scholarly journals Search for a way to improve the serum albumin binding function and the functional state of the liver when hypertension combined with non-alcoholic fatty liver disease

2022 ◽  
Vol 12 (1) ◽  
pp. 55-64
Author(s):  
Yurii Dzordzo ◽  
Serhiy Andreychyn

Recently, there has been a significant increase in interest in research on hypertension (HT), primarily due to its high prevalence. The interest in studying this problem is also exacerbated by the often insufficient effectiveness of existing treatments. The effect of concomitant pathologies on HT, in particular non-alcoholic fatty liver disease (NAFLD), remains poorly understood. The aim of the study – to evaluate the changes in the serum albumin binding function (SABF) and its relationship with the biochemical parameters of the blood when HT and HT combined with NAFLD and to suggest ways of medical correction of the detected disorders. Material and methods. 76 individuals with stage 2 HT with degree 2–3 arterial hypertension were examined. They were divided into two groups. Group 1 included 28 patients with HT without concomitant diseases who received basic hypertension therapy, and group 2 included patients with concomitant NAFLD. The latter in turn was divided into two subgroups: 2a – 27 patients who in addition to basic HT therapy received additional Antral hepatoprotector 200 mg three times a day for 2 months, and 2b – 21 patients who received only basic HT therapy. All of them underwent a standard clinical examination, as well as SABF, protein fractions, and liver function indicators. The comparison group consisted of 25 healthy individuals, comparable in age and sex. Results and Discussion. Patients in group 1 showed moderate changes in the functional state of the liver, but they did not exceed the norm, patients in group 2 – a significant decrease in SABF, as well as protein metabolism (decrease in total protein, albumin, albumin-globulin ratio and increase globulins) and liver function (increased activity of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidase, thymol levels, alkaline phosphatase and total bilirubin). After treatment, the majority of patients in subgroup 2 had a statistically significant increase in SABF and a quantitative improvement in protein fractions and functional state of the liver. In subgroup 2-b, where hepatoprotective treatment was not performed, significant changes in most indicators did not occur. The results may be related to the positive effect of the drug on the liver, which leads to improved functional status of hepatocytes and their protein-synthesizing ability. In subgroup 2 b, where hepatoprotective treatment was not performed, significant changes in most indicators did not occur. The results may be related to the positive effect of the drug on the liver leading to improved functional status of hepatocytes and their protein-synthesizing ability. Conclusions. Changes of the functional state of the liver are observed when HT without concomitant pathology. HT with NAFLD is accompanied by a significant decrease in SABF, changes in protein metabolism and the functional state of the liver. Prescribing Antral to such patients helps to increase SABF, normalize protein metabolism and improve the functional state of the liver.

Author(s):  
M. E. Statsenko ◽  
S. V. Turkina ◽  
S. V. Fabritskaya ◽  
N. N. Shilina ◽  
M. N. Titarenko ◽  
...  

Aim: to study the functional state of the kidneys in patients with chronic heart failure (CHF) and non-alcoholic fatty liver disease (NAFLD).Materials and methods. 144 patients with CHF aged 45-70 years were divided into two groups: group 1 — persons with CHF and NAFLD, group 2 — CHF without NAFLD. A clinical examination was performed, the indices of FLI steatosis and NFS liver fibrosis were calculated, the functional state of the kidneys and the adipokine status were evaluated.Results. The main group of patients with CHF and NAFLD is mainly represented by people with grade I obesity (73 (84%) vs 5 (9%), p<0.05). Among patients with CHF and NAFLD, a clinically significant decrease in GFR<60 ml/min/1.73 m2 was significantly more often detected compared to patients with CHF without NAFLD (37% vs 21% in groups 1 and 2, respectively). The level of albuminuria was significantly higher in the group of patients with CHF and NAFLD (200.7±22.3 [54.7;390] vs 92.6±23.4 [10.2;188.7] mg/g in groups 1 and 2, respectively). The percentage of individuals with an AU/CR. urine ratio >30 mg/g was statistically significantly higher in group 1 compared to group 2 (82.1 vs 51.1% in groups 1 and 2, respectively). The level of serum leptin was significantly higher and the concentration of serum adiponectin was significantly lower compared to group 2 in the main group of patients with CHF and NAFLD compared to the control group. There was a significantly higher occurrence of insulin resistance in patients with CHF and NAFLD. Correlation analysis revealed the presence of statistically significant associations between the parameters characterizing the functional state of the kidneys and the indices of FLI, NFD, adipokines, and the severity of insulin resistance.Conclusion. In patients with CHF and NAFLD, a significant deterioration in the functional state of the kidneys was found, in comparison with patients with “isolated” CHF with comparable FC.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lucia Aubert ◽  
Justo Sandino ◽  
Florencio Garcia ◽  
Elena Gutiérrez ◽  
Julian Segura ◽  
...  

