The role of endothelium-dependent factors, as well as disorders of intestinal microbiocenosis, in the pathogenesis of many chronic liver diseases is being widely studied. However, the effect of endothelial dysfunction on the progression of vascular lesions in patients with non-alcoholic steatohepatitis and type 2 diabetes mellitus remains unclear. The purpose of the study was to research the severity of endothelial dysfunction and intestinal dysbiosis in patients with non-alcoholic steatohepatitis and type 2 diabetes mellitus. Material and methods. 52 patients with non-alcoholic steatohepatitis and type 2 diabetes mellitus were examined. All patients underwent general clinic research where the qualitative and quantitative composition of the microflora of colon and indicators of endothelial dysfunction (von Willbrand factor, endothelin-1), endothelium-dependent and endothelium-independent vasodilation) were determined. Results and discussion. All patients with non-alcoholic steatohepatitis and type 2 diabetes mellitus showed dysbiotic changes in colon. At the same time the analysis of severity of dysbiotic changes in examined patients indicated mainly the III and II grade of dysbiosis (in 57.7% and in 23.1% of patients accordingly). I grade of dysbiosis was detected in 15.4% of patients and only 3.8% of cases have IV grade of dysbiosis. We also noted the presence of endothelial dysfunction in patients with non-alcoholic steatohepatitis and type diabetes mellitus manifested by the decrease of endothelium-dependent and endothelium-independent vasodilation and the increase in serum von Willbrand factor and endothelin-1 levels, compared with the control group. The correlation analysis indicated the dependence between the indicators of endothelial dysfunction and the severity of colonic dysbiosis in patients with non-alcoholic steatohepatitis and type 2 diabetes mellitus. At the same time, grade III dysbiosis correlated with all laboratory-instrumental indicators of endothelial dysfunction. In patients with non-alcoholic steatohepatitis and type 2 diabetes at grade II colon dysbiosis showed a strong correlation between the severity of endothelium-independent vasodilation (r=0.94; p<0.01), von Willbrand factor (r=0.84; p<0.01) and endothelin-1 level (r=0.92; p<0.01). We did not find correlation dependence in patients with grade IV dysbiosis. In patients with grade I dysbiosis negative correlation dependence occurred with the level of von Willbrand factor (r= -0.76; p<0.05) and endothelin-1 (r= -0.68; p<0.05). Conclusion. The patients with non-alcoholic steatohepatitis and type 2 diabetes mellitus had colonic dysbiosis, manly grade III and II. Endothelial dysfunction in patients with non-alcoholic steatohepatitis and type 2 diabetes mellitus was manifested by decrease in endothelium-dependent and endothelium-independent vasodilation indicators as well as increase of laboratory markers of endothelial dysfunction (von Willbrand factor and endothelin-1). A direct correlation between the degree of colon dysbiosis and the severity of progression of endothelial dysfunction was revealed in patients with non-alcoholic steatohepatitis and type 2 diabetes mellitus.

Keywords: non-alcoholic steatohepatitis, type 2 diabetes mellitus, colon dysbiosis, endothelial dysfunction

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