Efficacy L-Arginine In Patients With Nonalcoholic Steatohepatitis Associated With Metabolic Syndrome
Oleksandr Fediv, Volodymyr Shevchuk, Oksana Olinyk
Index Terms: nonalcoholic steatohepatitis, metabolic syndrome, endothelial dysfunction, haemocoagulation, fibrinolysis, L-arginine, blood.
Abstract: Background and Purpose: Recent research in the field of hematology indicate that among the many pathogenic mechanisms of development and progression of nonalcoholic steatohepatitis (NASH), which occurs on the background of the metabolic syndrome, an important role is played by endothelial dysfunction and violations of haemocoagulation. The aim of this research was to study the effectiveness of L-arginine as it corrects endothelial dysfunction and disorders of homeostasis haemocoagulation link in patients with NASH associated with the metabolic syndrome. Subjects and Methods: 128 patients with nonalcoholic steatohepatitis associated with metabolic syndrome were examined. Some patients (63 persons) received standard treatment according to national guidelines. To another group (65 patients) on the background of basic therapy L-arginine hydrochloride, followed by transition to oral form of L-arginine aspartate was administered. Blood levels of stable nitrogen monoxide metabolites (nitrites, nitrates), endothelin-1 and plasma recalcification time, prothrombin time, thrombin time, activated partial thromboplastin time, fibrinogen plasma level, activity of antithrombin III and coagulation factor XIII, potential activity of plasminogen, plasma fibrinolytic blood activity were studied. Results: Originally significantly increased levels of endothelin-1 decreased after the therapy in all studied groups, but more noticeable changes in the group with L-arginine appointment were observed (p<0.05). In the studied groups normalization of stable nitrogen monoxide metabolites after treatment was also noticed. Significant (p<0.05) increase in all haemocoagulation time characteristics and activities of antithrombin-III and factor XIII was found. The positive effect of L-arginine on blood fibrinolytic activity was noted. Discussion and Conclusion: Combined therapy of nonalcoholic steatohepatitis associated with metabolic syndrome, with a differentiated degreeal L-arginine assignment by double increasing the duration of use of parenteral form (L-arginine hydrochloride) and subsequent double increasing of oral form of the drug (L-arginine aspartate) in case of the classic metabolic syndrome and its phenotype (AH + AO + IGT/DM-2) compared with the scheme of his appointment in case of phenotype (AH + DLP + IGT/DM-2) and (AH + DL + AO) is more effective than traditional therapy (essential phospholipids, ursodeoxycholic acid, metformin) for correction of basic clinical and laboratory disease syndromes, restore the functional state of the endothelium and eliminate haemocoagulation violations.
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