Shevchuk V. Clinic and pathogenetic substantiation of differential treatment of nonalcoholic steatohepatitis in patients with metabolic syndrome

The dissertation is dedicated to the improving of the treatment of nonalcoholic steatohepatitis (NASH) in the patients with the most common phenotypes of the metabolic syndrome (MS) by the differentiated setting of L-arginine. By the examination of 128 patients with NASH associated with MS, found that nonalcoholic steatohepatitis associated with classic metabolic syndrome (arterial hypertension (AH) + abdominal obesity (AO) + dyslipidemia (DL) + glucose intolerance / diabetes mellitus type 2 (GI/DM-2)) and its phenotype (AH+AO+GI/DM-2), unlike the NASH-associated phenotypes of MS (AH+DL+GI/DM-2) and (AH+DL+AO), is accompanied by: significantly higher frequency of occurrence and intensity of clinical and biochemical syndromes; substantial violations of oxidant-antioxidant homeostasis, proteinase-inhibitor system of blood, the functional state of the endothelium, hemocoagulation and fibrinolysis, structural and functional properties of red blood cells; more pronounced cytokine imbalance; the most severity of steatosis, balloon and hyaline droplets dystrophy, histological activity, leading to progression of the liver fibrosis with predominance of F2-F3 stages. It is proved that complex therapy for NASH, association with the metabolic syndrome, with a graded assignment step of treatment with L-arginine, promotes more effective than traditional therapy (essential phospholipids, ursodeoxycholic acid), correction of the underlying clinical and laboratory disease syndromes; cytokine imbalance oxidative stress; violations of proteinase-inhibitor system of blood, the morpho-functional state of red blood cells, blood coagulation and fibrinolysis; endothelial dysfunction and improve the quality of life of the patients.7452