ABSTRACT
Objective of the study was to determine the effectiveness of various groups of hepatoprotectors in the treatment of patients with nonalcoholic steatohepatitis (NASH) sufferers of the accident at the Chornobyl NPP following the assessment of metabolic changes and control of persistent infections. MATERIALS AND METHODS: The study included 104 males with NASH, who were sufferers of the Chornobyl disaster and underwent examination and treatment in the conditions of the clinics of the National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine. Analysis of the course of the functional state of the liver before and after treatment with hepatoprotectors was carried out using laboratory methods of investiga tion. RESULTS: Hepatoprotectors of different groups used for the treatment of patients affected by the Chornobyl accident with NASH, differed in their effect on various chains in the pathogenesis of disease. Ursodeoxycholic acid (UDCA) drugs and preparations of holy thistle normalized the functional state of the liver and disorders of fat metabolism. Treatment with essential phospholipids eliminated cytolytic syndrome with a significant decrease in alanine amino transferase (p < 0.05), but increased alkaline phosphatase (p < 0.001), beta lipoproteins (p < 0.05), triglycerides (p < 0.05), the total cholesterol level remained elevated to (7.0 ± 0.8) mmol/L. Amino acid (AA) preparations normal ized the level of aminotransferases, eliminated the symptoms of cholestasis with a significant decrease in bilirubin (p < 0.001) and alkaline phosphatase (p < 0.001), positively influenced on fat and carbohydrate metabolism decreasing levels of beta lipoproteins (p < 0.05), triglycerides and glucose. Treatment with hepatoprotectors posi tively influenced on the state of antioxidant protection (AOP) - decreased before treatment in 56.5 % of patients, after treatment it reduced to 28.6 % (p < 0.05), the number of patients with elevated lipid peroxidation indices decreased from 39.1 % to 21.4 %. Titres of antibodies to persistent herpes virus infections, elevated before treat ment, under the influence of hepatoprotectors did not decrease to reference values. CONCLUSION: The most effective were drugs on the basis of AA, when applied they normalized the functional state of the, fat and carbohydrate metabolism, decreased lipoperoxidation and improved AOP state. Effect of drugs AA and UDCA on the level of antibodies to herpesvirus infection requires further study.
Subject(s)
Chernobyl Nuclear Accident , Herpesviridae Infections/drug therapy , Non-alcoholic Fatty Liver Disease/drug therapy , Occupational Exposure/adverse effects , Protective Agents/therapeutic use , Radiation Exposure/adverse effects , Radiation Injuries/drug therapy , Alanine Transaminase/blood , Alkaline Phosphatase/blood , Amino Acids/therapeutic use , Bilirubin/antagonists & inhibitors , Bilirubin/blood , Cholesterol/blood , Cnicus/chemistry , Emergency Responders , Herpesviridae Infections/blood , Herpesviridae Infections/etiology , Herpesviridae Infections/pathology , Humans , Lipid Metabolism/drug effects , Lipid Metabolism/radiation effects , Lipoproteins, LDL/blood , Liver/drug effects , Liver/metabolism , Liver/pathology , Liver/radiation effects , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/blood , Non-alcoholic Fatty Liver Disease/etiology , Non-alcoholic Fatty Liver Disease/pathology , Phospholipids/therapeutic use , Plant Extracts/chemistry , Plant Extracts/therapeutic use , Prospective Studies , Radiation Injuries/blood , Radiation Injuries/etiology , Radiation Injuries/pathology , Triglycerides/blood , Ursodeoxycholic Acid/therapeutic useABSTRACT
