nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-183-11-25-33nogr-1470Research ArticleКЛИНИЧЕСКАЯ ГАСТРОЭНТЕРОЛОГИЯCLINICAL GASTROENTEROLOGYНеалкогольная жировая болезнь печени и диастолическая дисфункция левого желудочка у больных с метаболическим синдромомNon-alcoholic fatty liver disease and left ventricular diastolic dysfunction in patients with metabolic syndromehttps://orcid.org/0000-0001-5823-7236ДжадхавС. Н.JadhavS. N.

Джадхав Свапнил Нивасрао, аспирант кафедры внутренних болезней, клинической фармакологии и нефрологии

191015, Санкт-Петербург, Кирочная ул., 41

Swapnil N. Jadhav (M. D. Physician), aspirant Department of internal diseases, clinical pharmacology and nephrology

191015, St. Petersburg, Kirochnaya street, 41

swapjul@hotmail.comРадченкоВ. Г.RadchenkoV. G.

Радченко Валерий Григорьевич, д. м. н., профессор 2 кафедры (терапии усовершенствования врачей)

194044, Санкт-Петербург, улица Академика Лебедева, д. 6

Valery G. Radchenko, Professor of 2nd Therapy department of postgraduate education

194044, St. Petersburg, Akademika Lebedev street, 6

ФГБУ ВО «Северо-Западный государственный медицинский университет имени И. И. Мечникова» МЗ РФРоссияNorth-Western state medical University named after I. I. Mechnikov, Ministry of health of the Russian FederationRussian FederationФГБВОУ ВО «Военно-медицинская академия имени С. М. Кирова» МО РФРоссияMilitary Medical Academy named after S. M. KirovRussian Federation202013112020183112533Copyright © Джадхав С.Н., Радченко В.Г., 20202020Джадхав С.Н., Радченко В.Г.Jadhav S.N., Radchenko V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1470

Целью исследования явилось определение частоты и характера проявлений диастолической дисфункции левого желудочка у больных неалкогольной жировой болезнью печени на фоне метаболического синдрома (МС).

Характеристика больных и методы исследования: Для решения поставленной задачи обследовано 227 больных с МС (130 мужчин и 97 женщин). Исследование включало два этапа. На первом этапе все пациенты с МС разделены на две группы: больные с наличием НАЖБП — 205 человек и 22 — без поражения печени. На следующем этапе выделена группа исследуемых НАЖБП с ДД левого желудочка (n=136) (66.34%) (основная группа) и пациентов с отсутствием ДД (n=69) (33.66%) (группа сравнения).

Результаты исследования

Результаты исследования: Представлены результаты диагностики, клинико-лабораторных проявлений диастолической дисфункции левого желудочка у 136 больных НАЖБП на фоне метаболического синдрома. Выявлены значимые факторы развития и прогрессирования диастолической дисфункции к которым относится увеличение массы тела и жировой ткани, инсулинорезистентность, дислипидемия, гиперурикемия, активность и стадия поражения печени. По данным структурно-функциональных изменений миокарда установлена роль диастолической дисфункции в развитии хронической сердечной недостаточности у больных НАЖБП с проявлениями метаболического синдрома.

Заключение

Заключение: Установлено, что развитие диастолической дисфункции левого желудочка у больных НАЖБП обусловлено морфофункциональным состоянием печени.

The purpose of the study was to determine the frequency and nature of manifestations of left ventricular diastolic dysfunction in patients with non-alcoholic fatty liver disease with the background of metabolic syndrome (MS).

Characteristics of patients and research methods: To solve this problem, 227 patients with MS (130 men and 97 women) were examined. The study was conducted in two phases. At the first stage, all patients with MS are divided into two groups: patients with NAFLD — 205 people and 22 — without liver damage. At the next stage, a group of NAFLD patients with left ventricular DD (n=136) (66.34%) (the main group) and patients with no DD (n=69) (33.66%) (the comparison group) were identified.

