The Influence of Pathogenetic Treatment on Peroxidation in Patients with Ischemic Heart Disease and Comorbid Nonalcoholic Steatohepatitis

Introduction. An excessive activation of lipid peroxidation (LP) plays a significant role in pathogenesis of either ischemic heart disease (IHD) or nonalcoholic steatohepatitis (NASH) that in chronic conditions leads to depletion of antioxidant protection (AOP) enzymes with increased risk of cell damage resulted from the influence of aggressive free radicals. Aim. To investigate the dynamics of lipid peroxidation and antioxidant protection activity in patients with ischemic heart disease and comorbid nonalcoholic steatohepatitis under the pathogenetic treatment. Materials and methods. 59 patients with IHD associated with NASH were examined, 11 (18.6 %) of them were women and 48 (81.4 %) – men. An average age was 53.7 ± 8.5 years. An efficiency of treatment was assessed in 1-month and 6-month periods. Activity of alanine (ALT) and aspartate (AST) transaminases, alkaline phosphatase (AP), gamma-glutamyltranspeptidase (GGTP) and total bilirubin content were analyzed in blood serum. Serum thiobarbituric acid-active (TBA-active) products, activity of superoxidedysmutase (SOD) were evaluated. Depending on prescribed therapeutic scheme patients were divided on groups: І (n = 31) – rosuvastatin 20.0 mg per day, ursodeoxycholic acid (UDCA) 15.0 mg/kg/day for 6 months, and L-carnitine 1.0 g bid for 3 months; ІІ (n = 28) – rosuvastatin 20.0 mg per day and UDCA 15.0 mg/kg/day, 6 months. Results. 1 month after the treatment with rosuvastatin 20.0 mg per day in combination with UDCA and L-carnitine in patients of the group І ALT activity decreased 1.8 fold, AST – 2 fold, GGTP – 2.8 fold in comparison with the indexes before the treatment. Among the patients of the group ІІ, who received treatment with rosuvastatin 20.0 mg per day in combination with UDCA, serum ALT decreased 1.5 fold, GGTP – 1.8 fold. In 6-month period serum ALT activity decreased 2.3 fold, AST – 2.4 fold, GGTP – 2.9 fold in patients of the group І in comparison with the indexes before the treatment. GGTP, AP and bilirubin levels were normal. In patients of the group ІІ ALT activity decreased 1.7 fold, AST – 2 fold, GGTP – 2.2 fold in comparison with the indexes before the treatment. In patients of the group I in 1-month and 6-month periods of treatment serum TBA-reactants decreased 1.9 fold and 2.8 fold respectively with simultaneous SOD activity rise 1.9 and 2.2 fold respectively in comparison with primary evaluation. In patients of the group II in 1-month treatment period content of TBA-reactants decreased 1.7 fold and in 6-month period – 2.9 fold in comparison with the indexes before the treatment. Yet, SOD activity increased 1.9 fold only in 6 months after the treatment. Conclusion. Combination of ischemic heart disease and nonalcoholic steatohepatitis is accompanied by thiobarbituric acid reactants 3-fold increase and superoxide dismutase 2.3-fold decrease in blood serum in comparison with norms on the background of elevated transaminases. Additional prescription of ursodexoycholic acid and L-carnitine combination for 6 months on the background of pathogenetic therapy allows to decrease thiobarbituric acid reactants 2.8 fold and to increase superoxide dismutase – 2.2 fold.