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Aim: To study the impact of type 2 diabetes mellitus (DM2) on the severity of liver steatosis and fibrosis in patients with non-alcoholic fatty liver disease (NAFLD)., Materials and Methods: To conduct a paired case-control study 2989 patients were examined at the Federal Research Center of Nutrition, Biotechnology and Food Safety. Pairs were matched by gender and age and distributed into groups: NAFLD + DM2+ ( n =313), NAFLD + DM2- (n=313) and a control group of patients without NAFLD and without DM2 ( n =313). The severity of liver steatosis was determined by measuring the controlled attenuation parameter. The severity of liver fibrosis was determined by measuring the liver stiffness measurement. Body composition of the patients was determined using bioimpedance measurements. Indicators of lipid and carbohydrate metabolism, and the serum activity of liver enzymes was determined by standard biochemical methods., Results: In NAFLD + DM2+ group compared to NAFLD + DM2- group, and in NAFLDM + DM2-compared to the control group, weight, BMI, waist and hip circumference, waist-to-hip ratio were higher, while in all. In NAFLD + DM2+ and NAFLD + DM2- groups the volume of fat mass directly correlated with the level of blood triglycerides ( r =0.21), HbA 1 с ( r =0.32) and fasting blood glucose ( r =0.35), and inversely correlated with high-density lipoproteins ( r =-0.19). In NAFLD + DM2+ group versus NAFLD + DM2- group severe steatosis (S3, 78% versus 59.4%; p< 0.001) and severe fibrosis (F4, 8% vs 2.6%; p< 0.001) was more common; 70% of patients in the NAFLD + DM2- group had no liver fibrosis according to elastography (F0), while in the NAFLD + DM2+ group only 43.2% of patients had no liver fibrosis ( p< 0.0001)., Conclusion: When NAFLD is accompanied by DM2, there is an increase in total fat mass, the severity of steatosis and liver fibrosis, and an associated deterioration of lipid metabolism. More than half of these patients have various stages of liver fibrosis, which indicates the progressive nature of the disease.

Aim    To study the incidence and effect of non-alcoholic fatty liver disease (NAFLD) on clinical outcomes in patients with decompensated chronic heart failure (DCHF).Material and methods    The study included 338 patients with NYHA functional class III-IV DCHF (51.2% men, mean age 72.8±11.7 years), arterial hypertension (AH) in 90%, myocardial infarction in 37%, atrial fibrillation in 64%, chronic kidney disease (CKD) in 42%, type 2 diabetes mellitus (T2DM) in 35%, left ventricular ejection fraction (LVEF) &lt;40% in 27%. NAFLD was diagnosed based on the 2021 Clinical Guidelines of the Russian Scientific Medical Society of Therapists and the Scientific Society of Gastroenterologists of Russia. The stage of liver steatosis was determined using transient elastometry with assessment of the controlled attenuation parameter (CAP) of ultrasound (S, dB/m) using a FibroScan device. Threshold CAP values &lt;294 dB/m corresponded to the degree of steatosis: S0; S1, 295-309 dB/m; S2, 310-330 dB/m; S3, ≥331 dB/m.Results    NAFLD was diagnosed in 28.9% of patients. The patients were divided into two groups: group 1 included patients with CHF and NAFLD (n=98 (28.9%), 50.0% men) and group 2 included patients with CHF without NAFLD (n=240 (71.0 %), 51.6% men). A multivariate regression analysis showed that independent predictors of NAFLD were systolic blood pressure ≥130 mm Hg (odds ratio (OR), 3.700; p &lt;0.001), history of T2DM (OR, 2.807; p &lt;0.005), and waist circumference &gt;111 cm (OR, 2.530; p &lt;0.012). Patients with CAP ≥331 dB/m (S3) had a worse prognosis during the 2-year follow-up for the composite adverse outcome (all-cause mortality + readmission) (Kaplan-Meier curves - Log-Rank p=0.035).Conclusions    NAFLD was detected in almost one-third of patients hospitalized for DCHF. AH, T2DM, and abdominal obesity were associated with a high risk of NAFLD. However, only severe steatosis (S3) was an independent predictor of adverse clinical outcomes during a 2-year period after adjustment for known risk factors.

Aim: To investigate the effect of ursodeoxycholic acid (UDCA) on the degree of steatosis, indicators of carbohydrate, lipid metabolism, body weight in patients with type 2 diabetes mellitus (DM) in combination with non-alcoholic fatty liver disease (NAFLD)., Materials and Methods: A prospective cohort comparative study included 36 patients with DM and NAFLD. Patients received UDCA at a dose of 15 mg/kg/day for 6 months, and also followed the recommendations for lifestyle changes through diet and exercise. To compare the results obtained during the study, a control group of patients was recruited that met the criteria for inclusion in the study. The statistical analysis included an assessment of the normality of the distribution of quantitative indicators, followed by the determination of the mean values and standard deviation or medians and quartiles, depending on the nature of the distribution, the reliability coefficient was determined by the Student, by Wilcoxon. Statistical processing was carried out in the Statistica 10 program., Results: According to the results of the study, a positive trend was noted in the change in the severity of fatty hepatosis. During the study, a statistically significant decrease in the level of ALT, AST was achieved in the group receiving UDCA (Ursofalk). The results of our study showed that the inclusion of UDCA (Ursofalk) in complex hypoglycemic therapy provides an additional improvement in carbohydrate metabolism. The obtained indicators in the course of the study demonstrate the positive effect of UDCA on weight loss. The greatest result was achieved in reducing waist, which is a positive prognostic factor in reducing the development and progression of NAFLD, diabetes and cardiovascular diseases. Positive changes were observed in relation to the lipid profile., Conclusion: The study demonstrated the positive effect of the drug UDCA (Ursofalk) on reducing the degree of liver steatosis, on carbohydrate, lipid metabolism, body weight in patients with DM in combination with NAFLD.

