Резюме
Іванова Л.М., Налапко К.К., Сидоренко Ю.В., Холіна О.А. Ефективність секвестрантів жовчної кислоти у хворих на неалкогольний стеатогепатит у сполученні з хронічним бронхітом та ожирінням.
Застосування препарату гуарем в комплексній терапії хворих на неалкогольний стеатогепатит у сполученні з хронічним бронхітом та ожирінням сприяє нормалізації ліпідного обміну.
Ключові слова: неалкогольний стеатогепатит, хронічний бронхіт, ожиріння, гуарем

Резюме
Иванова Л.Н., Налапко К.К., Сидоренко Ю.В., Холина Е.А. Эффективность секвестрантов желчной кислоты у больных неалкогольным стеатогепатитом в сочетании с хроническим бронхитом и ожирением.
Применение препарата гарем в комплексной терапии больных больных неалкогольным стеатогепатитом в сочетании с хроническим бронхитом и ожирением способствует нормализации липидного обмена.
Ключевые слова: неалкогольный стеатогепатит, хронический бронхит, ожирение, гуарем.

Summary
Ivanova L.N., Nalapko K.K., Sidorenko Yu.V., O.A.Cholina. Bile acid sequestrants efficacy in patients with nonalcoholic steatohepatitis in combination with chronic bronchitis and obesity.
Using of drug guarem in complex therapy of patients with nonalcoholic steatohepatitis in combination with chronic bronchitis and obesity contributes to the normalization of lipid metabolism.
Key words: nonalcoholic steatohepatitis, chronic bronchitis, obesity, Guarem.

Рецензент: д.мед.н., проф. Ю.Г. Бурмак

УДК 616.36 – 002 – 003.826 + 616.233 – 002 – 036.12

ДЗ «Луганський державний медичний університет»

ГЗ «Луганский государственный медицинский университет»

State Establishment "Lugansk State Medical University"

propedevtika2011@yandex.ua, ksenia-777@ukr.net, siderman@ukr.net, e-holina@mail.ru

Introduction

One of the factors of atherosclerotic vascular lesions is a disorder of cholesterol metabolism at chronic liver disease [1, 3]. Changes in receptor relationship between lipoproteins andf hepatocytes, inhibition of lipolysis leads to hyperlipidemia [9]. In chronic liver diseases, free cholesterol accumulates in the blood due to its etherification in the bloodstream [6, 8, 9, 11]. Lipid spectrum with increased cholesterol, low-density lipoprotein cholesterol ( LDL-C ), an excess of which render the damaging effect on the vascular endothelium through interaction with lipoprotein receptor apparatus of endothelial cells through inhibition of constitutive endothelial NO- synthase, activation of free radical oxidation inherent in patients with disorders of the hepatobiliary system [2, 4, 5, 7, 10, 12].

Objective: To investigate the efficiency of bile acid sequestrants in patients with nonalcoholic steatohepatitis in conjunction with chronic bronchitis and obesity.

Materials and methods

The study involved 52 patients with nonalcoholic steatohepatitis (NASH ) in combination with chronic bronchitis ( CB) and obesity (women - 62 % male - 38%), aged 23 to 75 years.

Verification of NASH was performed based on anamnesis, clinical, laboratory ( biochemical ) and sonographic examinations of the abdomen under the requirements of the Order of Ministry of Health of Ukraine from 13.06.2005, №271 "On approval of the protocols of care in the specialty" Gastroenterology ".

We studied the lipid profile, blood, namely, total cholesterol ( ZHS ), low density lipoprotein ( LDL ), very low density lipoproteins ( VLDL cholesterol ), high density lipoproteins ( HDL cholesterol ), triglycerides (TG ) Verification of the diagnosis of chronic bronchitis ( according to ICD- 10 code J 41.0) was carried out on the basis of history, clinical, laboratory and radiological examination as required by the Order of the Ministry of Health of Ukraine from 19.03.2007, № 128 "On approval of clinical protocols of care in the specialty" Pulmonology ".

