Prosolenko K. Non-alcoholic fatty liver disease in patients with essential and renoparenchymal arterial hypertension: features of formation, course, optimization of diagnosis and treatment strategy.

The dissertation deals with optimization of diagnosis and treatment of nonalcoholic fatty liver disease (NAFLD) in essential (EH) and renoparenchymal arterial hypertension (RPAH) on the basis of a comprehensive study of metabolic disorders, proinflammatory activity, oxidative stress and oxidative protection, genetic polymorphism and ultrasonographic features of the liver, kidneys and blood vessels in this category of patients. The obtained results indicate more significant changes in carbohydrate, lipid and purine metabolism, inflammation and oxidative stress, adiponectin and fetuin-A levels, markers of kidney damage in the presence of comorbidity of NAFLD with hypertension. It was found that the comorbidity of NAFLD and EH/RPAH is characterized by more pronounced activity of liver inflammation, steatosis and liver fibrosis. The presence of comorbidity with EH or RPAH in patients with NAFLD worsens the condition of portal blood flow. There are no differences in FibroMax and portal hemodynamics parameters between patients with comorbidity of NAFLD with EH and comorbidity of NAFLD with RPAH. Patients with NAFLD in combination with RPAH showed significantly more pronounced deterioration in renal function, higher pro-inflammatory activity and oxidative stress, a more significant decrease in adiponectin levels compared with isolated NAFLD and comorbidity of NAFLD and EH. It was found that structural and functional lesions of blood vessels and liver are more pronounced in patients with comorbidity of NAFLD and RPAH compared to comorbidity of NAFLD and EH in the absence of a difference in ultrasonographic parameters of the heart. New scientific data on the features of hemodynamic and metabolic disorders in comorbid pathology depending on the G276T polymorphism of the ADIPOQ gene have been obtained. In the comorbidity of NAFLD and EH / RPAH, the presence of G/T and T/T genotypes of ADIPOQ is associated with more pronounced disorders of carbohydrate, lipid metabolism and pro-inflammatory abnormalities, compared with the G/G genotype of this gene. The most influential factors of comorbidity of NAFLD with hypertension were determined and differences in their interaction in EH and RPAH were established. The influence of hypertension and hepatic steatosis on changes in laboratory and instrumental parameters during comorbidity of NAFLD and EH/RPAH was analyzed. Prolonged complex regimens with ursodeoxycholic acid and omega3-polyunsaturated fatty acids have been shown to be more effective than standard treatment.