Efficiency of treatment of patients with non-alcoholic steatohepatitis combined with diabetes mellitus type 2 using the s-adenosylmethionin


Keywords: non-alcoholic steatohepatitis, diabetes mellitus type 2, S-adenosylmethionin, treatment.

Abstract

Non-alcoholic fatty liver disease is an important cause of chronic liver damage in many countries and is growing rapidly in both adults and children due to obesity and diabetes type 2. Aim — investigate the effectiveness of complex treatment of patients for the course of NASH using S-adenosylmethionin on the background of basic therapy. The study included 25 patients with non-alcoholic steatohepatitis against type 2 diabetes, age on average (58.69±1.25) years. The control group comprised 15 healthy individuals. In order to identify the diagnosis, data from clinical and laboratory, biochemical and instrumental studies were fully integrated into account. Statistical processing of the results was carried out using Statistica 6.1. In the group of patients with NASH before treatment, the stage I of hepatosis was observed in 15% of cases, the second — in 50%, the third in 35%. Lipid blood spectrum revealed high levels of low and very low density lipoprotein and low levels of high density lipoprotein. High levels of triglycerides among men and high thyroid test among women were determined. The results of the complex (with the inclusion of S-adenosylmethionine) treatment for patients with NASH showed a significant improvement in the subjective state of patients: reduced complaints of discomfort in the right hypochondrium, general weakness, nausea and dizziness. In the ultrasound study in the group of NASH, the redistribution of the number of patients in the side with the reduction of heavier stages of hepatosis was observed: the number of patients with stage I hepatosis was determined in 52.9% of cases (an increase of 3.5 times), stage II — in 24.9% (reduction in 2 times), the third stage — in 22,2% (reduction by 1,5 times). Among all patients, the cytolysis, mesenchymal-inflammatory syndrome, cytology, hemograms improved, and lipid and metabolic parameters were stabilized, confirming the positive membranotropic effect of S-adenosylmethionin on the membrane structures of hepatocytes and indicating anti-inflammatory, hepatoprotective and regenerative effects of the drug in the treatment of patients with steatohepatitis combined diabetes mellitus type 2.

References

1. Arablinskij, A. V. & Chechenov, M. H. (2007). K voprosu o neinvazvnoj diagnostike zhirovogo gepatoza pri nealkogolnom steatogepatite. [On the issue of noninvasive diagnostics of fatty hepatosis in non-alcoholic steatohepatitis]. Radiologiya-praktika – Practice Radiology, 4, 16–32. Vzyato s https://cyberleninka.ru/article/n/k-voprosu-o-sposobstvuyuschih-faktorah-mehanizmah-razvitiya-i-lechenii-zhirovogo-gepatoza.

2. Babak, O. Ya., & Lapshina, E. A. (2016). Lechebnaya taktika u pacientov s nealkogolnoj zhirovoj boleznyu pecheni s uchetom urovnya citokeratina-18 v plazme krovi. [Therapeutic tactics in patients with non-alcoholic fatty liver disease, taking into account the level of cytokeratin-18 in plasma]. Suchasna hastroenterolohiia –Modern gastroenterology, 2 (88), 15–20. Vzyato s http://nbuv.gov.ua/UJRN/SGastro_2016_2_4.

3. Vlasenko, A. V. (2013). Vplyv nealkoholnoi zhyrovoi khvoroby pechinky v poiednanni z metabolichnym syndromom na perebih tsukrovoho diabetu. [Influence of non-alcoholic fatty liver disease combined with metabolic syndrome on the course of diabetes mellitus]. Suchasna hastroenterolohiia – Modern gastroenterology, 3 (71), 14–20. Vziato z http://nbuv.gov.ua/UJRN/SGastro_2013_3_4.

4. Dynnyk, N. V., Svintsitskyi, A. S., Soloviova, H. A., & Bohomaz, V. M. (2016). Metod modyfikatsii sposobu zhyttia v patsiientiv iz nealkoholnoiu zhyrovoiu khvoroboiu pechinky. [Method of lifestyle modification in patients with nonalcoholic fatty liver disease]. Praktykuiuchyi likar – Practitioner, 5, 6–8. Vziato z https://oberig.ua/media/files/Hepatology2.pdf.