Results of the study

Results of the study: the results of diagnostics, clinical and laboratory manifestations of left ventricular diastolic dysfunction in 136 patients with NAFLD on the background of metabolic syndrome are Presented. Significant factors of development and progression of diastolic dysfunction were identified, which include increased body weight and adipose tissue, insulin resistance, dyslipidemia, hyperuricemia, activity and stage of liver damage. According to the data of structural and functional changes in the myocardium, the role of diastolic dysfunction in the development of chronic heart failure in patients with NAFLD with manifestations of metabolic syndrome has been established.

Conclusion

Conclusion: it was Found that the development of left ventricular diastolic dysfunction in patients with NAFLD is due to the morphofunctional state of the liver.

неалкогольная жировая болезнь печени (НАЖБП)диастолическая дисфункция левого желудочкасистемное воспалениеинсулинорезистентностьгиперурикемияNon-alcoholic fatty liver disease (NAFLD)left ventricular diastolic dysfunctionsystemic inflammationinsulin resistancehyperuricemiaReferencesАгеев Ф. Т. Влияние современных медикаментозных средств на течение заболевания, качество жизни и прогноз больных с различными стадиями хронической сердечной недостаточности. / Ф. Т. Агеев // Дисс. .докт. мед. наук. – 1997. – С. 241.Ageev F. T. Influence of modern medications on the course of the disease, quality of life and prognosis of patients with various stages of chronic heart failure. Diss. doctor of medical Sciences, 1997, 241 P.Козулина, Е. А. Клинико-патогенетические особенности хронической сердечной недостаточности у женщин с абдоминальным ожирением в постменопаузальном периоде/ Кандидатская диссертация 2015гKozulina, E. A. Clinical and pathogenetic features of chronic heart failure in women with abdominal obesity in the postmenopausal period/ PhD diss. 2015.Лазебник Л. Б., Радченко В. Г., Джадхав С. Н., Ситкин С. И., Селиверстов П. В. Системное во спале ние и неалкогольная жировая болезнь печени./ Л. Б. Лазебник, В. Г. Радченко, С. Н. Джадхав, С. И. Сит кин, П. В. Селиверстов// Экспери мен тальная и клиническая гастроэнтерология. – 2019. т. 165(5) – с. 29–41. https://doi.org/10.31146/1682–8658-ecg-165–5–29–41Lazebnik L. B., Radchenko V. G., Dzhadhav S. N., Sitkin S. I., Seliverstov P. V. Systemic inflammation and non-alcoholic fatty liver disease. Experimental and Clinical Gastroenterology. 2019;(5):29–41. (In Russ.) https://doi.org/10.31146/1682–8658-ecg-165–5–29–41Пицко, Д. В. Роль гиперурикемии в прогрессировании и патогенезе неалкогольной жировой болезни печени / Д. В. Пицко // Гепатология и гастроэнтерология. – 2019. – Т. 3– № 2. – С. 145–150Pitsko, D. V. the Role of hyperuricemia in the progression and pathogenesis of non-alcoholic fatty liver disease. Hepatology and gastroenterology. 2019. Vol. 3, No. 2, pp. 145–150.Тополянская С.В., Вакуленко О. Н., Семашкова А. Е., Купина Л. М., Стрижова Н. В. Гиперурикемия и сердечно-сосудистые заболевания в старческом возрасте./ С. В. Тополянская, О. Н. Вакуленко, А. Е. Семашкова, Л. М. Купина, Н. В. Стрижова.// Клин. мед. – 2017. – vol. 95 (5) – P. 457–464.Topolyanskaya S. V., Vakulenko O. N., Semashkova A. E., et al. Hyperuricemia and cardiovascular diseases in old age. Klin. med. 2017. vol. 95 (5), pp. 457–464.Целуйко В.