HISTOLOGICAL AND HISTOCHEMICAL FEATURES OF LIVER AND LUNG TISSUE IN PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS AND OBESITY DEPENDING ON THE PRESENCE OF COMORBID CHRONIC OBSTRUCTIVE PULMONARY DISEASE.

Objective - to establish the pathomorphological features of liver and lung tissue of patients with non-alcoholic steatohepatitis (NASH) and obesity depending on comorbidity with chronic obstructive pulmonary disease (COPD). The study used autopsy material of 13 cases of NASH and class I obesity (Group 1), 14 cases of NASH, class I obesity with comorbid COPD of stage II-III (Group 2). For comparison, we used the autopsy material of 12 patients with isolated COPD of stage II-III (Group 3), as well as 11 practically healthy individuals (PHI), whose death was caused by polytrauma or traumatic brain injury or sudden coronary death. The groups were randomized by age, sex, and class of obesity. The average age of patients was 59.3±3.21. In Group 2 there was a maximum percentage of hepatocytes in the state of steatosis (1.9 times more than in Group 1, p<0.05), 1.6 times more hepatocytes in the state of fatty necrosis compared with NASH, p<0.05), oncosis (2.1 times, p<0.05), as well as lipofuscinosis (3.1 times more than in case of NASH with obesity, p<0.05). The combined course of obesity, NASH and COPD contributed to a significant increase in the number of lipocytes in the lungs (29.6 times, p<0.05) compared with isolated COPD, as well as a probable increase in their diameter (1.8 times, p<0.05). In the comorbid course of NASH, obesity and COPD, more intense histological and histochemical changes were observed, indicating more significant dysmetabolic disorders and the role of COPD in the activity of the inflammatory process in the liver, namely a higher % of steatosis in hepatocytes. Accumulation of adipocytes was observed in the lungs in this combined pathology, which probably indicates the aggravating effect of NASH and obesity on the course of COPD.

EFFECTIVENESS OF NONALCOHOLIC STEATOHEPATITIS CORRECTION ON THE BAСKGROUND OF OBESITY WITH CONCOMITANT CHRONIC KIDNEY DISEASE.

The article presents a theoretical generalization of the research results the effectiveness of heparisin on the state of the carbohydrate-protein components of the extracellular matrix of connective tissue in liver in patients with non-alcoholic steatohepatitis with obesity I-II degree and chronic kidney disease І-ІІ stage. The purpose of the study is to find out the effectiveness of heparisin (glycyrizine 40 mg, glycine 400 mg, L-cysteine hydrochloride 20 mg) on the state of the carbohydrate-protein components of the extracellular matrix in connective tissue of the liver in patients with non-alcoholic steatohepatitis (NASH) with obesity I-II degree and chronic kidney disease (CKD) І-ІІ stage. 98 patients with NASH on the background of obesity of the I-II degree were examined, including: 52 patients with NASH (I group) (without accompanying CKD), 46 patients with NASH with comorbid CKD І-ІІ stage (II group). The control group consisted of 20 practically healthy persons (PHPs) of the corresponding age and sex. Biopsy of the liver was performed on 32 NASH patients with CKD I-II, 28 patients with NASH without CKD. Patients on both groups of NASH received heparisin treatment (glycyrizine 40 mg, glycine 400 mg, L-cysteine hydrochloride 20 mg) (Valartin Pharma) by intravenous administration of 20 ml of the drug for 10 days followed by enteral administration of 2 tablets of heparysin (1 tablet : glycyrizine 25 mg, glycine - 25 mg, methionine - 25 mg) 3 times a day for 80 days. Patients with NASH and a comorbid flow of obesity and CKD of the І-ІІ stages, except for heparisin, received baseline therapy of CKD І-ІІ stage: chronic pyelonephritis. Heparizin therapy for 3 months contributed to the achievement of a collagen anabolic and catabolic balance by activating collagenase, inhibiting the activity of proteolytic inhibitors and collagenase, inhibition of fibroblast growth factor secretion, acute phase inflammation, reducing extracellular matrix fucoglycoproteinsdegradation in liver, and in general, reducing the activation of connective tissue components, by evidence which led to a decrease in the liver fibrosisindex according to the fibrotest in the range of 1.5-2.0 times.

PECULIARITIES OF THE CLINICAL COURSE OF NON-ALCOHOLIC STEATOHEPATITIS AGAINST THE BACKGROUND OF THE CHRONIC KIDNEY DISEASE OF THE I-III STAGE WITH SECONDARY ARTERIAL HYPERTENSION.

The article addresses the theoretical generalization of the clinical study of non-alcoholic steatohepatitis peculiarities in comorbidity with obesity and chronic kidney disease of the І-ІІІ stage, characterized by higher frequency and intensity of clinical and biochemical syndromes, the manifestation of which is likely to increase the occurrence of secondary arterial hypertension (portal hypertension syndromes, cholestasis, mesenchymal inflammation). Comorbid course of non-alcoholic steatohepatitis with chronic kidney disease is characterized by higher degree of liver steatosis compared to the patients with only non-alcoholic steatohepatitis (p<0.05), and a higher diagnostic threshold of the hepatorenal index values, which correlates with the Steato-test index (p<0.001) with strong interdependence.

[The use of complex tools ezetimibe, hepadyfu fosinopril and correction of blood pressure and endothelial dysfunction in patients with nonalcoholic steatohepatitis and essential hypertension stage II].

The article investigates the impact of complex tools fosinopril, hepadyf and ezetimibe for correction of functional state of the endothelium and changes in blood pressure in patients with nonalcoholic steatohepatitis, obesity and essential hypertension stage II.