Наукові праці. Кафедра внутрішньої медицини № 1
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Item Comparison of structural and functional vascular disorders in patiets with comorbidity of non-alcoholic fatty liver disease and two types of arterial hypertension(2023) Molodan, Volodymyr; Panchenko, Galyna; Prosolenko, Kostyantyn; Lapshyna, Kateryna; Shalimova, AnnaBackground: The aim was to conduct a comparative assessment of structural and functional vascular disorders in patiets with comorbidity of non-alcoholic fatty liver disease (NAFLD) and two types of arterial hypertension (HTN). Material and methods: The study included 329 patients 18–66 years old. All patients were divided into five groups: patients with comorbidity of NAFLD and primary HTN (121 subjects), patients with comorbidity of NAFLD and renal parenchymal HTN (88 subjects), patients with NAFLD (60 subjects), patients with primary HTN (30 subjects), patients with renal parenchymal HTN (30 people). The control group consisted of 20 healthy individuals of similar age and gender categories. Results: In the comparative analysis of the structural and functional ultrasonographic parameters of vessels, no significant differences between two comorbidity groups NAFLD + primary HTN and NAFLD + renal parenchymal HTN were found. The influence of AH and degree of liver steatosis on ultrasound indicators of arteries in examined patients with comorbidity was evaluated by MANOVA analysis. The influence of the HTN factor and the influence of the liver steatosis factor were evaluated separately, after which the influence of the comorbidity factor, i.e., the combined influence of these factors and one or another indicator, was evaluated. The additive effect of the factors of AH and liver steatosis was identified according to the parameters: intima media thickness, pulse wave velocity in the carotid artery, pulse wave velocity in the abdominal aorta and endothelial-related vasodilation, which indicates an important comorbid effect of NAFLD and primary/renal parenchymal HTN on the structural and functional state of arteries. Conclusions: There are no differences between the structural and functional indicators of arteries in patients with comorbidity of NAFLD + primary HTN and NAFLD + renal parenchymal HTN. The factor of the presence of HTN and the degree of liver steatosis significantly affect structural and functional indicators of the studied arteries.Item Comparison of structural and functional vascular disorders in patients with comorbidity of non-alcoholic fatty liver disease and two types of arterial hypertension(2023) Prosolenko, Kostyantyn; Molodan, Volodymyr; Panchenko, Galyna; Lapshyna, Kateryna; Shalimova, AnnaBackground: The aim was to conduct a comparative assessment of structural and functional vascular disorders in patiets with comorbidity of non-alcoholic fatty liver disease (NAFLD) and two types of arterial hypertension (HTN). Material and methods: The study included 329 patients 18–66 years old. All patients were divided into five groups: patients with comorbidity of NAFLD and primary HTN (121 subjects), patients with comorbidity of NAFLD and renal parenchymal HTN (88 subjects), patients with NAFLD (60 subjects), patients with primary HTN (30 subjects), patients with renal parenchymal HTN (30 people). The control group consisted of 20 healthy individuals of similar age and gender categories. Results: In the comparative analysis of the structural and functional ultrasonographic parameters of vessels, no significant differences between two comorbidity groups NAFLD + primary HTN and NAFLD + renal parenchymal HTN were found. The influence of AH and degree of liver steatosis on ultrasound indicators of arteries in examined patients with comorbidity was evaluated by MANOVA analysis. The influence of the HTN factor and the influence of the liver steatosis factor were evaluated separately, after which the influence of the comorbidity factor, i.e., the combined influence of these factors and one or another indicator, was evaluated. The additive effect of the factors of AH and liver steatosis was identified according to the parameters: intima media thickness, pulse wave velocity in the carotid artery, pulse wave velocity in the abdominal aorta and endothelial-related vasodilation, which indicates an important comorbid effect of NAFLD and primary/renal parenchymal HTN on the structural and functional state of arteries. Conclusions: There are no differences between the structural and functional indicators of arteries in patients with comorbidity of NAFLD + primary HTN and NAFLD + renal parenchymal HTN. The factor of the presence of HTN and the degree of liver steatosis significantly affect structural and functional indicators of the studied arteries.Item Comparison of structural and functional vascular disorders in patients with comorbidity of non-alcoholic fatty liver disease and two types of arterial hypertension(2023) Prosolenko, Kostyantyn; Molodan, Volodymyr; Panchenko, Galyna; Lapshyna, Kateryna; Shalimova, AnnaBackground: The aim was to conduct a comparative assessment of structural and functional