Evaluation of the effectiveness of long-term complex treatment schemes for patients with non-alcoholic fatty liver disease in combination with renal parenchymal arterial hypertension

Abstract

Objective — to evaluate the effectiveness and safety of the use of original schemes of complex treatment of patients with non‑alcoholic fatty liver disease (NAFLD) and renal parenchymal arterial hypertension (RPAH).
 Materials and methods. Investigation involved 45 patients with NAFLD and RPAH grade 2. The state of the liver was assessed with ultrasound examination. Liver steatosis, inflammation and fibrosis were evaluated with the use of FibroMax test (France). Blood biochemistry was analyzed with the standard generally accepted methods: lipids, aminotransferases, gamma‑glutamyl transpeptidase (GGTP), glucose, glycosylated hemoglobin, insulin, HOMA index, glomerular filtration rate (GFR) were determined according to the CKD‑EPI formula. Blood Levels of cytokeratin‑18, adiponectin, fetuin A, tumor necrosis factor‑α, and interleukin‑6 were determined by ELISA. The indicators of malondialdehyde and diene conjugates and superoxide dismutase were determined by spectrophotometry. Patients were divided into two groups. Group A patients (n=23) received losartan 25—50 mg/day in combination with indapamide 1.5—2.5 mg and atorvastatin 10—20 mg/day for 12 months. Group B patients (n=22) received extended complex treatment (ECT) losartan 25—50 mg/day in combination with indapamide 1.5—2.5 mg and atorvastatin 10—20 mg/day in combination with complex ω‑3 polyunsaturated fatty acids in a dose of 2 g/day and ursodeoxycholic acid (UDCA) in a dose of 10 mg/kg/day for 12 months.
 Results. Both regimens of 12‑month complex treatment of patients with NAFLD and RPAH effectively improved parameters of blood pressure, carbohydrate, lipid metabolism, renal function, inflammation and oxidative stress indicators. There was no significant difference in the effects on anthropometric indicators and systolic BP (p>0.05). Meanwhile, there was a significant difference in favor of ECT according to the diastolic BP — the difference in the shift of the indicator was 2.213 mm Hg (p<0.01). Almost all laboratory «liver» indicators, except for ALT, decreased to a greater extent in patients receiving the ECT regimen. Thus, according to the GGTP the shift difference was 13.970 U/L (p<0.001), and according to the cytokeratin‑18 the shift difference was 58.126 U/L (p<0.001). There was also a significantly greater effect of ECT on fibrosis, steatosis and inflammation of the liver according to FibroMax data. Thus, the difference between shifts was 0.08 (p<0.01), 0.12 (p<0.001) and 0.10 (p<0.01), respectively. The results of the comparative assessment of lipid and carbohydrate metabolism indicators were heterogeneous. Thus, the shift in total cholesterol was significantly greater in the ECT group and was 0.621 mmol/L (p<0.01). At the same time, the shift of the triglycerides was greater (–0.94±0.92 mmol/L) in this group, but had no significant difference with the shift of the group A –0.63±0.42 (p>0.05). There was also a significant difference between shifts in glycosylated hemoglobin in favor of the ECT scheme, the difference was 0.197% (p<0.05). According to other indicators of lipid and carbohydrate metabolism, there was a tendency towards the predominance of the ECT scheme, but no significant difference in shifts was found (p>0.05). The difference in blood creatinine and GFR shifts was significant and was 6.806 mol/L and 6.156 ml/min/1.73 m2, respectively (p<0.001). At the same time, the dynamics of the microalbuminuria in the two comparison groups were similar (p>0.05).
 Conclusions. The treatment scheme of a 12‑month complex treatment with the addition of ω‑3 polyunsaturated fatty acids 2 g/day and UDCA 10 mg/kg/day is more effective in terms of impact on clinical and laboratory indicators.