Aim: To characterize of the features of changes in the cavity and parietal microbiota of the small intestine in patients with non-alcoholic fatty liver disease (NAFLD)., Materials and Methods: Fifty four patients with NAFLD at the stage of steatosis and steatohepatitis at the age of 1860 years were examined. The diagnosis was verified by ultrasound of the hepatobiliary system using a SONIX OP analyzer (Canada), FibroMax test data and liver elastography using an AIXPLORER apparatus (France). The degree of steatohepatitis activity was determined by biochemical blood tests for alanine aminotransferase and aspartate aminotransferase on a Huma Star 600 analyzer (Germany). The cavity microbiota of the small intestine was evaluated using a Lactofan2 analyzer of the Association of Medicine and Analytics company (Russia) using hydrogen breath tests with lactulose. The parietal microbiota of the small intestine was examined using an Agilent 7890 gas chromatograph with mass-selective and plasma-ionization detectors (Agilent Technologies, USA)., Results: In the study of cavity enteric microbiota in patients with NAFLD, the syndrome of excessive bacterial growth was detected in 68.5% of cases, while it was caused in 48.6% of patients by a violation of the function of the ileocecal valve, in 21.7% by a deficiency of cleavage of lactulose microorganisms and/or slowing down the motility of the digestive tract. When studying the parietal enteral microbiota, the total bacterial load in patients with NAFLD was significantly lower compared with the control group due to a decrease in useful microbiota. At the same time, a decrease in all normal bacterial representatives Bifidobacterium, Lactobacillus and Lactococcus, Eubacterium and Propionibacterium was noted. The content of opportunistic microbiota in patients with NAFLD did not reveal significant changes., Conclusion: The syndrome of excessive bacterial growth in patients with NAFLD is associated with a decrease in useful parietal enteral microbiota.

We describe a 15-year girl, who developed panhypopituitarism and diencephalic obesity after surgical excision of craniopharyngioma, followed by nonalcoholic fatty liver disease and cirrhosis 5 years after surgery. Cirrhosis in this case manifested by hypoxia due to hepatopulmonary syndrome, and despite cure of craniopharyngioma by surgery and radiosurgery treatment and adequate hormonal substitution therapy patient died 9 years after surgery. Growth hormone substitutional therapy in patients with hypopituitarism, and steatohepatitis may decrease liver triglyceride accumulation and prevent end-stage liver disease.

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.

Purpose - to assess the probability of occurrence of the main cardiovascular events in the patients after revascularization interventions with a combined course of a stable coronary heart disease and non-alcoholic steatohepatitis (NASH) by indicators of fibrogenesis. 164 patients with stable coronary heart disease were observed, including: 54 patients with NASH (a main group); 110 patients without NASH (a comparison group). All patients underwent general clinical examination, electrocardiography, coronary angiography, echocardiography, assessment of liver function, markers of fibrosis and long-term prognosis by the Kaplan-Meier method. It was found that the patients with stable coronary heart disease, combined with NASH, are characterized by the fibrosis progression, that is characterized by a significantly high value of fibrogenesis markers. The presence of NASH in patients with stable coronary heart disease causes a worsening of the disease and forms a negative prognosis in such patients in a two-year term. The prognosis of the patients who underwent coronary artery stenting depends on the course of non-alcoholic fatty liver disease and is the most prognostically unfavorable against the combination of the FIB-4 index ≥2.0 and NASH.

Aim: Сomparative studying of changes in the spectrum of bile acids in bile in patients with nonalcoholic fatty liver disease and cholelithiasis., Materials and Methods: 140 patients were included in the survey: 50 - with nonalcoholic fatty liver disease and 90 - with cholelithiasis. The diagnosis of nonalcoholic fatty liver disease was established on the basis of ultrasound examination of the liver, the elasticity and fibrosis of liver by using the sonoelastography and liver biopsy. The prestone stage of cholelithiasis was established on the basis of ultrasound examination of the gallbladder and biochemical examination of bile. The level of total cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase, total bilirubin, alkaline phosphatase and gamma glutamyl transpeptidase were studied using the analyzer "Labsystems" (Finland). The spectrum of bile acids in bile is studied by mass spectrometry on AmazonX apparatus (Bruker Daltonik GmbH, Bremen, Germany)., Results and Discussion: Biochemical blood test revealed increase of cholesterol, triglycerides, cytolysis markers, and cholestasis, the most pronounced in patients with nonalcoholic fatty liver disease. Biochemical study of bile showed increase of cholesterol, decrease the total amount of bile acids and cholatecholesterol coefficient in the vesicle and hepatic bile in patients with nonalcoholic fatty liver disease and cholelithiasis. Mass spectrometry showed decrease the total amount of free bile acids (choloidal, chenodeoxycholic, deoxycholic) and increase the content of conjugated bile acids (glycocholic, glycodesoxycholic, taurocholic, taurodeoxycholic, ursodeoxycholic), the most pronounced in patients with nonalcoholic fatty liver disease., Conclusion: Unidirectional changes in the spectrum of bile acids in nonalcoholic fatty liver disease and cholelithiasis give reason to believe that the trigger mechanism in the disturbance of bile acids metabolism is the liver. Reduction of primary bile acids, imbalance of phospholipids and cholesterol disrupt the stabilization of bile, resulting in unfavorable conditions in the bile ducts to form stones.