Abstract Background and Aims Nowadays, there is growing evidence that non-alcoholic fatty liver disease (NAFLD) may be associated with renal impairment and have an impact on the evolution of renal function in patients with type 2 diabetes mellitus (DM). Our aim was to compare the effect on renal function and proteinuria in patients with type 2 DM according to the presence of NAFLD. Method Retrospective and observational study, including patients with type 2 DM, &lt; 70 years of age and with estimated glomerular filtration rate (eGFR) &gt; 30 ml/min/1,73 m2. NAFLD was defined with the presence of compatible ultrasonography and/or presence of fibrosis using NAFLD score. Metabolic syndrome (MSd) was defined as: obesity (body mass index (BMI) &gt; 30 kg/m2), hypertension and dyslipidaemia. Patients were classified according to the presence or absence of NAFLD. We analysed different clinical and analytical variables along the follow up. Results A total of 71 patients were included (66% males) with mean age of 57.4 ± 7.8 years. The median evolution of type 2 DM was 72.2 months (34.7 - 125.5 months) and 90.1% of the patients were treated with renin-angiotensin blockade. When comparing patients with (group 1, n=38) and without (group 2, n=33) NAFLD at the beginning of this study, we found no significant difference in eGFR (80.2 ± 40.4 ml/min vs 71.4 ± 31.8 ml/min), proteinuria (1.4 ± 2.7 g/24h vs 0.8 ± 1.0 g/24h) and glycated haemoglobin (6.8 ± 1.4% vs 7.2 ± 1.6%). On the other hand, we found significant difference in the presence of higher BMI (33.8 vs 29.3 kg/m2; .001) and presence of MSd (67.7 vs 32.3%; .03) in those patients with NAFLD. After a mean follow-up time of 74 months, we found significant differences in the loss of eFGR (-33.8 vs -13.9 ml/min; .003), but no difference in increase of proteinuria. We found an increase in incidence of chronic kidney disease in group 1 (50%) vs group 2 (10.5%). There were no differences in the need to initiate renal replacement therapy or all-cause mortality. Conclusion NAFLD in type 2 DM caused a mayor decline in renal function. We should, therefore, take into consideration the presence of NALFD and the presence of MSd to optimise treatment of associated risk factors.


2021 ◽  
Vol 21 (2) ◽  
Author(s):  
Somayeh Rajabi ◽  
Roya Askari ◽  
Amir Hossein Haghighi ◽  
Nasrin Razavianzadeh

Background: C1q/TNF-related protein (CTRP3) is a potent anti-inflammatory adipokine with activities, such as reduction of glucose level and inhibition of gluconeogenesis in the liver. However, the effect of exercise training on CTRP3 in patients with non-alcoholic fatty liver disease (NAFLD) remains unknown. Objectives: This study was done to investigate the effects of two different intensities of combined training on CTRP3 and insulin resistance in women with NAFLD and compare these two training patterns. Methods: Thirty-three women with NAFLD were randomly divided into three equal groups. Group 1 performed resistance training (RT), along with aerobic interval training (AIT) (2 - 5 intervals of four minutes, 70 - 75% HRmax), group 2 performed RT along with high-intensity interval training (HIIT) (8 - 13 intervals of one minute, 85 - 95% HRmax), and the control group did not participate in any training. The body composition measurements and blood sampling were carried out before and after 12 weeks of training. Data analysis was performed using repeated-measures ANOVA (α ≤ 0.05). Results: After 12 weeks, the CTRP3 level significantly increased in group 1 compared with the control group (P = 0.01) and group 2 (P < 0.001). The fasting glucose and fasting insulin levels significantly decreased in group 1 compared with the control group (P < 0.001 and P = 0.01, respectively). The insulin resistance index decreased in both group 1 and group 2; however, the difference was not significant compared with the control group (P > 0.05). Conclusions: Combined training (RT + AIT) in the present study increased the level of CTRP3; thus, it is likely that women with NAFLD can benefit from this program as a non-pharmacological adjunct treatment to prevent inflammation and progression of the disease.


