Prokopchuk O. Features of Liver Fibrosis After Chemotherapy in Patients with Normal and Excessive Body Weight

The dissertation aims to deepen the study and understanding of the occurrence, course, and progression of liver fibrosis in patients with normal and excessive body weight who have undergone chemotherapy due to the main disease (breast cancer). As liver fibrosis remains a complex problem today, the dissertation is dedicated to improving the diagnostic process and treatment tactics not only at the tertiary care level but also in primary care medical institutions, with the aim of uncovering key factors influencing its development in this patient population. The peculiarities of the clinical course of fibrosis induced by polychemotherapy for breast cancer in patients with normal and excess body weight were established. It has been proven that the indisputable etiological factor in the progression of chemotherapy-induced fibrosis in patients with normal and excess body weight is the disruption of lipid metabolism, which correlates with body weight, steatosis, and fibrosis stages. Direct and indirect liver fibrosis markers were used for the first time, as well as the pSWE elastography method to determine fibrosis stages depending on body weight in the group of patients who received chemotherapy for breast cancer. The main correlational relationships between the FIB-4, FibroTest indices, and pSWE elastography in patients with different body mass indices who received chemotherapy for breast cancer were identified. Scientific knowledge regarding the clinical and pathogenetic significance of collagen IV and TGF-β1 in the development of post-hepatitis fibrosis induced by polychemotherapy for breast cancer in patients with normal and excess body weight was expanded. Scientific data on the diagnostic capabilities and features of liver fibrosis verification using elastography were supplemented (Utility Model Patent No. 123951 dated 12.03.2018). The higher effectiveness and expediency of the treatment program, including the combination of ursodeoxycholic acid and vitamin E in patients with normal and excess body weight with medicament-induced liver damage, were proposed and demonstrated. This contributed to the reduction of clinical manifestations of liver damage, normalization of the activity of indirect liver fibrosis markers AST, ALT, gradual normalization of direct markers Col-4 and TGF-β1 according to dynamic observation data, as well as a decrease in liver parenchymal stiffness indicators by 17.9 % according to shear wave elastography.