ENDOGENOUS INTOXICATION, LIPID PEROXIDATION AND THE BODY'S ANTIOXIDANT SYSTEM IN GOUT PATIENTS WITH NON-ALCOHOLIC STEATOHEPATITIS
DOI:
https://doi.org/10.11603/mcch.2410-681X.2019.v.i3.10561Keywords:
gout, non-alcoholic steatohepatitis, endogenous intoxication, lipid peroxidation, antioxidant protection system, enterosorbentAbstract
Introduction. Gout and non-alcoholic steatohepatitis are common diseases, but the pathogenesis of this combined pathology has not been sufficiently studied.
The aim of the study – to investigate the severity of endogenous intoxication, malonedialdehyde content and superoxide dismutase activity in the blood of gout patients in combination with non-alcoholic steatohepatitis, as well as to study the therapeutic efficacy of 4th generation сarbon еnterosorbent “Carboline”.
Research Methods. 123 gout patients were examined during the exacerbation period, they were divided into 2 groups. Group I included patients with gout without liver damage, group II got patients with concomitant non-alcoholic steatohepatitis. Each of these groups was subdivided into subgroups, one of which, besides standard treatment, received carbon enterosorbent “Carboline”. All patients underwent a standard clinical examination, as well as a study of the level of average mass molecules in serum with the method of Habrielyan N. and coauthers, determination of malondialdehyde and superoxide dismutase activity in blood plasma by spectrophotometric method.
Results and Discussion. In patients with gout, increased levels of endotoxicosis and imbalance of lipid peroxidation and antioxidant protection were detected. These body changes intensified against the background of concomitant non-alcoholic steatohepatitis. The use of carboline enterosorbent in the complex treatment contributed to the reduction of endotoxicosis and improvement of lipid peroxidation and antioxidant protection: decrease of malonic dialdehyde concentration and increase of superoxide dismutase activity. The increase in endogenous intoxication and the imbalance between lipid peroxidation and antioxidant protection are clearly associated with impaired metabolism and decreased gastric and renal detoxification function, which is inherent in gout. The therapeutic efficacy of carboline is due to the high absorption activity of toxic metabolites in this enterosorbent.
Conclusions. Gout is accompanied by an increase of the endogenous intoxication, in particular the content of molecules of average weight in serum, the content of malondialdehyde and the reduction of superoxide dismutase. These changes are bigger on the background of non-alcoholic steatohepatitis. The use of carboline enterosorbent leads to a decrease of endotoxicosis and an improvement of these lipid peroxidation rates and antioxidant protection.
References
Bychkov, O.A., & Bychkova, N.H. (2018). Rol adhezyvnykh ta tsytokinovykh porushen u perebihu arterialnoi hipertenzii, poiednanoi z podahroiu [The role of adhesive and cytokine disorders in the course of hypertension combined with gout]. Vrachebnoe delo – Medical Practice, (5-6), 30-36 [in Ukrainian].
Mykhailiv, L.M. (2016). Suchasnyi stan problemy rannoi diahnostyky ta adekvatnoho likuvannia podahry [The current state of the problem of early diagnosis and adequate treatment of gout]. Problemy osteolohii – Problems of Osteology, 19 (2), 8-14 [in Ukrainian].
Ragab, G., Elshahaly, M., & Bardin, T. (2017). Gout: an old disease in new perspective–a review. Journal of Advanced Research, 8 (5), 495-511. DOI: https://doi.org/10.1016/j.jare.2017.04.008
Musso, G., Cassader, M., Paschetta, E., & Gambino, R. (2017). Thiazolidinediones and advanced liver fibrosis in nonalcoholic steatohepatitis: a meta-analysis. JAMA Internal Medicine, 177 (5), 633-640. DOI: https://doi.org/10.1001/jamainternmed.2016.9607
Chumak, A.A., Ovsiannikova, L.M., Kubashko, A.V., Sarkisova, E.O., Hasanova, O.V., Alokhina, S.M., & Pleskach, O.Ya. (2013). Osoblyvosti molekuliarnykh mekhanizmiv rozvytku nealkoholnoi zhyrovoi khvoroby pechinky [Features of molecular mechanisms of development of non-alcoholic fatty liver disease]. Ukrainskyi medychnyi chasopys – Ukrainian Medical Journal, (6), 33-40 [in Ukrainian].
Banini, B.A., & Sanyal, A.J. (2016). Nonalcoholic fatty liver disease: epidemiology, pathogenesis, natural history, diagnosis, and current treatment options. Clinical Medicine Insights: Therapeutics, 8, CMT-S18885.
