Львівський клінічний вісник (Jun 2020)
Redox Homeostasis Index as a Criterion for Differentiated Inclusion of Antioxidants in Complex Treatment of the Patients with Liver Cirrhosis of Different Severity Degrees and Evaluation of Its Effectiveness
Abstract
Introduction. The course of liver cirrhosis (LC) is determined by the appearance and increase of the severity of syntropic comorbid lesions caused by the redox homeostasis disorders with the prooxidants system activity predominance and realizing its pathogenetic mechanism through the endothelial dysfunction. Due to the important role of oxidative stress among the etiologic and pathogenetic mechanisms of the LC onset and course, the pharmacological impact on it in the complex treatment deserves priority, being one of the main “targets”. The aim of the study. To characterize the redox homeostasis index (RHI) as a criterion for the differentiated inclusion of antioxidants in the complex treatment of the patients with liver cirrhosis of different severity degree and evaluation of its effectiveness. Materials and methods. The study was conducted in three steps. After obtaining the written consent to conduct the survey, 75 patients (23 women (30.7 %), 52 men (69.3 %), mean age – 47.2 ± 10.4 years) were enrolled in a randomized trial with preliminary stratification by the presence of LC. All of them underwent the complex clinical-laboratory-instrumental examination and inpatient treatment at Lviv Regional Hepatology Center. The state of redox homeostasis was evaluated by the malondialdehyde (MDA) and catalase (CAT) levels determining, and, on the basis of the received results, we proposed to calculate RHI. Reduced RHI (18.1) – an indicator of the antioxidant system excessive activity. The first step of our study was to determine the RHI to detect the disorders of redox homeostasis in patients with different severity degrees before the treatment, i.e. obtaining the information about the presence of patients with reduced, normal and increased values, which allows us to recommend the modification of standard complex treatment using antioxidants (medicine containing retinol palmitate (vitamin A) 100 000 MO and α-tocopherol acetate (vitamin E) 0.1 g – 1 capsule per os once a day after meals daily, ascorbic acid 0.05 g – 2 tablets per os once a day after meals daily, selenium 0,0002 g – 1 tablet per os once a day after meals daily for two months) only for patients with reduced RHI. The second step of the study was devoted to the determination of RHI after a course of complex differentiated treatment of the same patients with LC of varying severity. The third step of the study was to compare the RHI obtained after the course of complex differentiated treatment of patients with LC varying severity degrees with the values of the RHI prior to treatment. The actual material was processed on a personal computer in Exсel 2010, Statistica 6.0, RStudio v. 1.1.442 and R Commander v. 2.4-4. The results obtained were presented as Me [25.0 %; 75.0 %]. The difference was considered statistically significant if p < 0.05. Results. The overwhelming majority of patients with LC (71 persons, representing 94.7 % of all those involved in the study) have disorders of redox homeostasis, among which patients with the signs of the prooxidant system prevalence and the antioxidant system activity attenuation are predominant (66 persons, accounting for 88.0 % of all those involved in the study), and the incidence of them significantly increases, as well as the value of RHI decreases with LC decompensation. Since redox homeostasis disorders with signs of attenuation of the antioxidant system activity have been diagnosed in the vast majority of patients with LC, and they determine to a large extent the features of the disease as well as the onset and severity increase of syntropic comorbid lesions, its medication adjustment is needed. RHI allows to determine the feasibility of including the antioxidants in their comprehensive treatment, as well as to determine its effectiveness, which depends on its indicators for the treatment and severity of liver cirrhosis and is the lowest in patients at the stage of decompensation of the disease. It is revealed that after the administering of the complex, differentiated standard treatment, modified by us, with the use of antioxidants RHI increases in patients with its primary decrease, which results in an improvement of the redox system state, which is the most pronounced in patients of class B, and the least – of class C by the criteria of C. G. Child – R. N. Pugh. Conclusions. The redox homeostasis index is an important criterion for assessing the state of redox homeostasis in patients with liver cirrhosis of different severity, that allows to determine the feasibility of including the antioxidants in their complex treatment, as well as to determine its effectiveness, which is the lowest in patients with decompensated liver cirrhosis.
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