UA140752U - METHOD OF CORRECTION OF PROGRESSION OF GLUCOSE HOMEOSTASIS DISORDERS IN PATIENTS WITH NON-ALCOHOLIC STEATOGEPATITITIS - Google Patents

Abstract

In the method of correcting the progression of disorders of glucose homeostasis in patients with nonalcoholic steatohepatitis by prescribing a comprehensive etiopathogenetic treatment of nonalcoholic steatohepatitis additionally prescribe guar 1 sachet 2 times a day - until the clinical effect.

Description

The useful model belongs to the field of medicine, namely to gastroenterology, therapy and other fields of clinical medicine, and can be used to correct the progression of glucose homeostasis disorders in patients with non-alcoholic steatohepatitis.

Today, nonalcoholic fatty liver disease (NAFLD) is one of the most common diseases in hepatology, which leads to a deterioration in the quality of life and a decrease in its duration. This is due, first of all, to a high risk of progression of nonalcoholic steatohepatitis (NASH) with the development of liver failure (BI hepatocellular carcinoma. The maximum risk of developing NAFLD was noted in the group of people with obesity, hypertriacylglycerolemia (Nagau 0.5, Yegaiipav O.T., Sagmip 9. T., Khi N., Vasene 5.V., 2017). The etiology of NAFLD is diverse, although its close connection with insulin resistance (IR) is noted. The liver is the main target of damage in conditions characterized by IR, which is a risk factor progression of hepatic steatosis in NASH, with its inherent risk of progression to cirrhosis.

IR is more pronounced in patients with abdominal obesity. These differences are caused by genetically different expression of adipocyte genes in abdominal and subcutaneous fat tissue (Kravchenko N.A., Klymenko N.N., 2012). Hyperglycemia and hyperinsulinemia have an important prognostic value in patients with NAFLD. Impaired carbohydrate tolerance and type 2 diabetes have been shown to stimulate lipogenesis (Sioba! Neay OBzegchayugu (СНО) daiga: Obrezyu, 2018). The increase in the number of overweight and obese people today is one of the most important health care problems in all countries, which is associated with a huge number of diseases associated with increased body weight (Dralova O.V. , 2012).

It is well known that NAFLD occurs frequently in the context of the metabolic syndrome (MS).

The prevalence of MS in patients with NAFLD increases with an increase in body mass index (BMI) (Va!teg M.G., dopeii U., Zspoeriega A., Biiskei! E., Tpoptapp MU., Oitoig U.R., 2010) .

As the closest analogue, the method of treatment of insulin resistance in patients with type 2 diabetes with accompanying non-alcoholic steatohepatitis was chosen (Method of treatment of insulin resistance in patients with type 2 diabetes with accompanying non-alcoholic steatohepatitis: pat. 70026 Ukraine. Mo 20031212151 dated 23.12.2003; publ. 15.09. 2004, Bull. Mo

From 9), in which metformin is prescribed in a dose of 500 mg 2 times a day, in addition to the basic treatment complex, glutargin is included in the case of a low degree of activity of steatohepatitis in 50 ml of 4 95 solution intravenously as a drip per 200 ml of 0.9 95 sodium chloride solution for 5 days , with a moderate degree of activity of steatohepatitis - for 10 days, and in the future - enterally 2 tablets (500 mg) C times a day for 2 months.

The disadvantages of the closest analogue are that when using the specified method, side effects of glutargin may be noted, namely general disorders: shortness of breath, pain behind the sternum, increased body temperature, chills, changes in the injection site, phlebitis; from the side of the cardiovascular system: atrial fibrillation, a decrease in blood pressure, tachycardia; from the side of the digestive system: nausea, pain in the epigastric area; from the immune system: hypersensitivity reactions, including skin rashes, itching, hyperemia, urticaria, angioedema.

The useful model is based on the task of improving the method of correcting the progression of glucose homeostasis disorders in patients with nonalcoholic steatohepatitis by prescribing the drug guar in addition to the complex etiopathogenetic treatment of nonalcoholic steatohepatitis.

Common features of a useful model and the closest analogue are the appointment of complex etiopathogenetic treatment of non-alcoholic steatohepatitis.

Distinctive features of a useful model from the nearest analog are that the drug guarem is additionally prescribed for 1 sachet (5 g) 2 times a day - until the clinical effect is obtained.

Definition of terms used in the description of the useful model: glucose homeostasis disorder, nonalcoholic steatohepatitis, etiopathogenetic treatment, guarem drug.

Theoretical prerequisites for the implementation of a useful model.

Insulin resistance is an insufficient biological response of cells to the action of insulin when its concentration is sufficient in the blood. It plays a significant role in the pathogenesis of carbohydrate metabolism disorders, which is manifested by the development of impaired glucose tolerance and type 2 diabetes.

Nonalcoholic fatty liver disease is a syndromic complex of interconnected nosologies, the components of which are: steatosis of the liver, that is, the accumulation of triacylglycerides and fatty inclusions in the liver over 5 95 of its weight.

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. At the moment, the distribution of the stage of development of fatty liver damage remains relevant.

Guar resin is a dietary fiber obtained from the endosperm of the seeds of Suatorzvi

Ivigtadopoioriv, contains up to 70 95 higher polysaccharide galactomannan. It is not absorbed from the digestive tract, is partially decomposed by bacteria and increases the volume of fecal masses by approximately 20 95. It is a product of plant origin, so the natural medicine of guar gum can be used in a regular diet during meals, dissolved in any liquid (juice, water, milk), or added to any food. Since it does not have a systemic effect, but affects only the level of the digestive tract, the preparation of guar gum can be used by children, pregnant women and lactating women for a long time.