5. Ivashkin, V. T. (Red.). (2015). Diagnostika i lechenie nealkogolnoj zhirovoj bolezni pecheni (metodicheskie rekomendacii dlya vrachej). [Diagnosis and treatment of non-alcoholic fatty liver disease]. Moskva: (b.i.) – Moskow: (w.h.p.). Vzyato s https://www.rsls.ru/files/Guidelines-RSLS-NASH-2015-09-21.pdf.

6. Mammaev, S. N. & Bagomedova, N. V. (2007). Citokinovaya sistema pri nealkogolnom gepatite. [Cytokine system with non-alcoholic hepatitis]. RZhGGK, 4, 35–39. Vzyato s http://www.gastro-j.ru/files/s6_1306313136.pdf.

7. Podymova, S. D. (2006). Zhirovoj gepatoz. Nealkogolnyj steatogepatit (evolyuciya predstavlenij o kliniko-morfologicheskih osobennostyah, prognoze, lechenii). [Non-alcoholic steatohepatitis (evolution of ideas about clinical and morphological features, prognosis, treatment)]. Terapevticheskij arhiv – Therapeutic archive, 4, 32–38.

8. Rojtberg, G. E., Lazebnik, L. B., Zvenigorodskaya, L. A., Sharhun, O. O., Ushakova, T. I., & Platonova, O. E. (2013). Neinvazivnye metody v diagnostike steatoza i fibroza pri nealkogolnoj zhirovoj bolezni. [Non-invasive methods in the diagnosis of steatosis and fibrosis in non-alcoholic fatty disease]. Eksperimentalnaya i klinicheskaya gastroenterologiya – Experimental and clinical gastroenterology, 7, 3–7. Vzyato s https://cyberleninka.ru/article/n/neinvazivnye-metody-v-diagnostike-steatoza-i-fibroza-pri-nealkogolnoy-zhirovoy-bolezni-pecheni.

9. Skripnik, I. N. (2013). Ocenka terapevticheskih podhodov k lecheniyu nealkogolnogo steatogepatita v Ukraine i ego vzaimosvyaz s faktorami riska: rezultaty otkrytogo multicentrovogo prospektivnogo issledovaniya DIREG_L_04443. [Evaluation of therapeutic approaches to the treatment of nonalcoholic steatohepatitis in Ukraine and its relationship with risk factors: results of open multicentre prospective study DIREG_L_04443]. Suchasna gastroenterologiya – Modern gastroenterology, 2 (70), 64–71. Vzyato s http://nbuv.gov.ua/UJRN/SGastro_2013_2_13.

10. Nakaz Ministerstva okhorony zdorovia Ukrainy 06 lystopada 2014 roku № 826. Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) medychnoi dopomohy. Nealkoholnyi steatohepatyt. [Order of the Ministry of Health of Ukraine November 06, 2014 № 826. Unified clinical protocol of primary, secondary (specialized) medical aid. Non-alcoholic steatohepatitis]. Vziato z http://mtd.dec.gov.ua/images/dodatki/2014_826Gepatyty/2014_826_YKPMD_NSTPT.pdf.

11. Lee, M. S., Bae, J. M., Joo, S. K., Woo, H., Lee, D. H., Jung, Y. J. … Kim, W. (2017). Prospective comparison among transient elastography, supersonic shear imaging, and ARFI imaging for predicting fibrosis in nonalcoholic fatty liver disease. PLoS One, 12 (11), e0188321. doi: 10.1371/journal.pone.0188321.

12. Sweet, P. H., Khoo, T. & Nguyen, S. (2017). Nonalcoholic Fatty Liver Disease. Prim Care, 44 (4), 599–607. doi: 10.1016/j.pop.2017.07.003.

13. Vilar-Gomez, E. & Chalasani, N. (2017). Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers. J Hepatol., 68 (2), 305–315. doi: 10.1016/j.jhep.2017.11.013.
Published
2018-08-08
How to Cite
Pavlovskyi, S. (2018). Efficiency of treatment of patients with non-alcoholic steatohepatitis combined with diabetes mellitus type 2 using the s-adenosylmethionin. Reports of Vinnytsia National Medical University, 22(1), 198-202. https://doi.org/https://doi.org/10.31393/reports-vnmedical-2018-22(1)-38