UA131175U - METHOD OF CORRECTION OF BLOOD LIPID SPECTRUM IN NON-ALCOHOLIC STEATOGEPATHY WITH COMEBORITY WITH OSTEOARTHrosis - Google Patents

Abstract

The method of correction of blood lipid spectrum in non-alcoholic steatohepatitis in comorbidity with osteoarthritis involves the use of complex etiopathogenetic treatment of osteoarthritis. Additionally, prescribe guar (1 pack / dose contains 5 g of guar gum) 1 sachet (5 g) or 1 tbsp of pellets (5 g) 3 times a day for 80 days.

Description

The useful model belongs to the field of medicine, namely to internal medicine and gastroenterology and can be applied to correct the blood lipid spectrum in non-alcoholic steatohepatitis with comorbidity with osteoarthritis.

The problem of the development and progression of non-alcoholic fatty liver disease (NAFLD) is currently one of the most important in modern internal medicine and has general medical and social significance (O.Ya. Babak, 2009, V.V. Kharchenko, 2013, K.M. Amosova , 2008). In Ukraine, from 1995 to 2005, mortality from cirrhosis of the liver of non-viral etiology among men aged 40 to 55 increased 3.5 times, and among men in general - 2 times (O. Ya. Babak, 2009) . At the same time, obesity is a very important problem in Ukraine and the world today (V.M.

Kovalenko, 2012). In Ukraine, one in four women and one in six men is overweight. In total, about 15,95% of the population of our country suffers from obesity (G.D. Fadeyenko, 2009; V.M. Hvorostinka, 2008). The social significance of the increase in the incidence of obesity is that it is the most important component of the metabolic syndrome and a risk factor for the development of vascular and various dysmetabolic complications (M.D. Tronko, P.M.

Karabun, 2006).

Among the complications of obesity, an important place is the formation of non-alcoholic steatosis of the liver and steatohepatitis, the occurrence of which reduces the quality of life of patients, contributes to the development of impaired glucose tolerance, significant disorders of lipid metabolism. Frequency of occurrence

NAFLD in obese patients is, according to various authors, from 4595 to 85905 (G.D.

Fadeyenko, 2009). The conducted studies established that the main etiological factors in the development of NAFLD are the uncontrolled use of hepatotoxic drugs (antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), exposure to harmful production factors (hepatotropic poisons), genetically determined storage diseases (hemochromatosis, Konovalov-Wilson disease, deficiency of a? 1-proteinase inhibitor), type 2 diabetes, obesity, etc. (O.Ya. Babak, 2009; G.D. Fadeyenko, 2009; N.V. Marchenko, 2009). The leading issue of the prognosis of steatohepatitis and steatosis is the transformation into cirrhosis of the liver, as well as its progression with the development of hepatocellular insufficiency (O. Ya. Babak, 2009). However, many questions regarding the mechanisms of development and progression of liver fibrosis against the background of nonalcoholic steatohepatitis (NASH) with comorbid obesity remain unexplored.

The problem of osteoarthritis (OA) has recently gained special importance and urgency due to the significant prevalence of the disease, the rapid development of functional disorders and the disability of people of various ages (N.M. Shuba, T.D. Voronova, T.N. Tarasenko, A. WITH.

Kryilova, 2012). In connection with the frequent occurrence of pain syndrome in patients with osteoarthritis (on the background of reactive synovitis), there is a need to prescribe nonsteroidal anti-inflammatory drugs (T.D. Zvyagintseva, A.M. Chernobaj, 2014). Application security problem. NSAIDs are especially relevant for patients with AS in combination with other diseases: arterial hypertension, obesity, NAFLD, which significantly change their course due to the use of these drugs (V.N. Kovalenko, G.A. Protsenko, 2012). Therefore, the application

NIPZP in OA with comorbidity with NAFLD against the background of obesity is a complex and ambiguous problem that requires further resolution.

An analogue of the useful model is the method of treating osteoarthritis (patent of Ukraine Mo 35156 IPC

AbIK 31/00, "Method of treating osteoarthritis", V.M. Kovalenko, O.P. Bortkevich, N.M. Shuba,

G.O. Protsenko, N.S. Boychuk, applicant - Institute of Cardiology named after Academician M.D. Strazheska Medical University

of Ukraine. - MO and 200712965; statement 23.11.2007; published 10.09.2008, Bull. Mo 17), in which diacerein is used as an anti-inflammatory and structural-modifying drug with the use of folic acid and vitamin B12, and diacerein is initially used in a dose of 1 capsule/day, and folic acid and vitamin B12 in a dose of 0.8-2.0 mg for 3 -4 weeks, and then diacerein is used at a dose of 2 capsules/day for 3-6 months.

The drawback of the analogue is that the treatment does not take into account the combination of osteoarthritis with non-alcoholic steatohepatitis. Sometimes, when used in individuals with individual hypersensitivity to any component of the drug, hypersensitivity reactions may occur.

