Kuzminska O. Clinical and pathogenetic features of the comorbid course of non-alcoholic steatohepatitis and coronary heart disease, optimization of treatment

The dissertation is devoted to the study of the main clinical and pathogenetic features of progression and mutual burdening of nonalcoholic steatohepatitis on the background of obesity of I-II degree and comorbid coronary heart disease (stable angina pectoris of II-III functional class), optimization of treatment of this comorbidity with by the way of icncluding to the treatment of L-carnitine and meldonium dihydrate. Studies have been conducted to determine the level of cytokeratin-18 in the plasma of patients with nonalcoholic steatohepatitis and coronary heart desease and its association with the disorders of carbohydrate, lipid metabolism, intensity of oxidative stress, plasma and platelet hemostasis. The value of determining the levels of cytokeratin-18, the calculation of hepatorenal index in the diagnosis of nonalcoholic steatohepatitis are clarified, which allow with high accuracy and specificity to differentiate steatohepatitis from liver steatosis. The relationship between the levels of cytokeratin-18, adiponectin, leptin and the progression of liver metabolic changes in patients with NASH and coronary heart desease has been demonstrated, which indicates the dependence of proinflammatory enzymatic activity of the liver, proatherogenic dyslipidemia and IR from cytokine levels. On the basis of clinical, biochemical, immunological studies, improved pathogenetic approaches to the complex therapy of nonalcoholic steatohepatitis with comorbid coronary heart desease. We proved the appropriateness of the use of L-carnitine and meldonium dihydrate as cytoprotective agents that contribute to the improvement of clinical symptoms, reduce the activity of cytolytic and mesenchymal-inflammatory syndromes, cholestasis, promote the elimination of atherogenic dyslipidemia, exhibit antioxidant properties, provide membrane stabilizing effects, reduce the endothelial dysfunction.