REDOX-HOMEOSTASIS FEATURES IN PATIENTS WITH LIVER CIRRHOSIS DEPENDING ON SEVERITY OF THE INTERNAL ORGANS SYNTROPIC COMORBID LESIONS

Abstract

Relevance and purpose. Oxidative stress, as an imbalance in the anti-/prooxidants system, is a direct cause or one of the most important pathogenetic links of many diseases. Liver cirrhosis is not an exception. With its decompensation the syntropic comorbid lesions that worsen prognosis and often cause the death of patients of working age occur. However, despite the prevalence of studying the pathogenetic mechanisms of liver cirrhosis, the relationship between the content of pro- and antioxidants in the blood and the presence of comorbidities in different C. H. Child – R. N. Pugh classes is still insufficiently studied. Therefore, the aim of the study is to identify the redox homeostasis features in patients with liver cirrhosis depending on the internal organs syntropic comorbid lesions severity. Materials and methods. The study was conducted in two stages. 75 patients (23 females (30.7%), 52 males (68.3%) (mean age – 47.2 ± 10.4 years) were included in the randomized trial with the preliminary stratification by the presence of liver cirrhosis. All of them were hospitalized and treated at the Department of Internal Medicine 1 at Danylo Halytsky Lviv National Medical University and the Gastroenterology Department of Lviv Regional Clinical Hospital – Lviv Regional Hepatology Center. All patients underwent the complex comprehensive clinical laboratory and instrumental examination of all organs and systems in accordance with the requirements of the modern medicine. To study the redox homeostasis state the contents of catalase and thiobarbituric acid products, in particular malondialdehyde, were determined. At the first stage, we determined the levels of malondialdehyde and catalase in the cirrhotic patients and syntropic comorbid lesions of the internal organs. According to the second stage we studied the dependence between the characteristic parameters of redox homeostasis changes and the severity of syntropic comorbidities in the cirrhotic patients using the correlation analysis. The actual material was handled on a personal computer in Excel 2010, Statistica 6.0, RStudio v. 1.1.442 and R Commander v.2.4-4 using descriptive statistics. The results obtained in the case of normal distribution were presented as M ± σ, where n is the number of patients examined in the group, in case of abnormal distribution – Me [25,0%; 75.0%]. The difference was considered statistically significant if p < 0.05. Results. In accordance with the first stage of the study, it was found that the malondialdehyde content was highest in patients with liver cirrhosis and varicose veins of the esophagus (VVE) of 3 degree, cirrhotic gastropathy (CGP) of 3 degree, varicose hemorrhoid veins (VHV) of 2 degree, cirrhotic cardiomyopathy of 3 degree, arterial hypotension of 2 degree, hepatopulmonary syndrome of 3 degree, hepatic encephalopathy (HE) of 3 degree, osteoporosis of 3 degree, anemia of 3 degree. The content of catalase was the lowest in patients with liver cirrhosis and with 3 degree VVE, 3 degree CGP, 3 degree VHV, 3 degree arterial hypotension, 3 degree hepatopulmonary syndrome, 3 degree HE, 2 degree osteoporosis, 2 degree anemia. In accordance with the second stage of the study it was revealed that the severity of VVE, CGP, VHV, cirrhotic cardiomyopathy, hepatopulmonary syndrome of hepatic encephalopathy, osteoporosis significantly increases with malondialdehyde content increasing. In its turn the content of catalase decreases with the VVE, CGP, VHV, cirrhotic cardiomyopathy, arterial hypotension, hepatopulmonary syndrome, osteoporosis severity increase. Conclusions. Patients with liver cirrhosis have some features of redox homeostasis disorders with increasing of malondialdehyde and decreased of catalase content, depending on the severity of the synthropic comorbid lesions of the internal organs, the correlation of which is most pronounced in the presence of hepatopulmonary syndrome, osteoporosis and cirrhotic cardiomyopathy.