The closest analogue of the useful model is the method of complex treatment of osteoarthritis in patients with arterial hypertension and obesity (patent of Ukraine Me 101675 MPK AbI1TR 29/00,

AbIK 31/00, "Method of comprehensive treatment of osteoarthritis in patients with arterial hypertension and obesity", Khukhlina O.S., Tanas O.V., applicant - Bukovyna State Medical University of the Ministry of Health of Ukraine - Application No. 201502985; statement 31.03.2015; published 25.09.2015, Bull. Mo 18), in which additional to complex etiopathogenetic treatment of osteoarthritis, diacerein (flexerin) is prescribed at a dose of 50 mg 1 time a day after meals during the first week with a further transition to 50 mg 2 times a day for 3 months (in total), because the drug NSAIDs - meloxicam (revmoxicam) at a dose of 1.5 ml intramuscularly for 2 weeks and standard therapy of hypertension in combination with obesity according to the protocol, which includes a Mo 10 diet, the use of drugs from the group of angiotensin-converting enzyme inhibitors: ramipril 5 -10 mg 1-2 times a day or perindopril 4-8 mg 1 time a day, or lisinopril 5-10 mg 1-2 times a day, or enalapril 5-10 mg 1-2 times a day; as needed, a diuretic indapamide 2.5 mg once a day and a statin - rosuvastatin 10 mg once a day.

The disadvantages of the closest analogue are that the treatment does not take into account the combination of osteoarthritis with non-alcoholic steatohepatitis, besides, diacerein begins to act from the 2nd week of treatment, and the patient suffers from pain before its onset.

The basis of a useful model is the task of improving the method of correcting the blood lipid spectrum in non-alcoholic steatohepatitis with comorbidity with osteoarthritis by prescribing the drug guar in addition to the complex etiopathogenetic treatment of osteoarthritis.

The task is solved by the fact that in the method of correcting the lipid spectrum of the blood in case of non-alcoholic steatohepatitis with comorbidity with osteoarthritis, which includes the use of complex etiopathogenetic treatment of osteoarthritis, according to a useful model, guar is additionally prescribed (1 sachet/dose contains 5 g of guar gum) 1 sachet (5 g) or 1 measuring spoon of granules (5 g) 3 times a day during meals for 80 days.

Guarem (1 packet/dose contains 5 g of guar gum) - guar gum is a dietary fiber that is obtained from the endosperm of the seeds of Suatorbtis eijgadopoiyu0by5. Guar gum is a polysaccharide that forms a viscous gel with water. Guar resin significantly prolongs gastric emptying, as well as the absorption of carbohydrates in the small intestine. Thus, it reduces hyperglycemia and insulin concentrations. With long-term use, guar gum reduces the initial level of glucose in the blood by approximately 1-2 mmol. It is believed that the serum cholesterol-lowering effect is due to reduced absorption of cholesterol, increased secretion of bile acids, and increased cholesterol metabolism in the liver. That is, the effect of guar gum is similar to the effect of resins that bind bile acids. With monotherapy with guar gum, the levels of total cholesterol and low-density lipoproteins in the serum are reduced by approximately 10-15 95.

Definition of terms used when describing a useful model.

Non-alcoholic steatohepatitis (NASH) is an independent nosological entity, which is characterized by an increase in the activity of liver enzymes in the blood and morphological changes in liver biopsies, similar to changes in alcoholic hepatitis - fatty dystrophy and an inflammatory reaction, but patients with

NASH do not drink alcohol in quantities that can cause liver damage. The term "non-alcoholic" emphasizes the separation of this nosological unit from alcoholic disease.

Steatohepatitis - inflammatory infiltration of the liver against the background of fatty dystrophy of hepatocytes and fibrosis, which can contribute to the development of steatogenic liver cirrhosis.

Osteoarthritis (deforming arthrosis) is a degenerative-dystrophic disease in which all articular surfaces are subject to pathological changes, which is also supplemented by the formation of marginal osteophytes. Osteophytes are specific growths that form on the surface of bone tissue.

Guarem (1 packet/dose contains 5 g of guar gum) is an oral hypoglycemic drug.

A useful model is implemented as follows.

A patient with non-alcoholic steatohepatitis and osteoarthritis is prescribed complex etiopathogenetic treatment of osteoarthritis, to which guarem is additionally prescribed 1 sachet (5 g) or 1 measuring spoon of granules (5 g) 3 times a day during meals for 80 days.

Examples of the use of a useful model.

Patient V., 58 years old. Diagnosis: Non-alcoholic steatohepatitis, moderately active. Osteoarthrosis, monoosteoarthrosis (right-sided coxarthrosis), without noticeable progression, clinical and X-ray stage I, FNS I. She complained of discomfort in the right subcostal area, nausea, joint pain, joint swelling, decreased appetite, general weakness, rapid fatigue.