The aim of the study was to establish the relationship between anthropometric characteristics, lipid-carbohydrate metabolism parameters, endothelial lipase (EL) levels of blood serum depending on the degree of liver steatosis in patients with non-alcoholic fatty liver disease and hypertension. 60 patients with NAFLD on the background of hypertension and overweight were examined. The examined patients were divided into three groups: with hypertension without increasing the NAFLD liver fat score (group 1, n = 16), with steatosis on the background of hypertension (group 2, n = 20), with steatosis with hypertension and with laboratory signs of steatohepatitis (group 3, n = 24). All patients were divided with accordance of age and sex. The contol group consisted of 20 healthy individuals. To identify liver steatosis, NAFLD liver fat score was used according to the formula: NAFLD liver fat score = - 2.89 + 1.18 × Metabolic syndrome (yes = 1/no = 0) + 0.45 × type 2 DM (yes = 2/no = 0) + 0.15 × insulin (mU /L) + 0.04 × AST (U/L) - 0.94 × AST/ALT. The concentration of EL serum was determined by ELISA method using Aviscera Bioscience INC reagents kit (USA). The study revealed a significant difference in groups of surrogate coefficient hepatic steatosis (NAFLD liver fat score), which also takes into account the sensitivity to insulin, significantly (SS effect 27,39; MS effect 13,69; F = 6,73; p = 0,002) increases from group to group with steatosis to steatohepatitis. In patients with steatohepatitis, the expression of abdominal fatty deposits is greater than in those who have steatosis. Thus, simultaneously with increasing BMI and abdominal fat deposition, significantly increases the concentration of triglycerides, LDL, and VLDL. The concentration of EL, which is involved in the metabolism of HDL, is lowest in patients of the control group (does not exceed 10 mmol / l) and increases progressively with steatosis with hypertension and with steatohepatitis compared with those suffering from hypertension without steatosis. In addition, an increase in EL is associated with the presence of metabolic disorders, which, in aggregate, makes it possible to attribute it to independent markers of the atherosclerotic process and cardiovascular risk.

Purpose - to assess the impact of lifestyle on non-alcoholic fatty liver disease (NAFLD) activity by influencing the fibrotic processes and hepatic steatosis in patients with stable coronary heart disease (CHD). 105 patients with stable CHD, combined with NAFLD were observed: Group I - control group; Group II - basic group. In each group, patients with non-alcoholic steatosis (subgroup A) and non-alcoholic steatohepatitis (subgroup B) were isolated. General clinical examination, electrocardiography, coronary angiography, echocardiography, liver functional state, serum lipid profile, fasting glucose, markers of fibrosis were conducted to all patients. After treatment in patients of Group II positive changes in all parameters vs. basal levels and the control group were found: significantly decreased body mass index, alpha-2-macroglobulin and type IV collagen levels; increased apolipoprotein A1 and haptoglobulin levels; decreased severity of dyslipidemia; improved parameters of the liver functional state. Modification of lifestyle of patients with stable CHD influences positively on the NAFLD course, reducing disease activity by inhibiting fibrotic processes and hepatic steatosis that, in general, inhibits the progression of this comorbid disorder.

Aim: To evaluate clinical features and metabolic disorders in men and women with non-alcoholic fatty liver disease (NAFLD).

Aim: To investigate the association of the polymorphic variants -204A > C (rs 3808607) in the CYP7A1 gene with the development of dyslipidemias in healthy individuals, in patients with non-alcoholic fatty liver disease (NAFLD) and in those with NAFLD concurrent with hypothyroidism., Subjects and Methods: DNA samples and lipidograms were examined in 180 patients, including 60 healthy individuals (Group 1), 60 patients with hypothyroidism concurrent with NAFLD (Group 2), and 60 patients with NAFLD (Group 3). All the patients underwent ultrasound examination of the thyroid gland and abdominal cavity organs; FibroMax scores were calculated., Results: All the study groups most frequently showed a homozygous AA genotype (86.6% of cases in Group 1, 80% in Group 2, and 83.3% in Group 3). The development of NAFLD in CC genotype carriers is characterized by the most pronounced changes in lipid metabolism (atherogenic index (AI), 7.32 in Group 3) compared to the genotypes AA (AI, 4.56 in Group 2 and 1.73 in Group 1) and CC (AI, 6.43 in Group 2 and 2.52 in Group 1) in functional insufficiency of thyroid hormones and relative normal conditions., Conclusion: The analysis of the relationship of polymorphic variants CYP7A1 rs 38088607 to lipid metabolic disturbances in the study groups showed that the significantly higher levels of atherogenic cholesterol fractions were determined in the CC genotype compared to AA genotype carriers and they did not depend on the presence of NAFLD and hypothyroidism. The findings make it possible to consider the AA homozygous genotype of variant mutation CYP7A1 rs 38088607 as protective against dyslipidemia. However, in functional insufficiency of thyroid hormones, the level of triglycerides is significantly higher in both genotypes, which suggests that hypothyroidism plays an essential role in the development of dyslipidemia and NAFLD.

The purpose of research was to study the characteristics of eating behaviour (EB) and indicators visceral adipose tissue (VAT) in patients with NAFLD and obesity stage of 1-2 or excessive body mass on the background of hypertension (H). We examined 100 patients with NAFLD in combination with overweight and obesity of 1-2 degrees (body mass index - BMI ≥25 kg/m2) on the background of H I-II stage. Patients with NAFLD and visceral obesity on the background of stage H of I-II the identified three types of violations of EB with a significant predominance of external breach type EB (p<0,05) regardless of BMI. It should be noted that the indicators of waist circumference (WC)/hip circumference (HC) were not statistically different in patients with different types of violations of EB, which is significantly different rates of volume VAT. The severity various types of violations of EB correlates with the increase in VAT, as evidenced by the presence of the relationship (r) severity various types of violations of EB with increase in VAT (p<0,05). The results of the study indicate that VAT - a highly informative biomarker of the prognosis of the disorders of nutritional status and risk of development of metabolic disorders, which depends on EB. Identified isolated cases of violations of EB among patients in the control group indicate the possible risk of increase VAT and the development of hormonal and metabolic disorders. Therefore, it is necessary to study the violations of EB on a larger scale to diagnose possible disorders of nutritional status, and to measure these standard anthropometric indicators such as BMI, WC, HC, WC/HC it is advisable to further carry out the measurement % VАT and IVO.

