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CARBOHYDRATE AND LIPID EXCHANGE CHANGES UNDER THE INFLUENCE OF TREATMENT OF PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS IN COMBINATION WITH OBESITY USING ADEMETHIONINE, ARGININE GLUTAMATE AND ROSUVASTATIN

In Ukraine, among the causes of death because of digestive tract diseases, alcoholic liver disease (ALD) has the second place. Due to the significant prevalence of obesity and the growing incidence of ALD, methods are being sought to prevent the progression of the pathological process in the liver, the occurrence of complications and to improve the quality of life of such patients. 
The aim of the study: to examine the effect of complex treatment with ademethionine, arginine glutamate and rosuvastatin on changes in lipid and carbohydrate metabolism in patients with alcoholic liver cirrhosis (ALC) in combination with obesity. 
Methods. The study included 156 patients diagnosed with ALC in combination with obesity, including 18 women and 138 men aged (45.3±8.9) years and a median duration of disease (5.1±2.8) years. Patients were divided into subgroups depending on the stage of Child-Pugh decompensation and depending on the applied treatment. 
Results. At the stage of decompensation, lipid metabolism and leptin levels were low, which indicates the depletion of body fat depots as the disease progresses. It may be due to the progression of the liver dysfunction, as it is actively involved in regulating the formation, destruction and accumulation of fats. Changes in carbohydrate metabolism in patients with ALC in combination with obesity were characterized by a significant increase in IRI, HOMA-IR index and a decrease in the QUICKI index, indicating the presence of insulin resistance (p<0.05). In determining the adipocytokine values, it was found that in decompensated liver function, the leptin rates decreased and the levels of adiponectin increased. Higher leptin content in the stage of compensation and subcompensation is also associated with increased secretion of adipose tissue. At the stage of decompensation, fat depots are depleted, so leptin levels are reduced. This decrease is directly related to the Child-Pugh and MELD scores. Adiponectin levels were decreased in the stage of compensation and increased with the progression of the disease and correlated with disease severity and the MELD score. It is thought that an increased adiponectin level indicates the level of anti-inflammatory reaction in response to hepatocyte damage. Significant deterioration in carbohydrate metabolism, adiponectin and leptin in patients receiving basic treatment was accompanied by deterioration of their condition and increased the risk of 3-month mortality. After the course of treatment in patients of group receiving ademethionine, arginine, glutamate and rosuvastatin at the stage of compensation and subcompensation, the rates of lipid, carbohydrate metabolism, adiponectin and leptin significantly improved and differed from those in patients receiving basic treatment and combination of basic treatment, ademethionine and arginine glutamate (p<0.05). At the stage of decompensation in the scheme with the inclusion of rosuvastatin it was possible to normalize the levels of HDL cholesterol, VLDL cholesterol, atherogenic coefficient and leptin, reduce the levels of adiponectin, IRI, HOMA-IR, HbA1c and increase the QUICKI index, which was accompanied by a decrease in Child-Pugh severity score and 3 month mortality MELD score. 
Conclusions. In patients with ALC in combination with obesity, the inclusion in the treatment of ademethionine, arginine glutamate and rosuvastatin helps to improve the course of the disease according to the lipid and carbohydrate metabolism, Child-Pugh and MELD scores.