2021 ◽  
Vol 74 (10) ◽  
pp. 2575-2579
Author(s):  
Iryna O. Khramtsova ◽  
Maria A. Derbak ◽  
Taras M. Ganich ◽  
Oleksandr O. Boldizhar ◽  
Yana V. Lazur

The aim: Was increase the effectiveness of treatment in patients with non-alcoholic fatty liver disease (NAFLD) comorbid with chronic obstructive pulmonary disease (COPD) by using ursodeoxycholic acid (UDCA) in combination with ademethionine. Materials and methods: Under observation was 98 patients with a diagnosis of NAFLD and COPD group II or their combination. Patients were divided into 3 groups: 1 (n = 36) – COPD + NASH – in addition to standard COPD therapy received UDCA 15 mg / kg / day – 6 months and ademethionine 1000 mg IV once a day for 10 days, followed by oral administration of 500 mg 2 times per day – 20 days, and group 2 (n = 32) – COPD + hepatic steatosis – in addition to standard therapy – UDCA 15 mg / kg / day – 6 months. Group 3 (n = 30) – COPD received standard therapy for COPD. Results: UDCA with ademethionine on the background of standard COPD therapy reduces the clinical manifestations of NAFLD and normalizes liver function. The combination of UDCA with ademethionine not only has a positive effect on the course of NAFLD, but also reduces the intensity of dyspnea, systemic inflammation, improves the external respiration function and reduces anxiety and depression. Patients receiving UDCA + ademethionine for 6 months of follow-up had no exacerbations of COPD. Conclusions: UDCA in combination with ademethionine in COPD courses have a positive effect on the course of NAFLD, and also reduces the intensity of dyspnea, improves the external respiratory function and reduces the frequency of COPD hospitalization.


2016 ◽  
Vol 4 ◽  
pp. 257-262 ◽  
Author(s):  
Anna Sabinicz ◽  
Dominika Maciejewska ◽  
Małgorzata Kaczorowska ◽  
Karina Ryterska ◽  
Dominika Jamioł-Milc ◽  
...  

2020 ◽  
Vol 9 (12) ◽  
pp. 4049
Author(s):  
Katrine D. Galsgaard

A key criterion for the most common chronic liver disease—non-alcoholic fatty liver disease (NAFLD)—is an intrahepatic fat content above 5% in individuals who are not using steatogenic agents or having significant alcohol intake. Subjects with NAFLD have increased plasma concentrations of glucagon, and emerging evidence indicates that subjects with NAFLD may show hepatic glucagon resistance. For many years, glucagon has been thought of as the counterregulatory hormone to insulin with a primary function of increasing blood glucose concentrations and protecting against hypoglycemia. However, in recent years, glucagon has re-emerged as an important regulator of other metabolic processes including lipid and amino acid/protein metabolism. This review discusses the evidence that in NAFLD, hepatic glucagon resistance may result in a dysregulated lipid and amino acid/protein metabolism, leading to excess accumulation of fat, hyperglucagonemia, and increased oxidative stress contributing to the worsening/progression of NAFLD.