The drug, thanks to its gel-forming ability, significantly increases the viscosity of liquid food and, due to the thickening of the diffusion layer of carbohydrates near the villi of the mucous membrane of the small intestine, slows down their absorption. By increasing the volume of chyme and slowing down the emptying of the stomach, guar provides a quick feeling of satiety. Thus, the drug reduces the feeling of hunger and the amount of food consumed. A decrease in the absorption of carbohydrates in the small intestine leads to a decrease in the peaks of hyperglycemia and insulin concentration.

The use of the drug guarem against the background of a low-calorie diet leads to a more effective reduction of glycemia, HrAiYs, and body weight. In addition, there is a tendency to decrease postprandial glycemia, decrease in the volume of the waist and hips.

To control the treatment, the patient is comprehensively examined before the correction, 30 and 90 days after the correction.

A useful model is implemented as follows.

A patient with non-alcoholic steatohepatitis with a violation of glucose homeostasis is prescribed complex etiopathogenetic treatment of non-alcoholic steatohepatitis and is additionally prescribed the drug guarem, 1 sachet (5 g) 2 times a day - until the clinical effect is obtained.

An example of using a useful model.

Patient M., 54 years old. She complained of heaviness and discomfort in the right hypochondrium, abdominal distension, general weakness and rapid fatigue. He has been ill for 7-9 years.

She was periodically treated at her place of residence. The patient underwent a number of examinations: general clinical blood and urine tests, biochemical blood tests for total cholesterol (C), high-density lipoprotein cholesterol (HDL) and triacylglycerol (TG).

A Comprehensive ultrasound examination (US) was performed on an ultrasound scanner "AO-4 Idea" (Viotedisa, Italy) with a convex sensor with a frequency of 3.5 MHz, which included ultrasound examination (US) on a real-time scale in B-mode.

Objective examination data: The general condition of the patient is conditionally satisfactory. Consciousness is clear.

The position in bed is active. The body structure is correct. The constitution is hypersthenic. Height - 179 cm.

Weight - 83 kg. The skin is of normal color, elastic, without rashes, dry. Mucous membranes are pale pink in color, without rashes and hemorrhages. Subcutaneous adipose tissue is excessively developed, more so on the abdomen. The muscles are well developed, their tone is preserved. There are no swellings.

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 per minute. The chest is not painful during palpation, it is elastic, the voice tremor is performed equally in symmetrical areas. Over the lungs, vesicular breathing, side respiratory noises are not heard, bronchophony, whispering is performed indistinctly equally over symmetrical areas of the lungs.

The area of the heart has not changed, the pulsation of the vessels of the neck is not noticeable, the jugular veins are not swollen in a sitting position. The tones of the heart are clear, rhythmic. The vascular bundle does not extend beyond the sternum. The waist of the heart in the form of a right angle. Heart rate (HR) - 80 bpm, pulse rhythmic, blood pressure 135/80 mm Hg. Art. The abdomen is soft on palpation, sensitive in the right hypochondrium. Liver - 3-4 cm from 3- below the edge of the costal arch. The edge is dense, 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 - 82 mm (enlarged); tail lobe: thickness -35 mm (enlarged); right lobe: anterior-posterior - 136 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 is uniform. The vascular pattern is impoverished.

Final diagnosis: Non-alcoholic steatohepatitis, moderate activity, in the acute stage.

Violation of glucose tolerance.

For this reason, complex etiopathogenetic treatment of non-alcoholic steatohepatitis was prescribed. 1 sachet (5 g) 2 times a day was added to the main treatment until the clinical effect was achieved.

During the study, there were no cases of side effects of the medication. The dynamics of the correction are presented in the following table. (510)

Table

Indicators of glucose homeostasis and the degree of insulin resistance in the patient

M., a patient with non-alcoholic steatohepatitis, in the dynamics of correction with the drug guar

Indicators Normative Before correction After 30 days After 90 days

Fasting glucose

Glucose h-z 2 h. 10.35

Insulin, μU/ml 26.87 15.54 11.03

NBA!S, 96

NOMAIV

It can be seen from the table that the use of complex etiopathogenetic treatment with the inclusion of the drug guarem was effective, as the indicators after correction approach the normative ones. The drug has proven its ability to achieve stable normalization of carbohydrate metabolism indicators for a long period of time; guar gum promotes rapid compensation of carbohydrate metabolism in case of impaired tolerance to carbohydrates, resensitization of insulin receptors and elimination of IR syndrome.

Therefore, the proposed method leads to the elimination of risk factors for the development of non-alcoholic steatohepatitis, contributes to the rapid compensation of carbohydrate metabolism in the case of impaired tolerance to carbohydrates, resensitization of insulin receptors and elimination of the syndrome of peripheral

IR of tissues (due to a decrease in the absorption of carbohydrates, fermentation products in the intestine, toxins of intestinal bacteria with increased excretion, a decrease in the degree of endogenous intoxication, oxidative stress) and, thus, eliminates the threat of decompensation of the process.

Technical result. The proposed method makes it possible to effectively correct the progression of glucose homeostasis disorders in patients with nonalcoholic steatohepatitis by eliminating signs of exacerbation of clinical syndromes of this pathology.

Claims (1)

USEFUL MODEL FORMULA A method of correcting the progression of glucose homeostasis disorders in patients with non-alcoholic steatohepatitis by prescribing a complex etiopathogenetic treatment of non-alcoholic steatohepatitis, which is distinguished by the fact that guarem is additionally prescribed 1 sachet 2 times a day - until the clinical effect is obtained.