CHANGES IN CARBOHYDRATE METABOLISM AND ADIPOCYTOKINES UNDER THE INFLUENCE OF TREATMENT OF PATIENTS WITH ALCOHOLIC CIRRHOSIS OF THE LIVER IN COMBINATION WITH OBESITY USING ADAMETHIONINUM AND ARGININE GLUTAMATE
DOI:
https://doi.org/10.11603/mcch.2410-681X.2020.v.i3.11514Keywords:
alcoholic liver disease, liver cirrhosis, obesity, adipocytokines, carbohydrate metabolismAbstract
Introduction. Alcohol-related liver cirrhosis is one of the leading causes of hospitalization and disability in patients with gastrointestinal disease.
The aim of the study – to learn the effectiveness of treatment of patients with alcoholic liver cirrhosis (ALC) combined with obesity depending on the stage of decompensation using ademethionine and arginine glutamate.
Research Methods. 215 patients, diagnosed with ALC, took part in the study, including 66 women and 149 men. 109 people had ALC with obesity and 106 people had ALC without obesity. Patients were divided into subgroups depending on the stage of decompensation according to Child-Pugh. Depending on the treatment protocol (b protocol – basic therapy, h protocol – basic therapy in combination with ademethionine and arginine glutamate), all patients were divided into subgroups.
Results and Discussion. In this study, the values of carbohydrate metabolism, adiponectin and leptin were used to evaluate the effectiveness of a three-month treatment regimen with ademethionine and arginine glutamate in patients with ALC in combination with obesity. Obese patients with ALC have a more severe course of the disease, accompanied by more pronounced clinical manifestations, impaired carbohydrate metabolism and imbalance of leptin and adiponectin levels. The inclusion of ademethionine and arginine glutamate in the treatment regimen for 3 months allowed to improve the general condition of patients, their clinical and laboratory parameters and reduce the rate of disease progression, which is reflected in improved carbohydrate metabolism, leptin and adiponectin and reduced indicators of the severity scale according to Child-Pugh and the 3-month MELD mortality score.
Conclusions. Inclusion of ademethionine and arginine glutamate in the complex treatment of patients with ALC in combination with obesity helps to reduce insulin resistance, improve leptin and adiponectin. In patients with ALC in combination with obesity, the inclusion in the complex treatment of ademethionine and arginine glutamate helps to improve the course of the disease according to the indicators of the severity scale using the Child-Pugh and MELD scales.
References
Eslam, M., Newsome, P. N., Anstee, Q. M., Targher, G., Gomez, M. R., Zelber-Sagi, S. et al. (2020). A new definition for metabolic associated fatty liver disease: An international expert consensus statement. Journal of Hepatology. DOI:10.1016/j.jhep.2020.03.039. DOI: https://doi.org/10.1016/j.jhep.2020.03.039
Diehl, A.M., & Day, C. (2017). Cause, pathogenesis, and treatment of nonalcoholic steatohepatitis. New England Journal of Medicine, 377 (21), 2063-2072. DOI:10.1056/nejmra1503519. DOI: https://doi.org/10.1056/NEJMra1503519
Košuta, I., Mrzljak, A., Kolarić, B., & Vučić Lovrenčić, M. (2020). Leptin as a key player in insulin resistance of liver cirrhosis? A cross-sectional study in liver transplant candidates. Journal of Clinical Medicine, 9 (2), 560. DOI:10.3390/jcm9020560. DOI: https://doi.org/10.3390/jcm9020560
Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., … Sanyal, A. J. (2017). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67 (1), 328-357. DOI:10.1002/hep.29367. DOI: https://doi.org/10.1002/hep.29367
Eslam, M., Sanyal, A. J., & George, J. (2020). MAFLD: A consensus-driven proposed nomenclature for metabolic associated fatty liver disease. Gastroenterology. DOI:10.1053/j.gastro.2019.11.312. DOI: https://doi.org/10.1053/j.gastro.2019.11.312
Kalafateli, M., Triantos, C., Tsochatzis, E., Michalaki, M., Koutroumpakis, E., Thomopoulos, K. et al. (2015). Adipokines levels are associated with the severity of liver disease in patients with alcoholic cirrhosis. World J. Gastroenterol., 21 (10), 3020-3029. DOI: 10.3748/wjg.v21.i10.3020. DOI: https://doi.org/10.3748/wjg.v21.i10.3020
Antwi, S.O., Mousa, O.Y., & Patel, T. (2018). Racial, ethnic, and age disparities in incidence and survival of intrahepatic cholangiocarcinoma in the United States; 1995-2014. Annals of Hepatology, 17 (2), 274-285. DOI:10.5604/01.3001.0010.8659. DOI: https://doi.org/10.5604/01.3001.0010.8659
Paducheva, S.V., Bulatova, I.A., Schekotova, A.P., Tretyakova, Y.I., & Schekotova, I.V. (2017). Possibilities of using MELD scale for determining hepatic cirrhosis degree of severity. Perm Medical Journal, 34 (6), 40-44. DOI: 10.17816/pmj34640%44.