2021 ◽  
pp. 136-143
Author(s):  
M. M. Maevskaya

The problem of modern medicine and modern society is a comorbid patient with metabolic disorders. Hypothetical portrait of such a patient: over 40 years old, overweight, arterial hypertension, coronary atherosclerosis, impaired carbohydrate and lipid metabolism, liver steatosis or steato-hepatitis, often with changes in the function of the musculoskeletal system. Rational pharmacotherapy of this patient is of fundamental importance. The article analyzes, from the point of view of polypotency, efficacy and safety, the main drugs used in Russia for treatment of non-alcoholic fatty liver disease in comorbid patients. Attention is paid to vitamin E, glycyrrhizin, ursodeoxycholic acid. Domestic and foreign studies of these drugs are analyzed, and the scope of their rational use is shown: reducing the risk of cardiovascular complications, a positive effect on the lipid spectrum, reducing the activity of serum transaminases and other hepatotropic effects. Their side effects are also considered, which should be taken into account when choosing the treatment of a comorbid patient. We have analyzed the efficacy and safety of new molecules that are in clinical trials and/or have not yet been registered in our country, e.g. obeticholic acid, cenicriviroc, tropifexor, etc. The ability of some molecules to act as biological enhancers is also highlighted, which is important to consider when prescribing combination therapy. Doctors are recommended to carefully consider and take into account all the features of a comorbid patient and choose for this category of patients safe drugs of hepatotropic action with simultaneous positive effect on the cardiovascular system. Among other things, it will avoid polypragmasy.


2015 ◽  
Vol 22 (2) ◽  
pp. 188-194
Author(s):  
Mohammod Feroz Amin ◽  
Syeda Rezina Sultana ◽  
Indrajit Prasad ◽  
Muhammad Abdur Rahim ◽  
Md Anisur Rahman ◽  
...  

Context: Non Alcoholic Fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome. The pathogenesis of steatosis and cellular injury is thought to be related mostly to insulin resistance. Insulin sensitizing drugs showed promising results in number of trials. This was an open label clinical trial in newly detected glucose intolerant patients with NAFLD, to evaluate the effectiveness and superiority of pioglitazone and metformin combination to metformin alone. Methods: Forty nine patients with newly detected abnormal glucose tolerance, naïve to any anti diabetic drug, were randomly selected, from the gastroenterology out-patient department of BIRDEM Hospital, Dhaka, with the findings of ultasonographic changes of fatty liver and raised ALT and assigned to 6 months treatment with pioglitazone 30 mg plus metformin 1700 mg daily (Group 1, n=27) or only metformin 1700 mg alone (Group 2, n=22). Results: Mean age of the study population was 45.80±8.54 years, Male female distribution of the study subjects were 65.3% and 34.7% respectively. Significant reduction of ALT, F, ABF, HbA1c, cholesterol, triglyceride of the study population were achieved either by metformin alone or with combination after six months (visit 1 vs visit 3, ALT: 97.99+22. vs 55±17.49 u/ l; Fasting sugar: 9.1+1.9 vs6.64±0.94, mmol/l; ABF: 13.3±2.5 vs 8.69±1.21 mmol/l; HBA1c: 8.1±0.9 vs 6.87±0.57%; Cholesterol: 205.9±30.1 vs 186.12±22.26 mg/dl; TG: 230.4+48.1 vs 166.2±31.82). In comparison between two groups, Group 1 had found to be significantly better glycemic control compared to their counterpart at the end of 6 months (Group 1 vs Group 2, FBG: 6.37±0.56 vs 6.98±1.2; ABF: 8.34±0.84 vs 9.1±1.46; serum cholesterol, TG, and ALT levels were also found to be significant change as Cholesterol: 178.89±18.59 vs 195±23.55 mg/dl; TG: 155.85±20.99 vs 178.91±38.24 mg/ dl; ALT: 55±17.49 vs 45.74±12.63 u/L. In final visit, ultrasonographic change also found to be significantlyimproved from fatty change to normal in patients with both metformin and pioglitazone group than patients on metformin alone. Conclusion: Treatment of NAFLD of newly detected Type 2 DM or IGT patients with high ALT by both metformin and pioglitazone is more effective in reduction of ALT and lipids and also able to reverse the severity of fatty changes of liver towards normal significantly. DOI: http://dx.doi.org/10.3329/jdmc.v22i2.21540 J Dhaka Medical College, Vol. 22, No.2, October, 2013, Page 188-194


2019 ◽  
Vol 15 (1-2) ◽  
pp. 25-33 ◽  
Author(s):  
V.P. Shypulin ◽  
L.M. Parunyan ◽  
V.V. Tishhenko ◽  
О.К. Kolyada ◽  
O.M. Ponomarov ◽  
...  

