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

Authors

  • O. S. Khukhlina Bukovinian State Medical University, Cherwnivtsi, Ukraine,
  • A. A. Antoniv Bukovinian State Medical University, Cherwnivtsi, Ukraine,
  • O. S. Voievidka Bukovinian State Medical University, Cherwnivtsi, Ukraine,
  • O. B. Kuzminska Bukovinian State Medical University, Cherwnivtsi, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2018.1.121991

Keywords:

nonalcoholic steatohepatitis, chronic kidney disease, insulin resistance, lipids, S-adenosylmethionine, meldonium

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.

References

Babak, O. Ya., Kolesnikova, А. V., & Sytnyk, K. Е. (2013) Profilakticheskie meropriyatiya pri nealkogol'noj zhirovoj bolezni pecheni: suschestvuet li sposob snizit' risk razvitiya zabolevaniya? [Preventive measures for non-alcoholic fatty liver disease: is there a way to reduce the risk of the disease?]. Suchasna gastroenterolohiia, 3(71), 103–109. [in Russian]

Babak, O.Ya., & Lapshyna, K. A. (2016) Lechebnaya taktika u pacientov s nealkogol'noj zhirovoj bolezn'yu pecheni s uchetom urovnya citokeratina-18 v plazme krovi [Therapeutic strategy in patients with non-alcoholic fatty liver disease, considering cytokeratin-18 level determination in blood plasma]. Suchasna gastroenterolohiia, 2(88), 15–20. [in Russian].

Drapkina, O. M., & Kostyukevich, M. V. (2011) Metabolicheskij sindrom: problema gepatotoksichnosti pri lechenii statinami [Metabolic syndrome: the problem of the hepatotoxicity in patients treated with statins]. Ateroskleroz i dislipidemii, 3(10), 45–51. [in Russian].

Pankiv, V. I. (2016) Izuchenie e'ffektivnosti preparata Vazonat v kompleksnom lechenii bol'nykh sakharnym diabetom 2-go tipa [Studying the Efficacy of Vazonat in Comprehensive Treatment of Patients with Diabetes Mellitus Type 2]. Mizhnarodnyi endokrynolohichnyi zhurnal, 4(76), 80–84. [in Russian].

Samorodskaya, I. V. (2013) Mel'donij: obzor rezul'tatov issledovanij [Meldonium: review of research results]. Russkij medicinskij zhurnal, 36, 1818. [in Russian]

Khukhlina, O. S., & Drosd, V. Yu. (2016) Optymizatsiia likuvannia nealkoholnoho steatohepatytu u khvorykh na ozhyrinnia ta ishemichnu khvorobu sertsia. [Optimization of treatment of nonalcoholic steatohepatitis in patients with obesity and сoronary artery disease]. Liky Ukrainy, 9(205), 46–52. [in Ukrainian].

Khukhlina, O. S., & Mandryk, O. Ye. (2014) Nealkoholnyi steatohepatyt ta hipertonichna khvoroba: osoblyvosti komorbidnoho perebihu, optymizovani pidkhody do likuvannia [Non-alcoholic steatohepatitis and hypertension: features of the comorbid course, optimized approaches to treatment]. Chernivtsi. [in Ukrainian].

Anstee, Q. M., & Day, C. P. (2012) S-adenosylmethionine (SAMe) therapy in liver disease: A review of current evidence and clinical utility. J. of Hepatol., 57(5), 1097–1109. doi: 10.1016/j.jhep.2012.04.041

Cederbaum, А. (2010) Hepatoprotective effects of S-adenosyl-L-methionine against alcohol- and cytochrome P450 2E1-induced liver injury. World J. Gastroenterol, 16(11), 1366–1376. doi: 10.3748/wjg.v16.i11.1366

Kowdley, K. V. (2014) Advances in the diagnosis and treatment of nonalcoholic steatohepatitis. Gastroenterol. Hepatol., 10(3), 184–186.

Downloads

How to Cite

1.
Khukhlina OS, Antoniv AA, Voievidka OS, Kuzminska OB. 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. Zaporozhye Medical Journal [Internet]. 2018Jan.31 [cited 2024Dec.23];(1). Available from: http://zmj.zsmu.edu.ua/article/view/121991

Issue

No. 1 (2018)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons
    2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
    3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)