Aim: To study the results of dynamic liver ultrasound elastography (LUE) in assessing the risk of complications of liver cirrhosis (LC) of different etiologies and to elaborate a monitoring program for estimation of the predictive value of elastography in patients with LC., Subjects and Methods: A total of 194 patients with LC of different etiologies, including 56 patients with alcoholic cirrhosis, 48 with LC and an outcome of nonalcoholic fatty liver disease, 53 with LC and an outcome of chronic hepatitis C, 23 with LC and an outcome of chronic hepatitis B, and 14 with an outcome of coinfection with hepatitis B and D viruses, were examined. An analysis was made between the presence of a number of LC complications and the results of LUE, by constructing the receiver operating characteristic (ROC) curves to select LUE threshold values, in which there was a high risk for LC complications (esophageal varices, bleeding esophageal varices, hepatic encephalopathy, and ascites)., Results: The investigation could obtain liver elastography threshold values expressed in kilopascals (kPa), which were proposed for use as a prognostic sign of the presence of complications caused by LC and assessed liver elastography threshold values for its mortality prediction. The predictive value of positive LUE results in determining the risk of different complications was 75.7 to 92.5%; that of negative results was 70 to 92.9%. An algorithm for individualized diagnostic and treatment policy was elaborated in relation to the liver elastography results obtained during the primary examination of a patient., Conclusion: The dynamic LUE findings in patients with LC of different etiologies suggest that the proposed LUE threshold values are efficient and may be used in practical healthcare, which will be able to timely correct management tactics for a patient and to monitor his treatment.

Aim: To optimize management tactics in patients with diseases of the liver and gallbladder in the presence of progressive psoriasis., Subjects and Methods: The investigation enrolled 78 patients with nonalcoholic fatty liver disease (NAFLD) and different forms of gallbladder abnormality in the presence of progressive moderate and severe psoriasis. The patients were randomly divided into 2 groups: 1) phosphogliv; 2) ursosan with the main active ingredient ursodeoxycholic acid (UDCA). A prospective follow-up study accompanied by dynamic clinical, laboratory, and instrumental monitoring was carried out for 24 weeks. Clinical, biochemical, and ultrasound studies, including liver elastography, were applied., Results: The use of UDCA (Ursosan 15 mg/kg for 24 weeks) to treat NAFLD and gallbladder abnormality in methotrexate-treated patients with progressive moderate and severe psoriasis contributed to the normalization of hepatic steatosis index, lipid composition, and lithogenic index, to the reduction of biliary sludge, and to the stabilization of liver fibrosis. Improvement in the functional status of the liver and gallbladder has contributed to the achievement of a more complete remission of dermatosis., Conclusion: The effects of UDCA in the therapy of NAFLD and gallbladder abnormality in patients with progressive psoriasis were greater than those of phosphogliv.

Aim: To estimate the diagnostic and informative value of clinical and laboratory parameters in the development and progression of liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) to enhance efficiency of their treatment., Subjects and Methods: An open-label case-control study included 77 patients with NAFLD. Clinical and laboratory examinations were done. To search for additional noninvasive fibrosis markers, the investigators studied the serum concentrations of insulin, leptin, adiponectin, matrix metalloproteinase-9 (MMP-9) and its inhibitors, such as tissue inhibitor of matrix metalloproteinases 1 (TIMP-1) and TIMP-2. All the patients underwent elastometry to assess the degree of liver fibrosis with the Metavir scale with the use of a Fibroscan machine., Results: The serum levels of low-density lipoproteins, glucose, MMP-9, and leptin proved to be most informative in assessing the progression of the initial stages (1-2) of fibrosis, as were the increased liver size detected by physical examination, systolic blood pressure, carbohydrate metabolic disorders, alanine/aspartate aminotransferase levels, waist-to-hip ratio, TIMP-1, and TIMP-2 in evaluating the progression of Stage II fibrosis 2 to Stage 3., Conclusion: The clinical and laboratory parameters can serve as reliable noninvasive markers that reflect the progression of fibrotic changes in liver tissue.

Objective: To evaluate the diagnostic value of MMP-9, TIMP-1 and 2 as non-invasive markers of liver fibrosis in the NAFLD to improve the management of patients with this pathology., Materials and Methods: We examined 99 patients with NAFLD and different stages of fibrosis, 83 men, 16 women, median age 45 (range 40-55) years. We assessed of risk factors for liver fibrosis in the NAFLD, anthropometric indicators, biochemical analysis of blood, abdominal ultrasonic studies, the levels of MMP-9, TIMP-1 and 2. Depending on the stage of fibrosis (0-4), established as a result of liver elastometry (Fibroscan), patients were divided into 5 groups: n = 27, n = 22, n = 23, n = 14, n = 13, respectively., Results: Between the groups in medical history, physical examination, calculation of BMI and the ratio of waist to hip volume (W/H) no significant differences were found. 64,6% of patients had abdominal obesity (BMI - 31,5 (29,1-33,9), W/H - 1,02 (1,01-1,05). Obesity and abdominal obesity (BMI, W/H) had a significant positive relationship of moderate streight (rs = (0,257), p < 0,04, rs = (0,301), p < 0,02, respectively), with the stage of liver fibrosis. The groups were significant differences in the level of glucose, total bilirubin (p < 0,04, p < 0,03, respectively). At the time of the examination, 57,5% of patients had steatosis, other patients had steatohepatitis. No significant differences in the level of liver function tests (ALT, AST) in the study groups were found. Significant differences were found in level of TIMP-2 (p < 0,04). TIMP-2 had a significant positive correlation with the severity of fibrosis in the hepatic tissue (rs = (0,349), p < 0,004)., Conclusion: TIMP-2 may be considered as a potential non-invasive marker for the diagnosis of liver fibrosis in patients with NAFLD.