И., Ашакидзе З. С. Выявление независимых предикторов рецидива мерцательной аритмии у больных с пароксизмальной и персистирующей формой фибрилляции предсердий/ В. И. Целуйко, З. С. Ашакидзе // МНС. – 2011. – № 4 (35) – С. 71–74.Tseluiko V. I., Vashakidze Z. S. Identification of independent predictors of atrial fibrillation recurrence in patients with paroxysmal and persistent atrial fibrillation. MNS. 2011. No.4 (35), pp. 71–74.Alihan O., Tolga S., Fatih T., Erdem Kocak. Relationship between Serum Uric Acid Levels and Nonalcoholic Fatty Liver Disease in Non-Obese Patients. Medicina. 2019. vol.55,.600 P.Alihan O., Tolga S., Fatih T., Erdem Kocak. Relationship between Serum Uric Acid Levels and Nonalcoholic Fatty Liver Disease in Non-Obese Patients. Medicina. 2019. vol.55,.600 P.Antonella Moreo, Giuseppe Ambrosio et. al. Influence of Myocardial Fibrosis on Left Ventricular Diastolic Function. Circ Cardiovasc Imaging. 2009. Vol.2, pp. 437–443.Antonella Moreo, Giuseppe Ambrosio et. al. Influence of Myocardial Fibrosis on Left Ventricular Diastolic Function. Circ Cardiovasc Imaging. 2009. Vol.2, pp. 437–443.Azevedo Paula S., Polegato Bertha F. et. al. Cardi ac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arqc Bras Cardiol. 2016. vol.106(1), pp. 62–69Azevedo Paula S., Polegato Bertha F. et. al. Cardi ac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arqc Bras Cardiol. 2016. vol.106(1), pp. 62–69Brunt EM, Kleiner DE et. al. Network NCR. Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinico-pathologic meanings. Hepatology. 2011. vol.53, pp.810–820.Brunt EM, Kleiner DE et. al. Network NCR. Nonalcoholic fatty liver disease (NAFLD) activity score and the histopathologic diagnosis in NAFLD: distinct clinico-pathologic meanings. Hepatology. 2011. vol.53, pp.810–820.Bouthoorn S., Valstar G. B. et. al. The prevalence of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in men and women with type 2 diabetes: A systematic review and meta-analysis. Diabetes & Vascular Disease Research. vol.15(6), pp.477–493Bouthoorn S., Valstar G. B. et. al. The prevalence of left ventricular diastolic dysfunction and heart failure with preserved ejection fraction in men and women with type 2 diabetes: A systematic review and meta-analysis. Diabetes & Vascular Disease Research. vol.15(6), pp.477–493Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015. vol.62(1 Suppl), pp.47–64Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015. vol.62(1 Suppl), pp.47–64Chen et al. Between hyperuricemia and metabolic syndrome. J Zhejiang Univ Sci B. 2007. vol.8(8), pp.593–598Chen et al. Between hyperuricemia and metabolic syndrome. J Zhejiang Univ Sci B. 2007. vol.8(8), pp.593–598Chen et al. Relationship Antonella Moreo, Giuseppe Ambrosio et. al. Influence of Myocardial Fibrosis on Left Ventricular Diastolic Function. CircCardiovascImaging. 2009. Vol.2, pp. 437–443Chen et al. Relationship Antonella Moreo, Giuseppe Ambrosio et. al. Influence of Myocardial Fibrosis on Left Ventricular Diastolic Function. CircCardiovascImaging. 2009. Vol.2, pp. 437–443Demir M, Lang S, Steffen HM. Nonalcoholic fatty liver disease – current status and future directions. J DigDis. 2015, vol.16(10), pp.541–57.Demir M, Lang S, Steffen HM. Nonalcoholic fatty liver disease – current status and future directions. J DigDis. 2015, vol.16(10), pp.541–57.Fallo F., Dalla P. A., SoninoN., et al. Non- alcoholic fatty liver diseases associated with left ventricular diastolic dysfunction in essential hypertension. NutrMetabCardiovascDis. 2009. Vol. 19, pp. 646–653Fallo F., Dalla P. A., SoninoN., et al. Non- alcoholic fatty liver diseases associated with left ventricular diastolic dysfunction in essential hypertension. NutrMetabCardiovascDis. 