Diagnostics and treatment of non-alcoholic fatty liver disease with concomitant asthenic syndrome
- Authors: Pavlov A.I.1, Ivolgin A.F.1, Katenko S.V.1, Eremin M.N.2, Molodova A.I.1, Levchenko O.B.2, Karakozov A.G.2
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Affiliations:
- Vishnevsky 3-rd Central Military Clinical Hospital
- Yevdokimov Moscow State University of Medicine and Dentistry
- Issue: Vol 93, No 8 (2021)
- Pages: 890-896
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/79423
- DOI: https://doi.org/10.26442/00403660.2021.08.200974
- ID: 79423
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Abstract
Aim. Analysis of the effectiveness of therapy for non-alcoholic fatty liver disease (NAFLD) with severe asthenic syndrome.
Materials and methods. In the period from 2017 to 2019, on the basis of the gastroenterology center of the Vishnevsky 3-rd Central Military Clinical Hospital, 247 patients with NAFLD, including those at the stage of steatohepatitis, and severe asthenic syndrome were examined and treated. The main group included 124 patients, the control group – 123 patients. All patients underwent complex laboratory and instrumental diagnostics and neuropsychological research using the subjective asthenia assessment scale (MFI-20). In both groups, domestic drugs were included in the therapy regimen: from the 1st to the 10th day, Heptrong solution 3 ml intramuscularly in the morning; from the 1st to the 60th day – UDCA 250 mg orally, 3 capsules at bedtime, Omega-3 forte 1000 mg, 2 capsules in the morning with meals. In group I patients received additionally – from the 1st to the 10th day intravenous drip Cytoflavin 10 ml + 0.9% NaCl solution 200 ml; pentoxifylline solution 5 ml + 0.9% NaCl solution 200 ml. Then, from the 11th to the 60th day, Cytoflavin inside, 2 tablets 2 times a day. Pentoxifylline inside 400 mg 1 tablet 3 times a day. All patients underwent neuropsychological examination using the subjective asthenia rating scale (MFI-20).
Results. The effectiveness of treatment in patients of both groups was assessed by clinical, laboratory data and neuropsychological studies. In the main group, a significant reduction in asthenic syndrome was achieved against the background of diagnosed NAFLD compared with the control group.
Conclusion. The early inclusion of patients with NAFLD and severe asthenic syndrome in the treatment regimen, in addition to the basic therapy of Cytoflavin, achieved a significantly high therapeutic effect in the form of normalization of the main clinical, laboratory and instrumental parameters, as well as a significant reduction in the manifestations of asthenia.
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##article.viewOnOriginalSite##About the authors
Aleksandr I. Pavlov
Vishnevsky 3-rd Central Military Clinical Hospital
Email: Angel2503@inbox.ru
ORCID iD: 0000-0003-1836-7946
доктор медицинских наук, доцент, начальник Центра гастроэнтерологии и гепатологии, главный гастроэнтеролог
Russian Federation, KrasnogorskAleksandr F. Ivolgin
Vishnevsky 3-rd Central Military Clinical Hospital
Email: Angel2503@inbox.ru
ORCID iD: 0000-0002-8849-680X
начальник неврологического центра, главный невролог
Russian Federation, KrasnogorskSergei V. Katenko
Vishnevsky 3-rd Central Military Clinical Hospital
Email: Angel2503@inbox.ru
врач консультант-психотерапевт
Russian Federation, KrasnogorskMikhail N. Eremin
Yevdokimov Moscow State University of Medicine and Dentistry
Email: Angel2503@inbox.ru
ORCID iD: 0000-0002-8798-5011
кандидат медицинских наук, ассистент кафедры пропедевтики внутренних болезней и гастроэнтерологии
Russian Federation, MoscowAlevtina I. Molodova
Vishnevsky 3-rd Central Military Clinical Hospital
Author for correspondence.
Email: Angel2503@inbox.ru
ORCID iD: 0000-0003-3302-6541
старший лаборант каф. пропедевтики внутренних болезней и гастроэнтерологии
Russian Federation, KrasnogorskOlga B. Levchenko
Yevdokimov Moscow State University of Medicine and Dentistry
Email: Angel2503@inbox.ru
ORCID iD: 0000-0002-6594-7006
ассистент кафедры пропедевтики внутренних болезней и гастроэнтерологии
Russian Federation, MoscowAram G. Karakozov
Yevdokimov Moscow State University of Medicine and Dentistry
Email: Angel2503@inbox.ru
ORCID iD: 0000-0002-3196-4457
доктор медицинских наук, профессор, профессор каф. пропедевтики внутренних болезней и гастроэнтерологии
Russian Federation, MoscowReferences
- Younossi Z, Tacke F, Arrese M, et al. Global Perspectives on Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis. Hepatology. 2019;69(6):2672-82. doi: 10.1002/hep. 30251
- Setiawan VW, Stram DO, Porcel J, et al. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort. Hepatology. 2016;64(6):1969-77. doi: 10.1002/hep. 28677
- Younossi ZM, Stepanova M, Afendy M, et al. Changes in the prevalence of the most common causes of chronic liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524-30. doi: 10.1016/j.cgh.2011.03.020
- Kallman J, O’Neill MM, Larive B, et al. Fatigue and health-related quality of life (HRQL) in chronic hepatitis C virus infection. Dig Dis Sci. 2007;52(10):2531-39. doi: 10.1007/s10620-006-9708-x
- D'Mello C, Swain MG. Liver-brain interactions in inflammatory liver diseases: implications for fatigue and mood disorders. Brain Behav Immun. 2014;35:9-20. doi: 10.1016/j.bbi.2013.10.009
- Gerber LH, Weinstein AA, Mehta R, Younossi ZM. Importance of fatigue and its measurement in chronic liver disease. World J Gastroenterol. 2019;25(28):3669-83. doi: 10.3748/wjg.v25.i28.3669
- Poynard T, Cacoub P, Ratziu V, et al. Fatigue in patients with chronic hepatitis C. J Viral Hepat. 2002;9:295-303. doi: 10.1046/j.1365-2893.2002.00364.x
- Newton JL. Systemic symptoms in non-alcoholic fatty liver disease. Dig Dis. 2010;28:214-9. doi: 10.1159/000282089
- Jopson L, Dyson JK, Jones DE. Understanding and Treating Fatigue in Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis. Clin Liver Dis. 2016;20:131-42. doi: 10.1159/000282089
- Jason L, Brown M, Evans M, et al. Measuring substantial reductions in functioning in patients with chronic fatigue syndrome. Disabil Rehabil. 2011;33:589-98. doi: 10.3109/09638288.2010.503256
- Котова О.В., Акарачкова Е.С. Астенический синдром в практике невролога и семейного врача. РМЖ. 2016;13:824-29 [Kotova OV, Akarachkova ES. Asthenic syndrome in the practice of a neurologist and family doctor. RMZh. 2016;13:824-29 (in Russian)].