Purpose of the Study: To assess the state of the hepatobiliary system in psoriasis andpsoriatic arthritis in order to establish a causal relationship and to identify clinical and functional predictors of psoriatic disease progression., Methods: The study includedpatients with extensive psoriasis vulgaris (n = 175) aged 18 to 66 years old and healthy donors (n = 30), matched by sex and age: Group 1--patients with psoriasis (PS, n = 77), group 2--patients with psoriatic arthritis (PsA, n = 98), group 3--control. The evaluation of functional state of the hepatobiliary system was performed by the analysis of the clinical and anamnestic data and by the laboratory-instrumental methods., Results: We identified predictors of psoriasis: triggers (stress and nutritionalfactor), increased total bilirubin, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, eosinophilia, giardiasis, carriers of hepatitis C virus, ductal changes andfocal leisons in the liver, thickening of the walls of the gallbladder detected by ultrasound. Predictors ofpsoriatic arthritis: age over 50 years, dyspeptic complaints, the presence of hepatobiliary system diseases, the positive right hypochondrium syndrome, the clinical symptoms of chronic cholecystitis, excess body weight, high levels of bilirubin, cholesterol and low density lipoprotein, hepatomegaly, non-alcoholic fatty liver disease., Conclusion: High activity of hepatocytes cytolysis, cholestasis, inflammation, metabolic disorders let us considerpsoriatic arthritis as a severe clinical stage psoriatic disease when the hepatobiliary system, in turn, is one of the main target organs in systemic psoriatic process. Non-alcoholic fatty liver disease and chronic cholecystitis are predictors of psoriatic disease progression.

One of the urgent problems of Endocrinology is the study of the mechanisms of formation and progression of nonalcoholic fatty liver disease (NAFLD) in patients with diabetes mellitus (DM) type 2. Prognosis depends on the stage of NAFLD in which the changes occur and secretion of adipocytokines in the first place, adiponectin. The aim of the study was to: define adiponectin levels in the circulation of patients with type 2 diabetes at different stages of NAFLD and its impact on the detection of metabolic changes, the establishment of linkages with carbohydrate, lipid, protein metabolism, and liver function. The study determined the relevance of the study of pathogenetic mechanisms of NAFLD in the future, because the violation of metabolic control and reduce the protective properties of adipocytokines in patients with comorbid disorders is of great interest to further improve diagnostic capabilities, prevent complications and improve the quality of life of these patients.

Unlabelled: Non-alcoholic fatty liver disease (NAFLD) is one of the most widespread diffuse liver pathologies among the patients over 40 years of age. The available algorithms for the pharmacological treatment of this disease do not always ensure the desirable results which makes their further development and improvement with the use of natural and preformed physical factors an important priority., Aim: The objective of the present study was to evaluate the effectiveness of the internal course of mineral waters of different balneological types and a bischofite aqueous solution for the treatment of the patients presenting with NAFLD., Patients and Methods: A total of 120 patients with non-alcoholic fatty liver disease were examined and treated with the use of the anamnestic, clinical, biochemical and immunochemical methods as well as sonographic studies of the digestive system and the statistical analysis., Results: The data on the effectiveness of the use of mineral waters of different balneological types and a bischofite aqueous solution in the treatment of NAFLD are presented. It is shown that the use of an aqueous solution of bischofite improves the clinical course of the underlying disease (p<0.05), concomitant diseases of the biliary tract (p<0.02) and irritable bowl syndrome complicated by constipation (p<0.003); also, it improves the functional state of the liver and the blood lipid profile (p<0.02) and significantly reduces insulin resistance (p<0.01), primarily due to the reduction of hyperinsulinemia (p<0.01). Using the mineral waters with the predominance of sulfates can improve the clinical course of liver diseases (p<0.01), biliary tract and intestines (p<0.02), normalize the functional state of the liver including that in the patients with non-alcoholic steatohepatitis (p<0.05,) significantly improve the blood lipid profile (p<0.02) due to the substantial improvement of disordered carbohydrate metabolism including that in the patients suffering from type 2 diabetes mellitus (p<0.05). The application of mineral waters with the elevated content of hydrocarbons improves the clinical course of NAFLD with the concomitant esophagogastroduodenal pathology (p<0.001) and simultaneously reduces the severity of insulin resistance due to the lowering of the level of hyperinsulinemia (p<0.001). Moreover, the mineral water-based therapy improves tolerance to carbohydrates, in the first place in the patients with type 2 diabetes mellitus (p<0.01), and restores the background lipid profile (p<0.05)., Conclusion: The studies has demonstrated the high efficiency of the non-pharmacological treatment resulting in the multifaceted and oppositely directional influence on the patients presenting with non-alcoholic fatty liver disease. The possibility of the differentiated application of mineral water and an aqueous solution of bischofite for the treatment of this pathology is confirmed depending on the stage of the disease, the severity of metabolic disorders, the presence of a concomitant pathology of the digestive system, type 2 diabetes mellitus, and hypertension.

The article presents data on non-alcoholic fatty liver disease and chronic viral hepatitis C in combination with opisthorchosis invasion. With the system approach considers the specific features of the clinical, laboratory and functional data in patients with combined pathology. Observed frequency of the pain, asthenic and allergic cholestatic syndromes, the latter as part of the triad Paltsev. The high efficiency of the placenta hydrolisat - laennec, as means of pathogenetic therapy.

