Effectiveness of oxidative stress correction at non-alcoholic steatohepatitis and diabetic kidney disease in patients with type 2 diabetes mellitus

Abstract

Objective — to study the state of oxidative‑antioxidant homeostasis, intensity of hepatocytes’ apoptosis based on the blood levels of cytokeratin‑18 in patients with non‑alcoholic steatohepatitis (NASH) and type 2 diabetes mellitus (DM 2) depending on the stage of diabetic kidney disease, and to investigate effects of the medications’ complex on the above factors.
 Materials and methods. The investigation was performed in the dynamics of treatment of 75 NASH patients with DM 2 and DKD of stage I — III. Depending on the treatment type, patients were divided into two groups. The control group (37 patients) was administered a hypocaloric diet with account of dietary restrictions #9, received essential phospholipids (Essentiale forte H) 300 mg 2 caps. 3 times a day) during 30 days for the NASH treatment, and antidiabetic and lipid‑lowering therapy with metformin hydrochloride (Metformin ‑Teva) 1000 mg per day, rosuvastatin (5 mg 1 time per day) for 1 month. The main group consisted of 38 patients and in addition to the similar 30 days of dietary recommendations, essential phospholipids, hypoglycemic and hypolipidemic therapy, received quercetin and povidone (Corvitin) 500 mg intravenously in 100 ml of isotonic sodium 10 mg for 10 days. The mean age of patients was (54.7 ± 3.56) years. Both groups were randomized by age, gender ratio and disease duration.
 Results. Before the treatment, the significant degree of oxidative stress was established, which was accompanied by accumulation in the blood of intermediate and final products of lipid peroxidation and oxidative modification of proteins. Blood plasma levels of malonic aldehyde exceeded the reference values in 2.1 times (p < 0.05). The state of the antioxidant defense system was significantly disbalanced. The blood levels of reduced glutathione were in 1.7 times lower than in healthy individuals (p < 0.05), glutathione peroxidase activity was inhibited in 1.3 times (p < 0.05), which explains the high intensity of oxidative stress in the examined patients.
 Conclusions. In patients with type 2 diabetes mellitus, accompanied by diabetic kidney disease with comorbid non‑alcoholic steatohepatitis, the significant increase in the oxidative stress intensity was observed, together with 1 to 3‑fold raise (p < 0.05) in the blood levels of intermediate and final products of lipid peroxidation and oxidative proteins’ modification.