vascular disorders in patiets with comorbidity of non-alcoholic fatty liver disease (NAFLD) and two types of arterial hypertension (HTN). Material and methods: The study included 329 patients 18–66 years old. All patients were divided into five groups:patients with comorbidity of NAFLD and primary HTN (121 subjects), patients with comorbidity of NAFLD and renal parenchymal HTN (88 subjects), patients with NAFLD (60 subjects), patients with primary HTN (30 subjects), patients with renal parenchymal HTN (30 people). The control group consisted of 20 healthy individuals of similar age and gender categories. Results: In the comparative analysis of the structural and functional ultrasonographic parameters of vessels, no significant differences between two comorbidity groups NAFLD + primary HTN and NAFLD + renal parenchymal HTN were found. The influence of AH and degree of liver steatosis on ultrasound indicators of arteries in examined patients with comorbidity was evaluated by MANOVA analysis. The influence of the HTN factor and the influence of the liver steatosis factor were evaluated separately, after which the influence of the comorbidity factor, i.e., the combined influence of these factors and one or another indicator, was evaluated. The additive effect of the factors of AH and liver steatosis was identified according to the parameters: intima media thickness, pulse wave velocity in the carotid artery, pulse wave velocity in the abdominal aorta and endothelial-related vasodilation, which indicates an important comorbid effect of NAFLD and primary/renal parenchymal HTN on the structural and functional state of arteries. Conclusions: There are no differences between the structural and functional indicators of arteries in patients with comorbidity of NAFLD + primary HTN and NAFLD + renal parenchymal HTN. The factor of the presence of HTN and the degree of liver steatosis significantly affect structural and functional indicators of the studied arteries. Key words: structural and functional vascular alterations; non-alcoholic fatty liver disease; hypertensionItem Markers of liver damage in comorbidity of nonalcoholic liver disease and hypertension(2020) Babak, Oleg; Prosolenko, KostyantynObjective: to study the features of liver damage and to study the main factors of influence on this process with comorbidity between non-alcoholic fatty liver disease and essential hypertension or renoparenchymal arterial hypertension. Materials and methods. The object of the study was 269 patients, included in three groups: group 1 - patients with non-alcoholic fatty liver disease (60 patients), group 2 - patients with comorbidity of non-alcoholic fatty liver disease and essential hypertension (121 patients), group 3 - patients with comorbidity of non-alcoholic fatty liver disease and renoparenchymal arterial hypertension (88 patients). The control group consisted of 20 healthy individuals of the same age and gender categories. Clinical examination of patients included an assessment of the parameters of an objective examination: in particular, anthropometric data and blood pressure according to standard methods. We studied both laboratory and instrumental markers of liver damage. To diagnose the condition of the liver and blood vessels in all patients, an ultrasound method was used. Some patients (212 people) underwent the Fibromax test. To assess the severity of insulin resistance, the HOMA index was calculated. Glomerular filtration rate was determined by the formula CKD-EPI. The level of cytokeratin-18 in blood plasma was determined by ELISA. Results and its discussion. A highly significant difference was found for most indicators between the groups of patients and the control group. The greatest difference was found in levels of transaminases (ALT and AST), gamma-glutamyl transpeptidase, as well as cytokeratin-18 (p <0.001). The most pronounced increase in transaminases was observed in patients of group 3. The levels of gammaglutamyltranspeptidase in patients of all three groups significantly exceeded the corresponding parameters of the control group, were the highest in group 3 - 68.10 ± 33.31 U/l. Moreover, this the indicator did not significantly differ between groups 2 and 3 (p> 0.05). Cytokeratin-18 was significantly increased in patients with nonalcoholic fatty liver disease, and was significantly different between all groups. Fewer patients with no hepatic fibrosis were recorded in group 1. We found significant correlation between the duration of non-alcoholic fatty liver disease and all markers of liver damage in group 1. Also, markers of liver damage positively correlated with body mass index, which indicates an important role obesity in the pathogenesis of non-alcoholic fatty liver disease. Given the correlations with the indicators of adiponectin, malondialdehyde, tumor necrosis factor-alpha, HOMA, we can state the important role of inflammation, oxidative stress, insulin resistance in the pathogenesis and development of non-alcoholic fatty liver disease. A strong negative correlation between cytokeratin-18 and glomerular filtration rate of - 0.402 (p <0.001) was also