Aim: The aim of the study was to assess the effectiveness of the inclusion in the scheme remaxol treatment of metabolic syndrome in patients with nonalcoholic steatohepatitis and diabetes mellitus 2 type., Materials and Methods: Data of 76 patients with metabolic syndrome in a non-alcoholic steatohepatitis and type 2 diabetes were analyzed. Patients were randomized by gender and age, and are divided into 2 groups according to the scheme of therapy: patients in group I (major - 38) conducted a basic therapy in combination with remaxol: intravenous infusion of 400 ml of 1 times a day for 10 days, group II patients (comparison - 38) combined basic therapy with intravenous ademetionine: 400 mg, in a solution diluted NaCL 0,9% 400 ml 1 time per day for 10 days. In addition to standard clinical and laboratory tests were studied biochemical parameters of liver activity, lipid and carbohydrate metabolism in the dynamics: before therapy and after its completion., Results: It was found that the inclusion in the scheme of drugs from the group of succinates (remaxol) reduces the severity of metabolic syndrome by reducing the manifestations of cholestasis and cytolysis, and improving lipid and glucose metabolism. As a result, significantly reduced the severity of the main clinical syndromes: asthenovegetative 46% and dyspeptic syndromes - 46% and 15%, respectively.

Objectives: The aim of our study was to investigate associations between the lipid profile, liver condition and the level of BMI., Methods: Our sample consisted of 58 patients: 30 - with morbid obesity and BMI - 40-49 (1 group), 28 - with superobesity, BMI - 50-69 (2 group). Lipids and hepatic functional tests were measured just prior to surgery. Ultrasound examination was used to estimate liver condition. Liver biopsy specimens were obtained at the time of surgery, classified according to the nonalcoholic fatty liver disease and steatohepatitis activity score., Results: Lower level of cholesterol has been found in the first group with morbid obesity. Higher level of triglycerides and very low-density lipoprotein has been found in the second group with superobesity (р=0,000 ANOVA). High-density lipoprotein was normal but significantly associated with BMI. The level of low-density lipoprotein was higher in the second group, but the difference between ptoups was not significant. BMI was associated with higher scores of ultrasonographic parameters and severity of steatosis, the increased prevalence of steatohepatitis and it activity. We also realized the positive correlation between ultrasonographic parameters and histological features., Conclusion: BMI has significantly positive correlations with the level of triglycerides and very low-density lipoprotein, ultrasonographic parameters, histological features of steatosis and steatohepatitis. The level of total cholesterol did not reflect all changes of lipid profile.

Aim: To evaluate the efficiency of Remaxol monotherapy in patients with nonalcoholic fatty liver disease (NAFLD) at the stage of steatohepatitis (SH)., Materials and Methods: The treatment of 156 patients with NAFLD at the stage of SH was analyzed. A study group included 84 patients who had received intravenous Remaxol, 400 ml, dropwise at a rate of 40-60 drops per minute once daily in the morning for 10 days; a control group of 72 patients had been treated with the conventional scheme., Results: During the treatment, the study group showed a rapider relief of the manifestations of asthenovegetative and dyspeptic syndromes and a reduction in the magnitude of biochemical manifestations of cytolytic and cholestatic syndromes than did the control group., Conclusion: Incorporation of Remaxol into the therapy regimen in patients with NAFLD at the stage of SH enhances the effectiveness of treatment.

The article presents the results of the study C677T and A1298C polymorphisms of MTHFR gene and their influence on plasma homocysteine levels in patients with nonalcoholic fatty liver disease (NAFLD). The study involved 100 patients with NAFLD and 40 apparently healthy individuals (control group). Determination of allelic polymorphism was performed by polymerase chain reaction with the detection results of hybridization by fluorescence in real-time. Determination of plasma homocysteine levels was performed by ELISA. As a result, studies have not found significant differences in the distribution of genotypes investigated C677T and A1298C MTHFR gene between patients with NAFLD and control group. We have detected statistically significant relationship between the level of homocysteine plasma C677T polymorphism of the MTHFR gene in patients with NAFLD and lack of connection with the A1298C polymorphism of the gene MTHFR.

At the patients with nonalcoholic steatohepatitis on a background of diabetes mellitus type II, after completion of the generally accepted medical treatment there was no normalization of indexes of the glutation system (the level of recovered glutation and activity of enzymes the glutation redox-system was saved decreased), that in a clinical plan was represented in.a presence unstable clinical and biochemical remission of disease.

At the patients with nonalcoholic steatohepatitis on a background of diabetes mellitus type 11, after completion of the generally accepted medical treatment there was no normalization of indexes of the glutation system (the level of recovered glutation and activity of enzymes the glutation redox--system was saved decreased), that in a clinical plan was represented in a presence unstable clinical and biochemical remission of disease.

Type 2 diabetes mellitus complicated by steatohepatitis is accompanied by a decrease in aconitate hydratase activity, increase in the content of diene conjugates, decrease in the concentration of α-tocopherol, and change in the citrate level in the blood serum of patients, which is evidence of the development of oxidative stress as a result of the intensification of free radical oxidation of biosubstrates and decreasing degree of antioxidant defense of the organism. Combined therapy with melaxen provided a more significant change of the investigated parameters toward the norm (on the average by 36%, p 0.05) in comparison with basic treatment. This result was evidently associated with implementation of the antioxidant effect of melatonin, the level of which is corrected under the action of the drug employed.

