Thesis for obtaining the scientific degree of the doctor of medical sciences in specialty 14.01.33 — мedical rehabilitation, physiotherapy and health resort. — Odessa National Medical University, Ministry of Health of Ukraine, Odessa, 2019.
The concept of new approaches to treatment of patients with nonalcoholic fatty liver disease (NAFLD) on the basis of differentiated use of natural and preformed factors is developed and scientifically substantiated.
The influence of aqueous solution of bishofite and mineral waters of different chemical composition and mineralization during the internal course treatment on the structural and functional characteristics of the liver in rats with experimental NAFLD was studied. The study demonstrated a unidirectional positive effect on biochemical and morphological changes in the liver, accompanied by significant reduction or disappearance of lipid vacuoles and elements of inflammatory reaction.
In patients with NAFLD, the effect of internal course administration of bishofite solution on the clinical picture of major and concomitant diseases of the digestive, lipid and carbohydrate metabolism dynamics was studied. The positive influence on the clinical course of the underlying disease, the accompanying biliary and gastroduodenal pathology, the irritable bowel syndrome with constipation, the restoration of the lipid profile of the blood, the reduction of insulin resistance, especially hyperinsulinemia, against the background of inhibition of lipid peroxidation processes.
The problem of influence of mineral waters of different composition and mineralization on the functional state of the liver, lipid and carbohydrate metabolism disorders in patients with nonalcoholic fatty liver disease was studied. It is proved that sulfate mineral waters are characterized by high efficiency in the levelling of signs of cytolysis and cholestasis, the restoration of the lipid blood spectrum, and an increase in the level of adiponectin. In contrast, hydrocarbonate mineral water is characterized by high efficacy against the signs of insulin resistance and, in particular, hyperinsulinemia, normalization of carbohydrate tolerance, and leptin level lowering. The severity of clinical and metabolic effects increases with mineralization of mineral water. At the same time, low-mineralized mineral waters contributed to a greater loss of body weight.
The patients with NAFLD are recommended differentiated use of the aqueous solution of bishofite of Poltava deposit, mineral water of hydrocarbonate and sulfate types of small and medium mineralization depending on the stage of the underlying disease (steatosis or steatohepatitis of the minimum degree of activity), concomitant pathology of the digestive system (pathology of the biliary tract, intestines, acid-related diseases), the nature and level of metabolic disorders (insulin resistance and hyperinsulinemia, hyperglycemia, impaired carbohydrate tolerance, dyslipidemia, obesity), profile of adipokines for preventing progression of liver disease, restoring lipid and carbohydrate metabolism, improving the quality of life.
Key words: non-alcoholic fatty liver disease, digestive organs, insulin resistance, atherogenic dyslipidemia, mineral water, bischofite aqueous solution, treatment.