Gorgui, J., Gasbarrino, K., Georgakis, M.K., Karalexi, M.A., Nauchec, B., Petridou, E.T. et al. (2017). Circulating adiponectin levels in relation to carotid atherosclerotic plaque presence, ischemic stroke risk, andmortality:Asystematic review andmeta-analyses. Metabolism, 69, 51-66. DOI: 10.1016/j.metabol.2017.01.002. DOI: https://doi.org/10.1016/j.metabol.2017.01.002
Baltieri, L., Chaim, E.A., Chaim, F.D.M., Utrini, M.P., Gestic, M.A., & Cazzo, E. (2018). Correlation between nonalcoholic fatty liver disease features and levels of adipokines and inflammatory cytokines among morbidly obese individuals. Arq. Gastroenterol., 55 (3), 247-251. DOI: 10.1590/S0004-2803.201800000-62. DOI: https://doi.org/10.1590/s0004-2803.201800000-62
Polyzos, S.A., Kountourasa, J., & Mantzoros, C.S. (2016). Adipokines in nonalcoholic fatty liver disease. Metabolism, 65 (8), 1062-1079. DOI: 10.1016/j.metabol.2015.11.006.
Jamali, R., Hatami, N., & Kosari, F. (2016). The correlation between serum adipokines and liver cell damage in non-alcoholic fatty liver disease. Hepat. Mon., 16 (5), e37412. DOI: 10.5812/hepatmon.37412. DOI: https://doi.org/10.5812/hepatmon.37412
Abenavoli, L., Milic, N., Di Renzo, L., Preveden, T., Medić-Stojanoska, M., & De Lorenzo, A. (2016). Metabolic aspects of adult patients with nonalcoholic fatty liver disease. World J. Gastroenterol., 22, 7006-7016. DOI: 10.3748/wjg.v22.i31.7006. DOI: https://doi.org/10.3748/wjg.v22.i31.7006
Buechler, C., Haberl, E., Rein-Fischboeck, L., & Aslanidis, C. (2017). Adipokines in liver cirrhosis. International Journal of Mollecular Sciences, 18 (7), 1392. DOI: 10.3390/ijms18071392. DOI: https://doi.org/10.3390/ijms18071392
Boutari, C., Perakakis, N., & Mantzoros, C.S. (2018). Association of adipokines with development and progression of nonalcoholic fatty liver disease. Endocrinol. Metab., 33 (1), 33-43. DOI: 10.3803/EnM.2018.33.1.33. DOI: https://doi.org/10.3803/EnM.2018.33.1.33
Adolph, T.E., Grander, C., Grabherr, F., & Tilg, H. (2017). Adipokines and non-alcoholic fatty liver disease: Multiple interactions. Int. J. Mol. Sci., 18, 1649. DOI: 10.3390/ijms18081649. DOI: https://doi.org/10.3390/ijms18081649
Ajmera, V., Perito, E.R., Bass, N.M., Terrault, N.A., Yates, K.P., Gill, R. et al. (2017). Novel plasma biomarkers associated with liver disease severity in adults with nonalcoholic fatty liver disease. Hepatology, 65 (1), 65-77. DOI:10.1002/hep.28776. DOI: https://doi.org/10.1002/hep.28776
Jamali, R., Razavizade, M., Arj, A., & Aarabi, M.H. (2016). Serum adipokines might predict liver histology findings in non-alcoholic fatty liver disease. World J. Gastroenterol., 22 (21), 5096-5103. DOI: 10.3748/wjg.v22.i21.5096. DOI: https://doi.org/10.3748/wjg.v22.i21.5096
Panera, N., Della Corte, C., Crudele, A., Stronati, L., Nobili, V., & Alisi, A. (2015). Recent advances in understanding the role of adipocytokines during non-alcoholic fatty liver disease pathogenesis and their link with hepatokines. Expert Review of Gastroenterology & Hepatology, 10 (3), 393-403. DOI: 10.1586/17474124. 2016.1110485.