- Swain MG. Fatigue in liver disease: pathophysiology and clinical management. Can J Gastroenterol. 2006;20(3):181-8. doi: 10.1155/2006/624832
- Swain MG, Jones DEJ. Fatigue in chronic liver disease: New insights and therapeutic approaches. Liver Int. 2019;39:6-19. doi: 10.1111/liv.13919
- Андреев Д.Н., Маев И.В., Дичева Д.Т., Кузнецова Е.И. Диагностика и лечение неалкогольной жировой болезни печени: обзор Европейских рекомендаций 2016 года. Consilium Medicum. 2017;19(8):8-13 [Andreev DN, Maev IV, Dicheva DT, Kuznecova EI. Diagnosis and treatment of non-alcoholic fatty liver disease: a review of the 2016 European guidelines. Consilium Medicum. 2017;19(8):8-13 (in Russian)]. doi: 10.26442/2075-1753_19.8.8-13
- Kaser S, Ebenbichler CF, Tilg H. Pharmacological and non- pharmacological treatment of non-alcoholic fatty liver disease. Int J Clin Pract. 2010;64(7):968-83. doi: 10.1111/j.1742-1241.2009.02327.x
- González-Regueiro JA, Higuera-de la Tijera MF, Moreno-Alcántar R, Torre A. Pathophysiology of hepatic encephalopathy and future treatment options. Rev Gastroenterol Mex. 2019;84(2):195-203. doi: 10.1016/j.rgmx.2019.02.004
- Маев И.В., Андреев Д.Н., Кучерявый Ю.А. Клиническая гепатология: алгоритмы диагностики и лечения. М., 2019 [Maev IV, Andreev DN, Kucheryavyy YuA. Clinical hepatology: algorithms for diagnosis and treatment. Moscow, 2019 (in Russian)].
- European Association for the Study of the Liver (EASL). European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-402. doi: 10.1111/dme.13565
- Оковитый С.В., Суханов Д.С., Заплутанов В.А., Смагина А.Н. Антигипоксанты в современной клинической практике. Клин. медицина. 2012;9:63-8 [Okovityy SV, Sukhanov DS, Zaplutanov VA, Smagina AN. Antihypoxants in modern clinical practice. Clinical medicine. 2012;9:63-8 (in Russian)].
- Есипов А.В., Иволгин А.Ф., Хритинин Д.Ф., и др. Клиническая эффективность нейрометаболической терапии диссомнических расстройств при астеническом синдроме. Журн. неврологии и психиатрии им. С.С. Корсакова. 2019;119(9):46-51 [Esipov AV, Ivolgin AF, Khritinin DF, et al. Clinical efficacy of neurometabolic therapy for dyssomnic disorders in asthenic syndrome. Journal of Neurology and Psychiatry S.S. Korsakov. 2019;119(9):46-51 (in Russian)]. doi: 10.17116/jnevro201911909146
- D'Mello C, Ronaghan N, Zaheer R, et al. Probiotics Improve Inflammation-Associated Sickness Behavior by Altering Communication between the Peripheral Immune System and the Brain. J Neurosci. 2015;35(30):10821-30. doi: 10.1523/JNEUROSCI.0575-15.2015
- Маев И.В., Андреев Д.Н., Кучерявый Ю.А., и др. Неалкогольная жировая болезнь печени с позиций современной медицины. Клиническая гепатология. М., 2020 [Maev IV, Andreev DN, Kucheryavy YA, et al. Non-alcoholic fatty liver disease from the standpoint of modern medicine. Clinical Hepatology. Moscow, 2020 (in Russian)].
- Маев И.В., Кучерявый Ю.А., Андреев Д.Н. Печень и билиарный тракт при метаболическом синдроме. Пособие для врачей. Клиническая гепатология. М., 2020 [Maev IV, Kucheryavyy YuA, Andreev DN. The liver and biliary tract in metabolic syndrome. A guide for doctors. Clinical Hepatology. Moscow, 2020 (in Russian)].
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