2009. Vol. 19, pp. 646–653Grassi D., Ferr L. et. al. Chronic Hyperuricemia, Uric Acid Deposit and Cardiovascular Risk. Current Pharmaceutical Design. 2013. vol.19, pp. 2432–2438Grassi D., Ferr L. et. al. Chronic Hyperuricemia, Uric Acid Deposit and Cardiovascular Risk. Current Pharmaceutical Design. 2013. vol.19, pp. 2432–2438Henein M. et al. Tissue Doppler analysis of age-dependency in diastolic ventricular behavior and fi lling. Eur. Heart Journal. 2002. Vol. 23, pp. 162–171.Henein M. et al. Tissue Doppler analysis of age-dependency in diastolic ventricular behavior and fi lling. Eur. Heart Journal. 2002. Vol. 23, pp. 162–171.Iacobellis G, Ribaudo MC, Leto G, Zappaterreno A, Vecci E, Di Mario U, et al. Influence of Excess Fat on Cardiac Morphology and Function: Study in Uncomplicated Obesity. Obesity Research. 2002. vol. 10(8), pp.767–73.Iacobellis G, Ribaudo MC, Leto G, Zappaterreno A, Vecci E, Di Mario U, et al. Influence of Excess Fat on Cardiac Morphology and Function: Study in Uncomplicated Obesity. Obesity Research. 2002. vol. 10(8), pp.767–73.Jadhav S.N., Radchenko V. G., Seliverstov P. V., Sitkin S. I. importance of insulin resistance in patients with nonalcoholic fatty liver disease and diastolic dysfunction of the heart. Preventive medicine. 2019, pp .52–59Jadhav S.N., Radchenko V. G., Seliverstov P. V., Sitkin S. I. importance of insulin resistance in patients with nonalcoholic fatty liver disease and diastolic dysfunction of the heart. Preventive medicine. 2019, pp .52–59Lugo M, Putong PB. Metaplasia. An overview. Arch Pathol Lab Med. 1984. vol.108(3), pp.185–189.Lugo M, Putong PB. Metaplasia. An overview. Arch Pathol Lab Med. 1984. vol.108(3), pp.185–189.Maiuolo J., Oppedisano F et. al. Regulation of uric acid metabolism and excretion. International Journal of Cardiology. 2016, vol.213, pp. 8–14.Maiuolo J., Oppedisano F et. al. Regulation of uric acid metabolism and excretion. International Journal of Cardiology. 2016, vol.213, pp. 8–14.Muiesan M. L., Agabiti-Rosei C., Paini A., Salvetti M. Uric Acid and Cardiovascular Disease: An Update. Eur Cardiol. 2016. vol.11(1), pp. 54–59Muiesan M. L., Agabiti-Rosei C., Paini A., Salvetti M. Uric Acid and Cardiovascular Disease: An Update. Eur Cardiol. 2016. vol.11(1), pp. 54–59Nishimura, R. A., Tajik A. J. Evaluation of Diastolic Filling of left ventricle in health and disease: doppler echocardoigraphy is the clinician’s Rosetta Stone.. J Am Coll Cardiol. 1997. vol. 30, pp.8–18Nishimura, R. A., Tajik A. J. Evaluation of Diastolic Filling of left ventricle in health and disease: doppler echocardoigraphy is the clinician’s Rosetta Stone.. J Am Coll Cardiol. 1997. vol. 30, pp.8–18Niskanen LK, Laaksonen DE, Nyyssönen K, et al. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch Intern Med. 2004 vol.164(14), pp.1546–1551.Niskanen LK, Laaksonen DE, Nyyssönen K, et al. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch Intern Med. 2004 vol.164(14), pp.1546–1551.Ohno M., Cheng C. P., Little W. C. Mechanism of Altered Patterns of Left ventricular Filling During the Development of Congestive Heart Failure. Circulation. 1994. V. 89, pp. 2241–2250.Ohno M., Cheng C. P., Little W. C. Mechanism of Altered Patterns of Left ventricular Filling During the Development of Congestive Heart Failure. Circulation. 