Zaporožskij Medicinskij Žurnal (Feb 2018)
The efficiency of metabolic impact of S-adenosylmethionine and meldonium on parameters of lipid profile and insulin resistance during comorbid course of nonalcocholic steatohepatitis, obesity and chronic kidney disease stage І-ІІ
Abstract
Objective – to investigate the influence of the complex of S-adenosylmethionine (Agepta) and meldonium (Vasonat) on the course of NASH with obesity and CKD, the state of the lipid profile of the blood, and the degree of insulin resistance. Materials and methods. The study involved 75 patients with NASH with comorbid obesity of the 1st degree and CKH of І–ІІ st. Three groups of patients were randomized by age, sex, obesity, activity of the cytolytic syndrome of NASH and the stage of CKN (chronic uncomplicated pyelonephritis with latent course in the phase of subsiding acute exacerbation) to determine the treatment effectiveness. The control group (24 persons) received hypocaloric diet, metformin 500 mg twice daily, rosuvastatin 10 mg 1 time per day, essentiale H as a hepatoprotective drug (1 capsule 3 times a day), canephron N (50 mg 3 times a day) during 90 days. The second group (26 people) received hypocaloric diet, metformin 500 mg twice daily, rosuvastatin 10 mg 1 time per day, canephron N (50 mg 3 times a day), S-adenosylmethionine (Agepta) (SAM) as hepatoprotective drug (200 mg 3 times daily sublingually) during 90 days. The third group (25 people) received hypocaloric diet, metformin 500 mg twice daily, rosuvastatin 10 mg 1 time per day, canephron N (50 mg 3 times a day), SAM (Agepta) (200 mg 3 times a day sublingually) and meldonium (Vazonat) (250 mg 2 times a day) during 90 days. The analysis of clinical manifestations of NASH and CKN of the III stage, biochemical, laboratory parameters of the functional state of the liver, kidneys, endothelium, ultrasonographic data were studied in dynamics in 30 and 90 days during treatment and in 3 months after the treatment. Results. The investigation found that S-adenosylmethionine (Agepta) and meldonium (Vasonat) in patients with non-alcoholic steatohepatitis with obesity and chronic kidney disease of I–II stage have positive metabolic effects which potentiate the effect of statins and insulin sensitizers (Metformin) with correction of preprandial and postprandial glycemia, decreased insulin resistance, optimized blood lipid profile, decreased liver steatosis. Conclusions. The complex therapy with S-adenosylmethionine (Agepta) and meldonium (Vazonat) is more effective in the correction of dysmetabolic manifestations of NASH, obesity and CKD.
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