found. Important in our opinion were the positive relationships between indicators of hepatic damage and blood pressure in groups 2 and 3, which may indicate a relationship within comorbidity. In general, the largest number of strong correlation bonds were found for cytokeratin-18, and the smallest for gammaglutamyltranspeptidase. The profile of the correlation between the main indicators did not differ much from group 2. Using ANOVA dispersion analysis, we found a close relationship between the degree of liver steatosis and the main markers of liver damage ALT, AST, GGT, cytokeratin-18, fibrotest, and actitest. The highest Fisher coefficient was recorded for cytokeratin-18 - F = 118.58 (p <0.001), actitest - F = 102.18 (p <0.001), fibrotest - F = 95.03 (p <0.001), gamma-glutamyltranspeptidase - F = 26.6 (p <0.001). Such data indicate a close relationship between the processes of fat accumulation, inflammation, and apoptosis in the liver with non-alcoholic fatty liver disease in the presence or absence of comorbidity with essential hypertension or renoparenchymal arterial hypertension. Conclusions. For patients with non-alcoholic fatty liver disease, in the presence of its comorbidity with essential hypertension or renoparenchymal arterial hypertension, a more pronounced increase in gamma-glutamyl transpeptidase, cytokeratin-18 and actitest was characteristic, which may indicate the presence of more active processes of inflammation and hepatic apoptosis. A negative effect of comorbidity with essential hypertension or renoparenchymal arterial hypertension on liver fibrosis was also found. Markers of liver damage are associated with the duration of non-alcoholic fatty liver disease activity, body mass index, adiponectin, markers of inflammation and oxidative stress, kidney function. The degree and list of correlation relationships differ with non-alcoholic fatty liver disease depending on the presence or absence of comorbidity with essential hypertension or renoparenchymal arterial hypertension. Severe liver steatosis strongly affects the processes of hepatic inflammation, fibrosis and apoptosis with the comorbidity of non-alcoholic fatty liver disease with essential hypertension or renoparenchymal arterial hypertension.Item Effectiveness of treatment of patients with nonalcoholic fatty liver disease and hypertension with use of complex therapy(2017-06-29) Babak, Oleg; Myasoedov, V.; Prosolenko, Kostyantyn; Molodan, Volodymyr; Lapshyna, KaterynaThe aim: to investigate the basic level and dynamics of lipid, carbohydrate metabolism, adiponectin, fetuin A, pro-inflammatory cytokines (TNF-alpha and IL-6) and ultrasound parameters of carotid arteries in patients with NAFLD and hypertension using complex therapy. Materials and methods. The study involved 88 patients with NAFLD with hypertension stage II, 2 degree, undergoing treatment in National Institute of Therapy named LT Malaya NAMS of Ukraine. Among 88 patients were 49 men (55.68%) and 39 females (44.32%). The median age was (51,3 ± 6,2) years. The control group consisted of 30 healthy volunteers of similar age category, male and female. We studied the lipid and carbohydrate metabolism, blood pressure, ultrasound of the liver, adiponectin, fetuin A and pro-inflammatory cytokines (TNF-alpha and IL-6) by conventional methods. The study of vascular endothelial motor function was conducted by determining the dynamics of blood flow in the brachial artery during reactive hyperemia as described by D. Celermajer. Determines the pulse wave velocity and endothelium-dependent vasodilation. Patients with NAFLD and hypertension (n = 88) were divided into two groups. Patients group I (n = 44) received lisinopril 10 mg / day, atorvastatin 10-20 mg / day. Group II patients (n = 44) received lisinopril 10 mg / day atorvastatin and 10-20 mg / day in combination with PUFA 2 g / d and UDCA 10 mg / kg / day. Duration of treatment was 12 months. All were given recommendations for a balanced diet and exercises. Results. In patients with NAFLD and hypertension abnormalitis of lipid and carbohydrate metabolism, increasing pro-inflammatory cytokines (TNF-alpha and IL-6), fetuin A and a decreasing of adiponectin were indicated. Also indicators of pulse wave velocity and endothelium-dependent vasodilation were violated. In our study, significantly better result was achieved when assigning complex therapy using UDCA and PUFA - group 2. Significantly better results than were achieved in group 2 in triglycerides, TNF-α and IL-6. In group 2 was possible to increase the level of adiponectin of 47.57% compared with 20.67% in group 1 (p <0.001). Significantly improved indices of endothelial function. Conclusions. Combination therapy comprising atorvastatin, lisinopril, UDCA and PUFA in combination with non-drug therapy in patients with NAFLD and hypertension compared with taking lisinopril and atorvastatin combination with non-drug therapy is more effective for the treatment and correction associated with NAFLD metabolic disorders that can help reduce the overall cardiometabolic risk and improving life prognosis in patients with NAFLD and hypertension.