1994. V. 89, pp. 2241–2250.Philip-Couderc P, Pathak A, Smih F, et al. Uncomplicated human obesity is associated with a specific cardiac transcriptome: involvement of the Wnt pathway. FASEB J. 2004. vol. 18(13), pp.1539–40.Philip-Couderc P, Pathak A, Smih F, et al. Uncomplicated human obesity is associated with a specific cardiac transcriptome: involvement of the Wnt pathway. FASEB J. 2004. vol. 18(13), pp.1539–40.RosenbergM. A., Gottdiener J. S., Heckbert S. R., Mukamal K. J. Echocardiographic diastolic parameters and risk of atrial fibrillation: the Cardiovascular Health Study. Eur Heart J. 2012. Vol. 33, pp. 904–912RosenbergM. A., Gottdiener J. S., Heckbert S. R., Mukamal K. J. Echocardiographic diastolic parameters and risk of atrial fibrillation: the Cardiovascular Health Study. Eur Heart J. 2012. Vol. 33, pp. 904–912Sauer A. J., Moss A. J., McNitt S., et al. Long QT syndrome in adults. J Am Coll Cardiol. 2007. Vol. 49, pp. 329–337.Sauer A. J., Moss A. J., McNitt S., et al. Long QT syndrome in adults. J Am Coll Cardiol. 2007. Vol. 49, pp. 329–337.Swedberg K., Cleland J., Dargie H. et al. The task force on heart failure of the European society of cardiology. Guidelines for diagnosis and treatment of chronic heart failure. Eur. Heart J. 2005. Vol. 26(11), pp. 1115–1140.Swedberg K., Cleland J., Dargie H. et al. The task force on heart failure of the European society of cardiology. Guidelines for diagnosis and treatment of chronic heart failure. Eur. Heart J. 2005. Vol. 26(11), pp. 1115–1140.Straus S. M., Kors J. A., De Bruin M. L., et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006. Vol. 47, pp. 362–367Straus S. M., Kors J. A., De Bruin M. L., et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006. Vol. 47, pp. 362–367Targher G, Mantovani A, Pichiri I et al. Nonalcoholic fatty liver disease is associated with an increased prevalence of atrial fibrillation in hospitalized patients with type 2 diabetes. ClinSci (Lond). 2013. vol.125, pp.301–309Targher G, Mantovani A, Pichiri I et al. Nonalcoholic fatty liver disease is associated with an increased prevalence of atrial fibrillation in hospitalized patients with type 2 diabetes. ClinSci (Lond). 2013. vol.125, pp.301–309Tracy P. Torres, E. Patrick Donahue, et al. Glucose Toxicity Is Responsible for the Development of Impaired Regulation of Endogenous Glucose Production and Hepatic Glucokinase in Zucker Diabetic Fatty Rats. Diabetes. 2006. Vol. 55, pp. 2479–2490.Tracy P. Torres, E. Patrick Donahue, et al. Glucose Toxicity Is Responsible for the Development of Impaired Regulation of Endogenous Glucose Production and Hepatic Glucokinase in Zucker Diabetic Fatty Rats. Diabetes. 2006. Vol. 55, pp. 2479–2490.Unger RH. Lipotoxic diseases. Annu Rev Med. 2002. vol.53, pp. 319–336.Unger RH. Lipotoxic diseases. Annu Rev Med. 2002. vol.53, pp. 319–336.Yamamoto K. Analysis of left ventricular diastolic function. Heart. 1996. Vol. 75, pp. 27–35.Yamamoto K. Analysis of left ventricular diastolic function. Heart. 1996. Vol. 75, pp. 27–35.Working Group Report, How to diagnose diastolic heart failure? European study group on diastolic heart failure. Eur. HeartJ. 1998. vol. 19, pp. 990–1003Working Group Report, How to diagnose diastolic heart failure? European study group on diastolic heart failure. Eur. HeartJ. 1998. vol. 19, pp. 990–1003Donnelly K. L, Smith C. I., Schwarzenberg S. J., et al. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005. Vol. 115, pp. 1343–1351.Donnelly K. L, Smith C. I., Schwarzenberg S. J., et al. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005. Vol. 115, pp. 1343–1351.

The authors declare that there are no conflicts of interest present.