He has been ill for 4-5 years. She was periodically treated at her place of residence. The patient underwent a number of examinations, including clinical blood and urine tests, biochemical tests (total bilirubin, conjugated and unconjugated bilirubin content, thymol test, proteinogram, coagulogram, blood lipid spectrum, blood amylase activity, electrolytes, enzyme activity: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AL), γ-glutamyltransferase (γ-HT7), blood urea, creatinine.

Complex ultrasound examination (US) was performed on an ultrasound scanner "ASH-4 Idea" (Vioteaisa, Italy). The stage of liver tissue fibrosis was studied using

FibroTest, the degree of fatty liver dystrophy was studied using SteatoTest (Viorgedissime, France). Examinations were carried out before treatment and on the 30th day of treatment.

The lipid spectrum of the blood was studied by the content of total lipids, total cholesterol (HO), triglycerides (TG), low-density lipoproteins (LDL) and high-density lipoproteins (HDL) in the blood with the help of diagnostic standard sets of the company "Sapizy Ts" (M.

Lviv). The level of LDL-C in the blood was calculated using the mathematical formula: content

TG/2,2. The atherogenicity index (AI) was also calculated based on the ratio of the content of total xCs/LDL.

Objective examination data: the general condition of the patient is of medium severity. Consciousness is clear.

The position in bed is active. Height - 172 cm. Weight - 86 kg. The skin is pale, inelastic, without rashes, dry. Mucous membranes are available for examination - pale pink in color, without rashes and hemorrhages. Both halves of the chest take equal part in the act of breathing. The type of breathing is mixed, with a predominance of thoracic. The frequency of respiratory movements is 18-20 per minute. Vesicular breathing is heard over the lungs, side breath sounds are not heard. The area of the heart has not changed, the pulsation of the vessels of the neck is noticeable, the jugular veins are not swollen in a sitting position. The tones of the heart are clear, rhythmic. Heart rate (HR) - 82/min, pulse rhythmic, of satisfactory properties, blood pressure - 120/80 mm. mercury Art. The abdomen is soft on palpation, sensitive in the right hypochondrium.

The liver is 2 cm from the edge of the costal arch. The edge is rounded, sensitive to palpation.

Ultrasound examination of abdominal organs. The liver was examined completely from the right hypochondrium, in the supine position. Dimensions: left lobe: anterior-posterior - 85 mm (enlarged), vertical 95 mm (enlarged); tail lobe: thickness - 35 mm (enlarged); right lobe: front-back - 132 mm, vertical - 178 mm (enlarged). The contour of the liver is even, indistinct, the lower edge is rounded, the capsule is not changed. The echo structure of the parenchyma of increased echogenicity with an indistinct granular pattern is heterogeneous. The sound conductivity of the tissue is significantly reduced (dorsal attenuation of the ultrasound signal). The vascular pattern is impoverished.

In this regard, correction of pathologies was prescribed according to the proposed method. The patient was comprehensively examined after treatment and after 12 weeks, examined every 2 weeks. After the correction, the patient's condition improved slightly: the pain syndrome, dyspeptic and astheno-vegetative syndrome decreased, and the general well-being improved.

The indicators of the blood lipid spectrum in patients with non-alcoholic steatohepatitis with comorbidity with osteoarthritis in the dynamics of treatment with guarem (Met) are shown in the table.

Measurement table

Notes: x - changes are probable in comparison with the indicator in the PZO (p«0.05); "x - changes are probable when comparing indicators in patients with NASH (p"e0.05);

I - changes are probable when comparing indicators before treatment (p<0.05).

Therefore, the proposed useful model allows reducing the intensity of progression of non-alcoholic steatohepatitis by eliminating signs of exacerbation of clinical syndromes of this pathology: correction of the main clinical and biochemical syndromes of the main and comorbid diseases, normalization of the blood lipid spectrum, normalization of the total cholesterol level,

LYNS (low-density lipoproteins) in blood serum. Compared to the closest analogue, the useful model leads to the probable elimination of risk factors for the development of non-alcoholic steatohepatitis in patients with osteoarthritis and eliminates the threat of complications.

The proposed method makes it possible to effectively correct the state of the blood lipid spectrum in non-alcoholic steatohepatitis with comorbidity with osteoarthritis by eliminating signs of exacerbation of clinical syndromes with comorbidity of these pathologies.

Claims (1)

USEFUL MODEL FORMULA The method of correcting the blood lipid spectrum in non-alcoholic steatohepatitis with comorbidity with osteoarthritis, which includes the use of complex etiopathogenetic treatment of osteoarthritis, which is distinguished by the fact that guar is additionally prescribed (1 packet/dose contains 5 g of guar gum) 1 sachet (5 g) or 1 measuring spoon of granules (5 g) 1 time per day during meals for 80 days.