The role of hydrogen sulfide in the progression of chronic obstructive pulmonary disease in patients with non-alcoholic steatohepatitis

Introduction: The steady increase in the incidence of comorbidity of chronic obstructive pulmonary disease and non-alcoholic steatohepatitis against the background of obesity in people of working age in Ukraine and in the world stipulates the need of investigation of the mechanisms of interconnection and the search for new factors of the pathogenesis of progression of this comorbid pathology. Attention to the role of hydrogen sulfide in the development of fibrosis has only been recently paid. The aim: To establish the role of hydrogen sulfide in the mechanisms of progression of chronic obstructive pulmonary disease and non-alcoholic steatohepatitis against the background of obesity. Material and methods: Materials and methods: 100 patients with chronic obstructive pulmonary disease have been examined, including 49 with non-alcoholic steatohepatitis and obesity of the 1st stage: group 1 ­ 28 patients with chronic obstructive pulmonary disease (2B GOLD); group 2 ­ 23 patients with chronic obstructive pulmonary disease (3C, D); group 3 ­ 25 patients with chronic obstructive pulmonary disease (2B) with non-alcoholic steatohepatitis; group 4 ­ 24 patients with chronic obstructive pulmonary disease (3C, D) and non-alcoholic steatohepatitis. The average age of patients was (47.3±3.1) years. There were 20 apparently healthy persons of the corresponding age and sex in the control group. Results: The received data confirm that patients with chronic obstructive pulmonary disease secondary to non-alcoholic steatohepatitis, which developed against the background of obesity, suffer from a significant increase in the synthesis of collagen and glycoproteins, accompanied by an ineffective resorption of newly formed collagen due to insufficient activation of collagenolysis and proteolysis, a significant imbalance in the connective tissue metabolism system, which leads to progressive fibrosis of the lungs and liver and disturbances of their functions. This was caused by the disorder of H2S homeostasis, confirmed by the data of correlation analysis. Conclusions: Patients with chronic obstructive pulmonary disease and non-alcoholic steatohepatitis, which developed against the background of obesity, are characterized by a significant increase in the synthesis of collagen and glycoproteins, which was accompanied by an ineffective resorption of newly formed collagen against the background of substantial activation of proteinase inhibitors (α2-MG), accompanied by the hyperproduction of nitrogen monoxide, endothelin-1, hyperlipidemia, deficiency of hydrogen sulfide liberation.

Clinical and pathogenetic features of nonalcoholic steatohepatitis for comorbidity with bronchial asthma on the background of obesity.

OBJECTIVE: Introduction: The comorbid flow of non-alcoholic steatohepatitis (NASH) and bronchial asthma (BA) on the background of obesity is often recently drawn to the attention of both practitioners and researchers . The aim of our study was to study the changes in the functional state of the liver and the dependence of the external respiration function in patients with non-alcoholic steatohepatitis in combination with bronchial asthma and obesity. PATIENTS AND METHODS: Materials and methods: The study was attended by 50 people aged from 30 to 50 years (average age 42 years), of which 40% were men and 60% women. Of these, 30 patients with obesity I degree (BMI greater than 30 kg / m2) non-alcoholic steatohepatitis was detected, and in 20 of patients, non-alcoholic steatohepatitis was combined with obesity of the I degree and persistent bronchial asthma of moderate severity. Duration of the disease was from 2 to 6 years. The control group consisted of 20 practically healthy persons (PHPs) of the corresponding age and sex. RESULTS: Results: In patients with NASH with comorbid BA and obesity I degree there are more noticed syndromes of cytolysis and cholestasis, mesenchymal inflammation, more significant changes in the liver, as evidenced by the low AST/ALT ratio in this group. Patients with non-alcoholic steatohepatitis on the background of obesity of the I degree with the addition of bronchial asthma of moderate severity and the persistent flow at the exacerbation phase, the content in the blood of markers of the activity of cytolysis of hepatocytes increases (increased activity of aminotransferases serum, p <0,05), cholestasis (increased contentof direct bilirubin in the blood, p <0,05, cholesterol activity, p<0,05, gamma-glutamyltransferase activity, p <0,05 and alkaline phosphatase, p <0,05) and mesenchymal inflammation (increase in the thyme test, p <0,05), which testifies to the aggravating factor and the impact of BA on the course of NASH. CONCLUSION: Conclusion: The presence of visceral obesity and nonalcoholic steatohepatitis in patients with bronchial asthma leads to the accumulation of its clinical course, the deepening of changes in the function of external respiration by obstructive type (a possible decrease in FEV1 and PEF, p<0.05). The presence of obesity and NASH contributed to the development of restrictive type of respiratory insufficiency in the form of a possible decrease in Vital capacity (VC, p<0,05) in patients without BA, and in patients with NASH and obesity with BA, which significantly aggravated its course.