Objective - to study of the structure of comorbid diseases in patients with nonalcoholic fatty liver disease (NAFLD), exposed to ionizing radiation due to the Chornobyl accident, and in the groups of comparison. Materials and methods. Array of surveyed males was divided into 4 groups: the main group - 136 patients with NAFLD affected by the Chornobyl NPP accident, the first comparison group (Ð CG) - 28 affected by Chornobyl NPP accident without liver disease, the second comparison group (II CG) - 50 patients with NAFLD not exposed to factors of the Chornobyl disaster, and the third comparison group (III CG) - 16 unexposed persons without liver disease. Results. A significant amount of co-morbid pathology was found in all studied groups but III CG: at the average from 4.1 ± 0.4 diseases in II CG to 5.2 ± 0.2 in the main group of patients (p < 0.05), among which in 6.6-7.1 % of cases more than 10 diseases were established. The most common disorders were cardiovascular and cerebrovascular and endocrine diseases. Structure of comorbid pathology in NAFLD in the main study group differed from this in II CG by a significantly greater frequency of detection of cerebrovascular diseases (73.5 and 56 %, p < 0.05). As for features of the metabolic syndrome in Chornobyl accident sufferers essential hypertension (71.3 % ), discirculatory encephalopathy (48.5 %) and thyroid diseases (47.1 %) were more frequent than in II GC: correspondingly 58 % (p < 0.001), 28 %, (p < 0.01), and 30 %, (p < 0.05). Essential hypertension in only 35.7 % patients without NAFLD (I CG) was detected (71.3 % in the study group, p < 0.01), and chronic cerebrovascular insufficiency in 71.4 % (39.7 % in the study group, p < 0.01). Conclusion. Structure of comorbid pathology in NAFLD patients sufferers of the Chornobyl NPP accident was different both in a large number of identified diseases and nosological structure. The most common disorders were cardiovascular, cerebrovascular, and endocrine diseases. Significantly higher incidence of essential hypertension, vascular encephalopathy, and thyroid disease was determined.
ABSTRACT
Objective - to define the features of viruses persistence belonging to the Herpesviridae family in patients with non-alcoholic fatty liver disease (NAFLD) who had been exposed to the factors of Chornobyl NPP accident. Material and methods. The main group included 45 male NAFLD patients sufferers of Chornobyl NPP accident with absorbed doses of external irradiation in the range of 10-580 mSv. The group of nosology comparison consisted of 20 male NAFLD patients with the doses of irradiation within the limits of natural radiation background and regulated doses of medical irradiation. Antibodies to the viruses of herpes simplex 1/2 types (anti-HSV-1/2 IgG), cytomegalovirus (anti-CMV IgG) and Epstein-Barr virus (anti-EBV IgG) were determined by ELISA according to instructions of manufacturer. Results. There were no patients in both groups without IgG antibodies characterizing persistence of some Herpesviridae representative. Tendencies to the increase of antibodie levels to the viruses of herpes simplex, cytomegaly and Epstein-Barr in the seropositive patients, who had been exposed to the factors of Chornobyl NPP accident relative to the patients of group of nosology comparison were found. There were no differences between the subgroups of patients with steatohepatosis (SH) and nonalcoholic steatohepatitis (NASH) in the main group by anti-HSV-1/2 IgG and anti-CMV IgG levels while in the group of comparison SH patients had 60.5 % higher level of anti-HSV-1/2 IgG (p < 0.05) than NASH patients and anti-CMV IgG - 88.2 % respectively. Besides for NASH patients of main group anti-CMV IgG level exceeded 79.6 % (p = 0,02) analogical level for NASH patients in the group of comparison. The mixt infection by the viruses of 1/2 types herpes simplex and cytomegaly was most often determined in all groups with the direct correlation between the levels of anti-HSV-1/2 IgG and anti-CMV IgG. The markers of cytomegalovirus monoinfection were registered only in NASH patients both in main group and in the group of comparison. Conclusion. According to the presence of class IgG antiviral antibodies, NAFLD patients regardless of radiation influence in anamnesis have high prevalence of Herpesviridae family viral infection: herpes simplex 1/2 types, cytomegalovirus and Epstein-Barr virus. In the group of patients who had been exposed to the factors of Chornobyl NPP accident greater part of seropositive results and higher mean values of the probed antibodies titres were registered than in the groups of comparison. The mixt infection by the viruses of herpes simplex 1/2 types and cytomegaly was registered in most patients with existence of direct correlation between the levels of anti-HSV-1/2 IgG and anti-CMV IgG.
