Treatment optimization of non-alcoholic steatohepatitis in obesity patients with comorbidity with chronic obstructive pulmonary disease:correction of dyslipidemia and insulin resistance

Abstract

Objective — to assess the effectiveness of treatment with Antral and its combination with Phytostatin as regards its effects on the state of blood lipid spectrum, glycemia, the degree of insulin resistance in patients with non‑alcoholic steatohepatitis (NASH) against the background of obesity with comorbidity with chronic obstructive pulmonary disease (COPD).Materials and methods. The investigation involved 90 NASH patients with obesity of I degree and COPD 2 — 3 D, from them 25 patients (group 1 — control group) received basic NASH therapy for 60 days (Essential phospholipids in a dose of 300 mg, 2 cuspules three times a day) and COPD therapy (budesonide 160 mg + formoterol fumarate 4.5 mg) inhaled 2 times per day for 60 days, ipratropium/fenoterol (250/500 mg/ml) nebulizer inhalation 2 times per day, azithromycin 500 mg, 1 time per day for 10 days). The second group (35 subjects) in addition to the same basic COPD therapy, received Antral (Farmak, Ukraine) 200 mg, 3 times per day for 60 days as a hepatoprotector. The third group (30 patients), except for the same basic COPD treatment, received Antral (Farmak, Ukraine) 200 mg, 3 times per day as a hepatoprotector, and Phytostatin (polyconazole) 20 mg after dinner for 60 days. The average age of patients was (55.7 ± 3.22) years. The control group consisted of 30 apparently healthy persons (AHP).Results. After the treatment, the total lipids level in blood of patients from the 1st group has not decreased significantly and exceeded the normative data (p < 0.05), while in patients of the 2nd and 3rd groups it has decreased by 15.6 % and 23.3 %, respectively (p < 0.05). The total cholesterol level indicated a significant decrease in all groups by 9.2 %, 19.3 % and 23.9 % (p < 0.05) in comparison with the pre‑treatment data, still exceeding the AHP (p < 0.05). The increased pre‑treatment triacylglycerol’s blood level significantly reduced only in patients of the 2nd and 3rd groups by 22.2 % and 31.5 %, respectively (p < 0.05), but did not reach normative data. At the same time, in patients of the 1st group, changes in treatment dynamics were not significant (p < 0.05). Analysis of postprandial glycemia in patients of the 1st, 2nd and 3rd groups showed a decrease in glucose levels by 10.6 %, 21.3 % and 21.9 %, respectively (p < 0.05) compared to the pre‑treatment parameters (p < 0.05) with the normalization of the indicator. The fasting HOMA IR index was reduced (respectively by 11.1 %, 46.2 %, and 46.8 % (p < 0.05)).Conclusions. The effects of Antral and Phytostatin (polyconazole) have been established as regards the correction of lipid distress syndrome with a significant decrease of the levels of total cholesterol, triacylglycerols, low‑density lipoprotein cholesterol (p < 0.05), which was accompanied by a significant decrease of liver steatosis degree. In the dynamics of treatment with Antral and Phytostatin for 60 days, NASH patients with concomitant COPD and obesity demonstrated significant decrease of blood insulin levels, that were raised at baseline, as well as normalization of the postprandial blood glucose levels and reduction of insulin resistance (р < 0.05).