Milić, S., & Štimac, D. (2012). Nonalcoholic fatty liver disease/steatohepatitis: epidemiology, pathogenesis, clinical presentation and treatment. Digestive Diseases, 30 (2), 158-162. DOI: https://doi.org/10.1159/000336669
Babak, O.Ya., & Kurinna, O.H. (2016). Vplyv nemedykamentoznoho likuvannia na antropometrychni pokaznyky patsiientiv iz nealkoholnoiu zhyrovoiu khvoroboiu pechinky ta ozhyrinniam [Effect of non-drug treatment on anthropometric parameters of patients with non-alcoholic fatty liver disease and obesity]. Suchasna hastroenterolohiia – Modern Gastroenterology, (6), 18-23 [in Ukrainian].
Radchenko, O.M., & Kondratiuk, M.O. (2009). Syndrom endohennoi intoksykatsii v klinitsi vnutrishnikh khvorob (ohliad literatury ta vlasni sposterezhennia) [Endogenous intoxication syndrome in an internal medicine clinic (literature review and observations)]. Medychna hidrolohiia ta reabilitatsiia – Medical Hydrology and Rehabilitation, 7 (3), 25-32 [in Ukrainian].
Feisa, S. (2019). Nealkoholna zhyrova khvoroba pechinky ta komorbidni zakhvoriuvannia: dyferentsiiovanyi pidkhid do pryznachennia antyoksydantiv [Non-alcoholic fatty liver disease and comorbid diseases: a differentiated approach to antioxidant administration]. Psychosomatic Medicine and General Practice, 4(1), e0401137-e0401137 [in Ukrainian].
Ore, A., & Akinloye, O.A. (2019). Oxidative stress and antioxidant biomarkers in clinical and experimental models of non-alcoholic fatty liver disease. Medicina, 55 (2), 26. DOI: https://doi.org/10.3390/medicina55020026
Mazepa, Yu.S., Tereshchenko, V.P., & Pishchykov, V.A. (2010). Klinichni aspekty zastosuvannia enterosorbentiv [Clinical aspects of the use of enterosorbents]. Ukraina. Zdorovia natsii – Ukraine. Nation's Health, (1), 87-93 [in Ukrainian].
Tkachova, O.V., Serdiuk, I.S., Tkacheva, O.V., & Serdiuk, I.S. (2018). Protypodahrychni zasoby: doslidzhennia asortymentu, sotsialno-ekonomichnoi dostupnosti ta obsiahiv spozhyvannia v Ukraini [Anti-gout remedies: study of the range, socio-economic availability and consumption in Ukraine]. Ukrainskyi biofarmatsevtychnyi zhurnal – Ukrainian Biopharmaceutical Journal, (2), 36-40 [in Ukrainian].
Yushko, L.O., Sarnatska, V.V., Sakhno, L.O., Melnyk, V.O., Kornieieva, L.M., & Nikolaiev, V.H. (2009). Analiz adsorbtsii bilokzviazanykh metabolitiv i toksyniv, kharakternykh dlia pechinkovoi nedostatnosti enterosorbentamy riznoho pokhodzhennia [Analysis of adsorption of protein-bound metabolites and toxins characteristic of liver failure by enterosorbents of various origins]. Dopovidi Natsionalnoi akademii nauk Ukrainy – Reports of the National Academy of Sciences of Ukraine, (9), 177-181 [in Ukrainian].
Unifikovanyi klinichnyi protokol pervynnoi, vtorynnoi (spetsializovanoi) medychnoi dopomohy “Nealkoholnyi steatohepatyt”: nakaz MOZ Ukrainy vid 06.08.2014 № 826 [Unified clinical protocol of primary, secondary (specialized) medical care "Non-alcoholic steatohepatitis": order of the Ministry of Health of Ukraine of August 8, 2014 No. 826] [in Ukrainian].
European Association for the Study of the Liver, & European Association for the Study of Diabetes (EASD. (2016). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Obesity Facts, 9(2), 65-90. DOI: https://doi.org/10.1159/000443344
Osodlo, H.V., & Fedorova, O. O. (2016). Kombinovanyi zakhyst pechinky – osnova suchasnoi hepatoprotektsii [Combined liver protection is the basis of modern hepatoprotection]. Ratsyonalnaya farmakoterapiya – Rational Pharmacotherapy, (39), 2 [in Ukrainian].
