Intensity of systemic proteolysis and endotoxicosis in patients with non-alcoholic steatohepatitis associated with obesity and comorbid chronic obstructive pulmonary disease in the dynamics of treatment with hepatoprotectors

Abstract

Background. The prevalence of non-alcoholic steatohepatitis (NASH) and chronic obstructive pulmonary disease (COPD) is gaining global significance in the population of economically developed countries with a growing trend in Ukraine. The purpose was the determination of the intensity of systemic proteolysis and endo­genous intoxication before treatment and the efficacy of hepatoprotective therapy in patients with NASH against the background of obesity, depending on the comorbidity of COPD. Materials and methods. Seventy-six patients with NASH, grade 1 obesity and COPD 2–3 D were screened and divided into 3 groups according to the treatment received. The control group (C group) consisted of 23 patients receiving basic treatment for NASH (essential fatty acids complex 300 mg 2 capsules 3 times daily) for 30 days and baseline COPD therapy. Twenty-five patients (group 2 — primary, O1), in addition to similar COPD therapy, for the treatment of NASH, instead of essential fatty acids complex, received antral at a dose of 200 mg 3 times a day for 30 days. The third group (basic, O2) involving 28 patients with NASH, grade 1 obesity and COPD 2–3 D, in addition to similar COPD therapy, for the treatment of NASH, instead of essential fatty acids complex, received antral at a dose of 200 mg 3 times daily and, additio­nally, policosanol at a dose of 20 mg after the dinner for 30 days. The comparison group consisted of 30 apparently healthy individuals. Results. The proposed therapy with antral reduced the intensity of lysis of azoalbumin, azocasein and azocol in patients of group O2: at day 30, the decrease was 1.3, 1.2 and 1.6 times (p < 0.05), respectively, in patients of the group O1: on day 30, the decrease was 1.2, 1.2 and 1.6 times (p < 0.05), respectively, compared to the pre-treatment values. In the group C, the values decreased less intensively (p < 0.05): only the azocol values were likely to change — 1.3 times (p < 0.05) with the presence of a significant difference with the groups O1 and O2 (p < 0.05). Conclusions. The combined administration of antral for 30 days resulted in a significant correction of proteinase-inhibitory homeostasis in patients with NASH associated with obesity and COPD, which was accompanied by a significant decrease in endotoxicosis (p < 0.05) and damaging effect of systemic proteolysis (p < 0.05).