LIVER DYSFUNCTION DUE TO PROLONGED AMIODARONE USE IN PATIENTS WITH ATRIAL FIBRILLATION

The purpose of this work was to study liver function due to prolonged use of amiodarone in patients with coronary heart disease (CHD) and atrial fibrillation (AF). Methods. 78 patients with CHD and AF, HF IIA aged (65.5 ± 1.3) years and 20 practically healthy persons of the corresponding age (63.4±2.4) years - men and women in similar proportions were examined. All patients were divided into 2 groups depending on the treatment of CHD and AF. The first group included 58 patients with CHD and AF, which received amiodarone from six months to 5 years at the base of the baseline therapy at a dose of 200-100 mg per day. The second group consisted of 20 patients receiving baseline therapy and as an antiarrhythmic drug bisoprolol. In order to study the features of non-alcoholic fatty liver disease (NAFLD) depending on the duration of amiodarone intake, patients of the I group were divided into two subgroups: IA - patients with CHD and AF who received amiodarone more than six months to one year at a dose of 200 mg per day; IB - patients with CHD and AF who received amiodarone from 1 to 5 years in a dose of 200-100 mg per day. All patients underwent general, clinical, ultrasound and biochemical studies to determine the activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST), arginase, alkaline phosphatase (AP), gamma-glutamyltranspeptidase (GGTP), lipid peroxida-tion (LPO): content in the blood of malonalde-hyde (MA) and conjugated dienes (CD) and antioxidant defense (AOD): the activity of ceruloplasmin and the saturation of transferrin by iron spectrophotometrically. Results. The results of a comprehensive examination of patients with CHD and AF who continued receiving amiodarone in standard doses allowed to reveal that clinical changes in liver damage were detected in fifth part of patients, while cholestatic syndrome was predominantly observed with an increase in AP and GGTP activity in 53.4% and an increase in the echo density of the echostructure of the liver in 37.9%, and rarer - a cytolytic syndrome with an increase in the activity of ALT, AST in 24.1%, which is accompanied by an increase in the activity of arginase, activation of the processes of the LPO and the imbalance system and AOD. Conclusions. In 43 (74.1%) patients with CHD and prolonged use of amiodarone, dysfunction of the liver was revealed, which manifested in most cases by steatosis (72.1%), and rarely by steatohepatitis (32.6%), more expressed with an increase in the duration of taking amiodarone.