statistically significant (p <0.05) positive dynamics of hepatocyte cytolysis indicators was achieved in comparison with those before treatment and with the control group (p <0.05), as well as the lipid profile (p <0.05). Conclusion. The study showed that using ademetionine in patients with comorbid course of non-alcoholic fatty liver disease and arterial hypertension promoted regression of the stage of liver fibrosis, a significant decrease in the level of pentraxin-3, C-reactive protein, and an improvement in metabolic parameters. Appointment of ademetionine is an expedient method of treating patients with comorbid course of non-alcoholic fatty liver disease and arterial hypertension as a pathogenetic medicine with a pronounced antifibrotic, anti-inflammatory and cytoprotective effect