The Aim of the Study: to conduct a comprehensive assessment of features of combined course NASH and functional constipation using laboratory parameters, the data of instrumental methods, indicators of quality of life in comparison with patients with Nash without proven pathology of the intestine., Materials and Methods: In the cross-sectional comparative study involving 102 patients with NASH, among which identified patients with functional constipation, there were formed two groups: study group (patients with NASH and functional constipation) and comparison group (patients with NASH without pathology of the intestine). All patients underwent a comprehensive assessment of laboratory data (markers of cytolysis, cholestasis, lipid and carbohydrate metabolism), results of instrumental methods (hydrogen breath test), quality of life (questionnaire SF-36)., Results: All patients with NASH, regardless of the presence of functional bowel pathology was characterized by hyperlipidemia with a tendency to lower HDL and raise LDL with normal levels of triglycerides, fasting hyperglycemia, increased postprandial glucose, glycated hemoglobin and HOMA--IR higher than normal values and the availability of the SIBO. NASH is often associated with functional constipation (68.6%). Patients with functional constipation and NASH have a significantly higher average level of ALT (127.3 ± 58.4 U/I in the control group and to 103.5 ± 74.6 U/I in the comparison group, p = 0.02), more frequent association with the SIBO (65.7% in the main group opposed to 43.7% in the comparison group, p = 0.014) and a lower quality of life compared with patients without pathology of the intestine., Conclusion: NASH has frequent association with functional constipation, worsens its course, resulting in a significant increase in the level of the marker of cytolysis (ALT), the more expressed SIBO and a palpable decline in the quality of life of patients, therefore the impaired intestinal function in these patients requires close attention.

Unlabelled: The study was designed to assess the relationship between the level of plasma concentration of insulin-like growth factor-1 (IGF-1) and indices of the functional state of the liver and the level of resistin in patients with non-alcoholic fatty liver disease (NAFLD) and its combination with diabetes mellitus (DM) 2 types depending on the trophological status., Materials and Methods: It were examined 90 patients with non-alcoholic fatty liver disease and its combination with type 2 diabetes mellitus--with normal body weight and obesity, as well as 20 healthy individuals. The study was carried out using the following methods: clinical, laboratory and instrumental (including liver biopsy)., Results: It was found an inverse relationship between the level of IGF-1, and the level of AST, ALT, AST/ALT, total and conjugated bilirubin, alkaline phosphatase in groups of patients with comorbid disorder and also an inverse relationship between the level of IGF-1 and resistin. There was established the significant decrease of plasma level of IGF-1, significant increase of plasma level of resistin and also impairment of liver function indices in all groups in comparison with the controls, and most pronounced changes in patients with comorbid disorders and obesity., Conclusion: The established relationships suggests that the decrease of IGF-1 may represent the presence of syndromes of cytolysis and cholestasis in patients with NAFLD, type 2 DM and obesity. In order to determination the disorder of the reparative function of the liver is recommended to determine the level of IGF-1 in patients with combination of NAFLD and type 2 DM. Patients with the level of IGF-1 (< 143.9 ± 4.92 ng/ml) should refer to the risk of progression of liver function disorders. The inverse correlation between resistin levels and the level of IGF-1 in plasma confirms the existing relationship between their productions.

Unlabelled: The aim of the study was to assess the links between leptin, resistin and tumor necrosis factor-alpha (TNF-α) and indexes of the functional liver condition in patients with non-alcoholic fatty liver disease (NAFLD), type 2 diabetes mellitus (DM 2) and with its combination., Materials and Methods: It were examined 110 patients: 20 of them were with NAFLD, 20 patients with DM 2 and 70 patients with combined disorders (NAFLD+ DM 2), which were divided into 2 subgroups -20 patients with normal body weight and 50 patients with obesity (body mass index ≥ 30 kg/m2). The control group included 20 healthy individuals. It was a complex clinical, laboratory (with definition of indexes of protein, pigment, enzyme and carbohydrate metabolism, levels of adipokines) and instrumental (ultrasound of the liver and liver biopsy (for 8 patients)) investigation., Results: It was shown a significant increase of plasma levels of leptin, resistin, TNF-α in patients with this combined pathology. It was established the significant correlations between leptin, resistin, TNF-α and indexes of functional liver condition in these patients., Conclusion: In patients with NAFLD, DM 2 and with its combination, particularly with concomitant obesity, there is an imbalance of the products of adipose tissue, which sign is increasing of leptin, resistin and TNF-α. Relationships between leptin, resistin, TNF-α and indexes of the functional liver condition mainly in subgroup 3-b would give a reason to believe that obesity is activated and compounded te hormone-metabolic disorders that affect liver function.

Aim: To detect early diagnostic criterions of hepatocellular inflammation and portal hypertension for revealing the progressive course of nonalcoholic fatty liver disease (NAFLD)., Materials and Methods: We have studied 58 patients with NAFLD: 6 with steatosis, 47 with steatohepatitis (SH), 5 with class A liver cirrhosis (LG). Liver biopsy was performed in 24 (41.4%) patients with estimation of histological activity index (HAI) and fibrosis by Brunt method. Abdominal sonography and dopplerography of portal and spleen venous bloodflow with estimation of portal vein congestive index (CI) were performed in all patients., Results: Among conventional laboratory markers of parenchimatous damage gammaglutamiltransferase (GGTF) was increased more frequently--in 77.6% of patients, then alaninaminotransferase (ALAT)--in 62.0% and aspartataminotransferase (ASAT)--in 51.7% of patients. GGTF correlated more closely with HAI: with fatty cellular degeneratic r = 0.82 (p < 0.01), bottled cellular degeneration--r = 0.65 (p < 0.05), lobular inflammation--0.58 (p < 0.05), fibrosis r = 0.67 (p < 0.05), than ALAT--0.51 (p < 0.05), 0.48 (p < 0.05), 0.42 (p < 0.05), 0.51 (p < 0.05) accordingly. Liver venous perfusion worsening was revealed already in moderate SH, when clinical symptoms of portal hypertension were absent. CI in portal vein correlated closely with HAI r = 0.78 (p < 0.05) and fibrosis r = 0.69 (p < 0.05) in NAFLD, that confirmed its diagnostic role in detection of parenchimatous and vascular liver architectonics deterioration and portal hypertension development., Conclusion: GGTF is more sensitive parenchimatous damage marker in NAFLD than ALAT and ASAT. Liver venous perfusion study with estimation portal vein congestive index permits to reveal the portal hypertension long before clinical symptoms of this syndrome appearance. Liver parenchimatous damage and its perfusion disturbance confirm the NAFLD progressive course.

