Introduction. 80% of patients with diabetes mellitus (DM) type 2 have certain manifestations of metabolic syndrome (MS), characterized by obesity, dyslipidemia, insulin resistance (IR), hypertension and liver disease. Most patients require combination therapy of hypertension and diabetes and high cardiovascular risk, coupled with chronic nonalcoholic liver disease (HNUP). The aim of the research. To evaluate antihypertensive effect of low-dose combination therapy with perindopril, indapamide combined with livolinom forte concerning patients with MS and HNUP and their effects on carbohydrate and lipid metabolism. Materials and methods. The study involved 32 male patients aged 30 to 60 years (average age 43,6 ± 4,1 years) diagnosed with MS NAFLD. All patients were subject to anthropometric, general clinical, laboratory and instrumental methods of research. Determining the level of blood sugar fasting and 2 hours after a meal was performed by glucose-oxidant method. The defeat of the cardiovascular system (CVS) verified using daily monitoring of blood pressure (BP). Analyzed the following parameters: systolic blood pressure (SBP), diastolic blood pressure (DBP), the average blood pressure (SATd, DATd) average night blood pressure (condensate, serviceable), the index of variability (IV) in the daytime and nighttime SBP (IV SATd, IV condensate) and DBP (IV DATd, IV serviceable), circadian index (CI, SBP, DBP CI). Also applied research ECG, Holter monitoring, echo-cardiography. Diagnosis NAFLD established on the basis of complaints, anamnesis (patients do not abuse alcohol), laboratory examinations (serum determined levels of bilirubin and its fractions, cholesterol, high density lipoproteins (HDL), triglycerides (TG), and determined the activity of aspartate aminotransferase (AST ) and alanine aminotransferase (ALT), take into account the negative ELISA for viruses hepatitis B and C. Depending on the intended treatment the patients were divided into two clinical groups. Group1 included 16 patients with MS and NAFLD who in addition to antihypertensive therapy with perindopril and indapamide (dose of perindopril was 5-7,5 mg / day, depending on blood pressure, indapamide - 2.5 mg / day ) appointed hepatoprotective drug action - livolin forte 1 capsule 3 times daily for 1 month. Patients of II group (16 patients) with MS and NAFLD as hepatoprotector received silimarin 1 capsule 3 times daily for 1 month. Results and discussion. All 32 patients revealed an abdominal-visceral obesity. Body mass index (BMI) of patients of Group 1 amounted 32,6 ± 2,1 kg / m2, waist size - 112 ± 1,5 cm, BMI of patients of Group II - 31,3 ± 3,7 kg / m2, waist size - 113 ± 0,6 cm. Under the influence of combination antihypertensive therapy observed normalization of blood pressure (SBP reduction 11.9%, 12.8% condensate, DATd 8.9% serviceable 11.2%) patients in Group I and in accordance with (SATd 11, 0% condensate by 11.1%, 6.4% DATd, serviceable 8.8%) patients in group II. Controlling carbohydrate metabolism study was carried out using the daily glycemic profile and glucose serum fasting. Before treatment, noted the increase in blood glucose levels in all patients studied. Complex treatment had a positive impact on the dynamics of glucose in the blood serum, namely, patients of group 1 and blood sugar dropped to 5,5 ± 0,2 mmol / l to 5,2 ± 1,1 mmol / l in group II patients . The effectiveness of treatment was assessed through analysis of the dynamics of blood biochemical parameters (ALT, AST, bilirubin - noted a decrease in their activity). It should be noted that a more pronounced positive effect in the group of patients (group I), who additionally received livolin forte. State treatment of lipid metabolism characterized by the following indicators: increased TG and SW, and the concentration of HDL, by contrast, was lower than the norm. Against the background of the treatment using livolin Forte noted a decrease in TG from 2,2 ± 0,5 mmol / l to 1,8 ± 0,3 mmol / L, normalization of W with 6,4 ± 1,1 mmol / l to 5,5 ± 0,6 mmol / l, increased HDL-C at patients of group 1. This explains the presence in the preparation of phospholipids, affecting disturbed fat metabolism through the regulation of metabolism of lipoproteins, resulting in neutral fats and cholesterol are converted into forms suitable for transportation, particularly by increasing the ability of high-density lipoprotein (HDL) connect cholesterol, and aimed for further oxidation. Vitamin complex reveals hypolipidemic effect and prevents fatty liver; pyridoxine as a coenzyme involved in the metabolism of phospholipids, amino acids and proteins; Thiamin is involved in carbohydrate metabolism; Riboflavin is the cofactor of many respiratory enzymes; tokoferyl acts as an antioxidant at the cell membrane, prevents oxidation of unsaturated fatty acids. Conclusions: Patients with alcoholic fatty liver disease on the background of MS a disorder of lipid and carbohydrate metabolism is observed. Application of Livolin forte in treatment of patients with MS NAFLD on the background leads to normalization of lipid metabolism and functional parameters of the liver. Further study of the mechanisms of formation of nonalcoholic staetohepatytis to develop optimal methods their correction and prevention.
Keywords: non-alcoholic fatty liver disease, metabolic syndrome, diagnostics, treatment
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