For the first time, it was established that in COPD patients comorbid with NAFLD, a high frequency
of exacerbations leads to a significant increase number of combined liver damage, namely a combination of
steatosis, fibrosis, and inflammation, compared to patients with a low frequency of COPD exacerbations
(p<0.05). For the first time it was established that deep stages of liver steatosis (S≥2.0) are 1.5 times more
often registered in patients with COPD exacerbations (more than 2 times a year), compared to patients with a
small number of exacerbations (37.1% vs. 28.9% (p<0.05)). Scientific data on the leading pathogenetic role
of COPD in maintaining systemic inflammation and its influence on the NAFLD progression are
substantiated based on established correlations between markers of chronic systemic inflammation, the
frequency of COPD exacerbations and stages of liver fibrosis. It was determined that in COPD patients
comorbid with NAFLD, in conditions of frequent exacerbations of COPD, significantly (p<0.001) higher
levels of inflammatory biomarkers outside the exacerbation (CRP, TNF-α and neopterin) are recorded than
in patients with a small number of exacerbations and correlate with a high level of TGF-β1 (r=0.47; p<0.05,
r=0.46; p<0.05, r=0.39; p<0.05). A positive correlation between TNF-α and neopterin with the number of
anti-neutrophil elastase antibody was revealed (r=0.38; p<0.05 and r=0.42; p<0.05) which confirms their
participation of the maintenance of systemic inflammation. It was determined that TIMP-1 levels are directly
proportional to the concentration of anti-neutrophil elastase antibody, increase with the deepening of the
stages of fibrosis to F2 (r=0.46; p<0.05) and do not depend on the frequency of COPD exacerbation which
indicates the maintenance of systemic inflammation on period between exacerbations. New data were
obtained regarding the direct correlation of body mass index (BMI), cholesterol concentration, triglycerides,
and alanine aminotrasase activity with the number of anti-neutrophil elastase antibody (r=0.43; p<0.05 and
r=0.45; p< 0.05, r=0.43; p<0.05, r=0.41; p<0.05). The treatment tactics for patients with COPD comorbid
with NAFLD have been improved, which includes taking ademetionine in the therapy of COPD in
combination with UDCA, which has a positive effect not only on the course of NAFLD, but leads to a
decrease in the levels of anti-neutrophil elastase antibody, reduces the number of COPD exacerbations and
improves the quality of life (both physical and mental components) by reducing levels of anxiety and
depression.