Unlabelled: Early diagnosis of insulin resistance (IR) in patients with non-alcoholic fatty liver disease (NAFLD) is relevant in connection with the possibility of timely correction and the primary prevention of cardiovascular disease., Objective: To evaluate the diagnostic significance of the new metabolic index (MI) in the early diagnosis of IR in patients with NAFLD., Materials and Methods: In 494 patients with ultrasonographic evidence of NAFLD have been studied lipid and carbohydrate metabolism. Indirect methods of assessment of IR were analyzed and we proposed a new MI., Results and Discussion: NAFLD is accompanied by a progression of metabolic disorders and atherogenic dyslipidemia, disorders of carbohydrate metabolism, changes in the functional state of the liver. In the early stages of IR for the initial isolate changes of carbohydrates and lipid metabolism MI index is more sensitive to the existing violations, and with the progression of changes in laboratory parameters observed its gradual increase., Conclusions: MI can be recommended in clinical practice for screening IR in NAFLD patients for further in-depth examination.

Purpose: Electrogastroenterography (EGEG) is a method of measuring action potentials of the digestive tract. The aim of the study was to evaluate the main features of the gastrointestinal myoelectrical activity (GI MEA) in patients with nonalcoholic fatty liver disease (NAFLD) associated with metabolic syndrome (MS)., Materials and Methods: GI motility function in fasting and postprandial periods by the peripheral EGEG (EGEG system "Gastroenterological GEM-01") were recorded in 33 patients with NAFLD associated with MS, 26 patients with mixed type of Irritable Bowel Syndrome (IBS) and 10 healthy volunteers aged from 18 to 70 years., Results: Total fasting GI MEA data of patients with NAFLD associated with MS (Me = 40,99 MB) dominated over the same in patients with IBS (Me = 23.84 mV) and healthy volunteers (Me = 11.26 mV), the differences between EGEG parameters was not significant but critical (H = 5.997, p = 0.050). This trend was observed in postprandial period (H = 0.891, p = 0.640). In postprandial period total GI MEA in patients with NAFLD associated with MS was increased in 36.4% patients (95% CI: 24.7-56.3%) only while in IBS patients and healthy volunteers total GI MEA tract were increased in 76.9% patients (95% CI: 58.0-89.0%) and in 90.0% (95% CI: 59.6-98.2%) correspondently (χ2 = 14.12, p = 0.001). Postprandial ratio (PPR) (ratio between total GI MEA in postprandial and fasting periods) of GI MEA were less than 1.0 in patients with NAFLD associated with MS (Me = 0.65) and less then PPRs in patients with IBS and healthy volunteers (H = 10.378, p = 0.006). PPR in patients with IBS was less then this ratio in healthy volunteers (Me = 1.48 vs Me = 1.66) CONCLUSION: The increased total GI MEA is observed in patients with NAFLD associated with MS. Patients with NAFLD associated with MS have abnormal GI MEA in response on food stimulation. This fact may be important in the development of NAFLD and MS.

Diet modification is widely used for the treatment of non.alcoholic steatohepatitis (NASH). Caloric restriction was shown to be effective in normalizing bldod lipid profile, increasing insulin sensitivity and subsequent normalization of aminotrasferases blood level. The aim of the study was to compare low-calorie diet (LCD) with isocaloric diet (ICD) in patients w,ith NASH. 174 NASH patients [86 females (39,43±1,53 years old) and 88 males (41,7±2,0), BMI 36,8±0,8 kg/m2] were randomly assigned (as 1:2) for LCD (1600-1700 kcal/day) or ICD (2500-2700 kcal/day) calculated according to patients'sex, age, resting energy expenditures and daily physical activity. Caloric restriction was achieved by decreasing consumption of carbohydrates and fat in LCD, whereas for ICD the caloric consumption was established according to the recommended daily values for proteins, fat and carbohydrates for ideal BMI for every patient. Blood chemistry and body composition were assessed at baseline and after 1 mo of prescribed diets. Compliance for the diet was also evaluated using previously validated questionnaire. After 1 mo of dietetic interventions total body mass and lean mass significantly decreased in both groups, but in LCD group it was significantly more prominent decrease in compare to ICD group (9,3±1,8 vs 6,2±1,7 kg and 6,6±0,4 vs 1,4±0,6 kg, p<0,05), whereas fat mass decreased better in ICD group (4,8±0,7 vs 2, 7±0,8kg, p<0,05). Mean ALT level was decreased in ICD group (77,5±41,7 vs 98,8±45,7, p<0,01), but not in LCD group (81,2±50,6 vs 77,2±31,8, p=NS) whereas blood cholesterol, triglycerides, high density lipoprotein woere significantly decreased in both groups. Moreover during the diet intervention in 72% of patients from LCD group ALT increased. Compliance index was much higher in ICD group, than in LCD group (85% vs 54%). Thus, one month of lCD leads to decrease in ALT activity in majority of NASH patients, higher loss of fat mass, lower loss of lean mass and associated with better compliance in compare to LCD.