Relevance. Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease on the one hand, and on the other, remains an unnoticed significant risk factor for cardiovascular disease. The course of NAFLD is often exacerbated by concomitant metabolic syndrome (MS). Existing medication for NAFLD has shortcomings in its efficacy and focus on non-alcoholic steatohepatitis (NASH). Given the lack of effective medication registered for NASH, optimizing NAFLD treatment is an urgent task. Pioglitazone (PPAR-γ agonist) is an insulin sensitizer recommended for the treatment of NASH after liver biopsy. The lack of efficiency of pioglitazone is probably due to the pleiotropic effect of PPAR-γ gene. Among the mutations of PPAR-γ gene, the most common Pro12Ala polymorphism. The PPAR-γ gene is a nuclear transcriptional regulation protein that affects adipocyte differentiation, fatty acid metabolism, and insulin sensitivity. Studies in Ukraine regarding the efficacy of pioglitazone in the treatment of NAFLD in combination with MS, depending on presence rs 1801282 (Pro12Ala) polymorphism in PPAR-γ gene, have not been performed previously. Objective - to study the effectiveness of treatment with pioglitazone in patients with NAFLD and MS, depending on presence rs 1801282 (Pro12Ala) polymorphism in gene PPAR-γ. Materials that methods. 93 patients with NAFLD and concomitant MS participated in the clinical-genetic intervention study. The randomization method of patients was divided into two groups, comparable in age, sex, and body mass index. All patients were offered a comprehensive weight loss program consisting of a 12-week follow-up. The comprehensive weight loss program included lifestyle modification: a reduction in diet of 500 kcal from the physiological daily energy expenditure and its physical activity for 150-200 min per week, the problems of adherence to recommendations were additionally discussed during the visits. The patients of the first group adhered to the comprehensive weight loss program and received pioglitazone 15 mg / day. Patients in the second group adhered only to comprehensive weight loss program. Overall, the program consisted of 5 visits over a 12-week period. All patients underwent a molecular genetic study of detecting rs 1801282 (Pro12Ala) polymorphism in PPAR-γ gene, as well as anthropometric measurements, laboratory and instrumental examinations (Ultrasound steatometry) before and after 12 weeks of treatment. Results. Comparative analysis revealed that patients with NAFLD and MS in group 1 who adhered to comprehensive weight loss program and received pioglitazone at a daily dose of 15 mg had a more significant decrease in controlled attenuation parameter (p <0.05) compared with patients in group 2, which only the comprehensive weight loss program complied. In group 1, liver steatosis rates had a direct correlation with BMI (r = 0.33), visceral fat (r = 0.475), ALT (r = 0.42), TG (r = 0.48), fasting insulin (r = 0.38). The prevalence of minor allele 12Ala rs 1801282 of the PPAR-γ gene polymorphism in patients with NAFLD in combination with MS is 15%. Group 1 patients showed an association (p = 0.03) of the presence of 12Ala rs 1801282 allele in PPAR-γ gene polymorphism with a decrease of controlled attenuation parameter score, OR = 8.6 (95% CI 1.0–78.7). Patients in Group 2 found no association (p = 0.59) in the reduction of steatosis score with the presence of  12Ala allele, HS = 1.6 (95% CI 0.3–8.0). Conclusions. In patients with NAFLD and concomitant MS, additional prescribing to the comprehensive weight loss program of pioglitazone (15 mg / day for 12 weeks) is likely to reduce steatosis. In patients with NAFLD in combination with MS, there is an association of the presence of 12Ala allele in PPAR-γ gene polymorphism and the effectiveness of pioglitazone 15 mg, OR = 8.6 (95% CI 1,0-78.7) compared to 12Pro allele.


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