PATHOGENETIC SUBSTANTIATION OF L-ARGININE APPLICATION AT COMBINED CLINICAL COURSE OF NON-ALCOHOLIC STEATOHEPATITIS AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE TAKING INTO ACCOUNT POLYMORPHOUS VARIANT G894T OF THE GENE OF ENDOTHELIAL NO-SYNTHASE

Abstract

Objective. The aim of the study was to investigate the functional state of the endothelium and liver, carbohydrate metabolism and lipid spectrum of blood, depending on the polymorphism of the eNOS gene (G894T / G1917T) in patients with non-alcoholic steatohepatitis combined with chronic obstructive pulmonary disease, in the dynamics of complex treatment with baseline L -arginine.Material and methods. The efficacy of administering L-arginine to 60 patients with non-alcoholic steatohepatitis in combination with chronic obstructive pulmonary disease, taking into account the polymorphism of the eNOS gene (G894T/G1917T), was studied by examining the content of endothelin-1, the number of circulating desquamated endotheliocytes, sVCAM-1, stable metabolites of nitric oxide, total cholesterol, triglycerols, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and high-density lipoprotein cholesterol, the presence of glucose and glycosylated hemoglobin in the blood on an empty stomach.Results. The use of L-arginine hydrochloride (intravenously) followed by administration of L-arginine aspartate (per os) against a background of baseline therapy of non-alcoholic steatohepatitis in patients suffering from chronic obstructive pulmonary disease with GG genotype and with GT + TT genotype (with dose adjustment and treatment duration) contributes to a significant decrease of endothelin-1 the level, sVCAM and the number of circulating desquamated endotheliocytes, while the level of nitrates / nitrites in the blood serum increases. At the same time there is a positive dynamics of glucose, glycosylated hemoglobin, total bilirubin, aminotransferase activity, γ-glutamyltranspeptidase, triglycerol, low and high density lipoprotein cholesterol in blood serum.Conclusions. The use of L-arginine in the complex treatment of patients with non-alcoholic steatohepatitis combined with chronic obstructive pulmonary disease leads to a more pronounced improvement in the functional state of the liver and endothelium, carbohydrate metabolism and lipid profile in the group of patients with GG genotype and in the group of patients with GT + TT genotype, which was used to adjust the dose and duration of treatment compared to the group of patients with GT + TT genotype, who did not undergo treatment correction and to whon L-arginine was not prescribed.