Lebed K. Clinical and pathogenic features and treatment of patients with chroniс obstructive pulmonary disease, combined with nonalcoholic steatohepatitis

The thesis is devoted to solving of scientific problem - improving quality of diagnostic and effectiveness of treatment of patients with chroniс obstructive pulmonary disease (COPD), combined with nonalcoholic steatohepatitis (NASH). The work summarizes details of complex clinical, laboratory and instrumental examination of 106 patients with COPD in combination with NASH aged from 40 to 69 years, 78 (73.5%) men, 28 (26, 5%) women. Patients were randomized in two groups: the main group - 52 patients whose treatment was supplemented with roflumilast 1 tablet (500 mcg) 1 every day and essliver forte 2 capsules 3 times a day for 3 months, and the comparison group - 54 patients treated only by means of basic therapy. Clinical picture of exacerbation of COPD combined with NASH, characterized by bronchial obstruction, asthenic-neurotic syndrome, hepatomegaly. Comorbid diseases accompanied by a significant decrease in quality of life on all scales, and exercise tolerance. Patients with comorbidity have obstructive changes external breathing function. In 66% of patients predominated obstruction of small bronchi. Exacerbation of COPD combined with NASH is accompanied by metabolic intoxication syndrome, increased level of systemic inflammation. Disorders of energy metabolism characterized by decreased ATP content and increased of levels of ADP and AMP. In patients with COPD in combination with NASH there is an imbalance of blood cytokine profile and increased activity adipokin system. The frequency of exacerbations of COPD in patients with comorbid pathology is most intensively correlated with of systemic inflammation, an imbalance of cytokine profile, severity of the syndrome of "metabolic" intoxication. Therapy of patients with COPD, combined with NASH, with inclusion of combination of roflumilast and essliver forte positively influenced the course of comorbid pathology, which manifested in reducing symptoms, improving quality of life, exercise tolerance, external breathing function, biochemical parameters and reduced the frequency of exacerbations of COPD.