Effectiveness of treatment of patients with nonalcoholic fatty liver disease and hypertension with use of complex therapy

Abstract

The aim: to investigate the basic level and dynamics of lipid, carbohydrate metabolism, adiponectin, fetuin A, pro-inflammatory cytokines (TNF-alpha and IL-6) and ultrasound parameters of carotid arteries in patients with NAFLD and hypertension using complex therapy. Materials and methods. The study involved 88 patients with NAFLD with hypertension stage II, 2 degree, undergoing treatment in National Institute of Therapy named LT Malaya NAMS of Ukraine. Among 88 patients were 49 men (55.68%) and 39 females (44.32%). The median age was (51,3 ± 6,2) years. The control group consisted of 30 healthy volunteers of similar age category, male and female. We studied the lipid and carbohydrate metabolism, blood pressure, ultrasound of the liver, adiponectin, fetuin A and pro-inflammatory cytokines (TNF-alpha and IL-6) by conventional methods. The study of vascular endothelial motor function was conducted by determining the dynamics of blood flow in the brachial artery during reactive hyperemia as described by D. Celermajer. Determines the pulse wave velocity and endothelium-dependent vasodilation. Patients with NAFLD and hypertension (n = 88) were divided into two groups. Patients group I (n = 44) received lisinopril 10 mg / day, atorvastatin 10-20 mg / day. Group II patients (n = 44) received lisinopril 10 mg / day atorvastatin and 10-20 mg / day in combination with PUFA 2 g / d and UDCA 10 mg / kg / day. Duration of treatment was 12 months. All were given recommendations for a balanced diet and exercises. Results. In patients with NAFLD and hypertension abnormalitis of lipid and carbohydrate metabolism, increasing pro-inflammatory cytokines (TNF-alpha and IL-6), fetuin A and a decreasing of adiponectin were indicated. Also indicators of pulse wave velocity and endothelium-dependent vasodilation were violated. In our study, significantly better result was achieved when assigning complex therapy using UDCA and PUFA - group 2. Significantly better results than were achieved in group 2 in triglycerides, TNF-α and IL-6. In group 2 was possible to increase the level of adiponectin of 47.57% compared with 20.67% in group 1 (p <0.001). Significantly improved indices of endothelial function. Conclusions. Combination therapy comprising atorvastatin, lisinopril, UDCA and PUFA in combination with non-drug therapy in patients with NAFLD and hypertension compared with taking lisinopril and atorvastatin combination with non-drug therapy is more effective for the treatment and correction associated with NAFLD metabolic disorders that can help reduce the overall cardiometabolic risk and improving life prognosis in patients with NAFLD and hypertension.