Anthropometric study included height, body weight, waist circumference and volume thighs. To assess body weight was used body mass index (BMI ) - Quetelet index, calculated as the ratio of body weight (in kilograms ) to height (in meters), built in the square. According to the WHO (1998), in patients with a BMI 25-29,9 kg/m2 diagnosed overweight, with a BMI 30-34,9 kg/m2 - I degree of obesity, with a BMI 35-39,9 kg/m2 - II degree of obesity, while a BMI over 40 kg/m2 - III obesity degree. The study included patients only with alimentary- constitutional obesity type.

Of the patients studied was formed two groups randomized by age, sex, duration and frequency of exacerbations NASH: main (28 persons) and comparison ( 24 people ). Patients in both groups received standard treatment according to the Order of Ministry of Health of Ukraine № 436 "On approval of clinical protocols of medical care in" Gastroenterology ": diet therapy in accordance with the recommendations of Professor. NV Kharchenko and GA Anokhin (2008), hepatoprotectors ( karsil or Silibor ) and the Order of the Ministry of Health of Ukraine № 128 "On approval of clinical protocols of care in the specialty" Pulmonology ": an exacerbation of chronic bronchitis - antimicrobial, anti-inflammatory, detoxifying, antihistamines, bronchodilators, multivitamins, physical therapy facilities ( UHF or inductothermy on the chest, inhalation of mucolytic formula ). The patients of the main group in addition to standard therapy administered drug guarem, which is a dietary fiber that is obtained from the endosperm of the spermatic Cyamopsis tetragonolobus. Effect of lowering LDL in plasma is due to a decrease in cholesterol absorption, increased secretion of bile acid and cholesterol metabolism enhancement in the liver. Guarem administered 5 g 2 times a day for three months.

Statistical analysis of the results was carried out using multivariate analysis of variance with the use of licensed software packages Microsoft Office 97, Microsoft Exel Stadia 6.1/prof and Statistica.

Obtained results and discussion

In the study of lipid profile of patients with comorbidity in 86.7 % of cases detected dyslipidemia, the most common form of which were hypertriglyceridemia and / or low HDL cholesterol.

ZHS level was 5,26 ± 0,32 mmol / l (normal - 4,42 ± 0,57 mmol / l, p < 0.05), LDL - 3,19 ± 0,31 mmol / l (normal - 2 51 ± 0,35 mmol / l, p < 0.05) ; HDL cholesterol - 0,88 ± 0,21 mmol / l (normal - 1,23 ± 0,20 mmol / l, p > 0.05), TG - 3,29 ± 0,7 mmol / l (normal - 1 71 ± 0,15 mmol / l, p < 0.05) was observed atherogenic dyslipidemia that IIa and type ΙΙb by D. Fredrickson ( 1970), which is characteristic of chronic liver disease and is manifested by increased content of triglycerides and decreased HDL cholesterol. Was observed a positive correlation between the level of HDL and LDL cholesterol (r = +0,94). Changes in antiatherogenic HDL fractions were shown a decrease in HDL cholesterol, which contributed to the accelerated development of atherosclerotic process in the vascular wall.

Thus, in patients with NASH examined in conjunction with HB and obesity observed significant changes in blood lipid spectrum : increasing concentrations of atherogenic ( HDL, triglycerides, LDL cholesterol, VLDL cholesterol ) and lowering antiatherogenic fraction ( HDLC) lipids.

It was found negative correlation with the level of HDL cholesterol and LDL cholesterol (r = -0,64 and r = -0,44, respectively). Positively correlated with each other atherogenic fractions: cholesterol and triglycerides (r = +0,74), HDL and LDL cholesterol (r = +1,0), triglycerides and LDL cholesterol (r = +0,74).

Use of drug in patients with guarem group contributed positive impact on lipid metabolism. So, at the end of treatment there was a decrease ZHS to 4,73 ± 0,30 mmol / l; levels of LDL cholesterol - up to 3,06 ± 0,31 mmol / l; TG - up to 3,02 ± 0,29 mmol / l, HDL index remained unchanged.

The results obtained showed a pronounced tendency to influence lipid-lowering bile acid sequestrants – drug guarem.

Conclusions

1. Application Guarem drug in the treatment of patients with nonalcoholic steatohepatitis in a combination of chronic bronchitis and obesity contributes to the normalization of lipid metabolism.

2. Later we considered that it’s necessary to study the effect of drug guarem on lipid peroxidation and antioxidant defense in patients with reviewed combined pathology.

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