APPLICATION OF BETARGIN IN THE TREATMENT OF STABLE CORONARY HEART DISEASE AND NON-ALCOHOLIC FATTY LIVER DISEASE

Abstract

The aim of the research: to study the influence of betargin on the clinical course of stable coronary heart disease (CHD) and non-alcoholic fatty liver disease (NAFLD), indicators of CSI (TNF?, IL-6 and IL-10), endothelial dysfunction, on the condition of central hemodynamics and blood flow in the liver veins. Object and methods: the study included 83 subjects of both sexes aged 40-69 years with the diagnosis of CHD: exertional stable angina, FC -, HF 0- concurrent with NAFLD (steatohepatosis), in the absence of destabilization of the course for two months. In order to identify the diagnosis of CHD and NAFLD, the data of clinical, laboratory and instrumental studies were taken into account in accordance with the standards of patients examination. All patients received standard therapy for 2 months. After that, they were divided into 2 groups - study group (35 subjects) and comparison group (48 people). At the beginning of the research, patients in both groups underwent echocardiography to study the parameters of central hemodynamics and ultrasound pulsed Doppler sonography of the liver to determine the rate of blood flow in the portal and hepatic veins. The concentration of cytokines (CK) in the blood was determined: TNF?, IL-6 and IL-10 using the enzyme immunoassay method; expression of kappa B kappa inhibitor (IkB?) by realtime polymerase chain reaction (Real-time PCR); the number of circulating endothelial microparticles (CEM) in the peripheral blood by detecting the expression of CD32 and CD40 antigens by flow cytometry. Further, the study group received the baseline therapy along with administering betargin at a dose of 2000/2000 mg twice a day per os, while the comparison group received only the baseline therapy. We evaluated the results of this study after 2 months by means of re-examination in the abovementioned volume of methods. Results: in application of integrated therapy with betargin, the results of treatment showed a significant improvement in the general condition of patients: increased vigor and work capacity, stabilization of the clinical course of exertional angina: reduced number and duration of pain attacks in the heart region from 3-4 times / week to 1 time, decreased frequency of nitroglycerin intake, increased endurance of physical activity when climbing stairs. The state of the digestive system also improved: the feeling of gravity and discomfort in the right hypochondrium, the attacks of heartburn, feeling of bitterness in the mouth and bloating decreased. The application of this therapy had a positive effect on the state of central hemodynamics: the value of systolic function of LV (EF) was improved by 8% and LV diastolic function, which was evaluated by the ratio of the phases of transient flow E / A and DT. The rate of blood flow in the portal vein significantly decreased: v = 0.33 0.07 m/s (p = 0.0002) by 16.3%. Moreover, a reliable decrease in CEM was observed: CD32 CD40 = 2.04 1.53 (p = 0.046), which indicates the reduction of endothelial dysfunction. After administration of betargin, a significant decrease in expression of the iKB? mRNA gene in mononuclear cells (p = 0.048) was observed, which is associated with reduced transcriptional activity of NF-kB and has an anti-inflammatory effect, that is also confirmed by a significant decrease in TNF? and a minor decrease of IL-6 (p 0.05, respectively), as well as a reliable increase of IL-10 (p <0.004). Conclusion: the obtained results determine the expediency of recommending the use of betargin in the treatment of CHD concurrent with the hepatobiliary pathology, namely NAFLD.

Keywords

• coronary heart disease
• nonalcoholic fatty liver disease
• chronic systemic inflammation
• endothelial dysfunction
• central hemodynamics
• blood flow in the portal and hepatic veins