EVALUATION OF THE EFFECTIVENESS OF COMPLEX THERAPY USING A PROBIOTIC AND REBAMIPIDE ON THE DYNAMICS OF BIOLOGICAL MARKERS OF INTESTINAL DAMAGE AND DYSBIOTIC CHANGES IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AFTER COVID-19
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i4.14309Keywords:
non-alcoholic fatty liver disease, intestinal lesions, COVID-19, zonulin, calprotectin, α1-antitrypsin, dysbiosisAbstract
SUMMARY. The identification of effective biomarkers for the study of intestinal damage in patients with non-alcoholic fatty liver disease (NAFLD) in COVID-19 and the development of methods for their correction is an extremely relevant issue today.
The aim – to determine the effectiveness of complex therapy on the dynamics of biological markers of intestinal damage (zonulin, calprotectin (FCP), α1-antitrypsin (α1-AT)) and the severity of colon dysbiosis in patients with NAFLD and intestinal damage after COVID-19.
Material and Methods. 104 patients with NAFLD after COVID-19 were examined. Patients were divided into 2 groups depending on the method of treatment: group I included 50 patients who received a probiotic (containing Bifidobacterium bifidum, Bifidobacterium lactis and vitamin D3), and group II included 54 patients who, in addition to the probiotic, received rebamipide. All patients underwent general clinical examinations.
Results. The main complaint in patients with NAFLD after COVID-19, indicating intestinal damage, was constipation, which was diagnosed in 52.0–50.0 % of patients before treatment. The treatment helped to reduce constipation in patients of group II by 40.0 % (р<0.001), while in patients of group I – by 30.0 % (p<0.01). The conducted complex therapy contributed to a more pronounced significant decrease in the level of FCP, zonulin and α1-AT both in the blood serum and in the faeces in the examined patients. The level of zonulin in the blood serum and faeces in patients of group II decreased by 4.3–4.0 times (p<0.001), while in patients of group I the corresponding dynamics was 2.5–2.1 times, respectively (p<0.01). The therapy with probiotics and rebamipid is an effective means of correcting dysbiotic changes in patients with NAFLD and intestinal damage after COVID-19, which was manifested by the normalisation of bifidus and lactobacilli, reduction of opportunistic and pathogenic microflora (Enterobacter, Citrobacter, Klebsiella, Clostridium, Staphylococcus, Proteus, Candida).
Conclusions. In patients with NAFLD after COVID-19, intestinal damage is manifested by constipation, flatulence and occasional pain along the colon. In patients with NAFLD after COVID-19, intestinal damage and impaired barrier function are indicated by an increase in serum and faecal levels of FСР, zonulin, and α1-AT. Combination therapy using a probiotic containing Bifidobacterium bifidum and lactis, vitamin D3 in combination with rebamipide is an effective method for correcting the levels of inflammatory biomarkers and intestinal barrier (FCP, zonulin and α1-AT) in patients with NAFLD after COVID-19.
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