An Effect of Ursodeoxycholic Acid on Inflammation, Steatosis and Liver Fibrosis and Atherogenesis Factors in Patients with Non-Alcoholic Fatty Liver Disease: Results of the USPEH Study
M. V. Mayevskaya,
M. Yu. Nadinskaia,
V. D. Lunkov,
I. Yu. Pirogova,
E. V. Chesnokov,
Kh. B. Kodzoeva,
V. T. Ivashkin https://doi.org/10.22416/1382-4376-2019-29-6-22-29
Abstract
Aim. To evaluate effects of ursodeoxycholic acid (UDCA) on inflammation, steatosis and liver fibrosis and atherogenesis factors in patients with non-alcoholic fatty liver disease (NAFLD).
Materials and methods. The study included 139 patients with NAFLD who received 15 mg/kg of UDCA (Ursosan®) per day for 24 weeks. Before and after the study, liver function and lipid metabolism, liver steatosis index FLI, intimamedia thickness (IMT) of the carotid arteries were determined. The cardiovascular risk was calculated according to the ASCVD 2013.
Results. The use of UDCA in patients with NAFLD led to a decrease in ALT (p < 0.001), AST (p < 0.001) and GGT (p < 0.001) activity; total cholesterol concentration (p < 0.001); triglycerides (p < 0.001); and LDL (p < 0.001) in the blood and the FLI liver steatosis index (p < 0.001). In addition, the rate of cardiovascular risk (p = 0.022) and IMT (р = 0.048) in women also decreased.
Conclusions. The use of UDCA in NAFLD reduces the activity of inflammatory processes in the liver, its steatosis, and also improves lipid metabolism and exerts potential anti-atherogenic effects. Against the background of UDCA administration, there was no progression of liver fibrosis. None of the participants in the observational programme reached a normal body mass by the end of the program; therefore, the attained positive changes should be attributed directly to the effects of UDCA.
Materials and methods. The study included 139 patients with NAFLD who received 15 mg/kg of UDCA (Ursosan®) per day for 24 weeks. Before and after the study, liver function and lipid metabolism, liver steatosis index FLI, intimamedia thickness (IMT) of the carotid arteries were determined. The cardiovascular risk was calculated according to the ASCVD 2013.
Results. The use of UDCA in patients with NAFLD led to a decrease in ALT (p < 0.001), AST (p < 0.001) and GGT (p < 0.001) activity; total cholesterol concentration (p < 0.001); triglycerides (p < 0.001); and LDL (p < 0.001) in the blood and the FLI liver steatosis index (p < 0.001). In addition, the rate of cardiovascular risk (p = 0.022) and IMT (р = 0.048) in women also decreased.
Conclusions. The use of UDCA in NAFLD reduces the activity of inflammatory processes in the liver, its steatosis, and also improves lipid metabolism and exerts potential anti-atherogenic effects. Against the background of UDCA administration, there was no progression of liver fibrosis. None of the participants in the observational programme reached a normal body mass by the end of the program; therefore, the attained positive changes should be attributed directly to the effects of UDCA.
About the Authors
M. V. Mayevskaya
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Department of Propaedeutics of Internal Diseases
119435, Moscow, Pogodinskaya street, 1, build. 1
M. Yu. Nadinskaia
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Cand. Sci. (Med.), Assoc. Prof., Department of Propaedeutics of Internal Diseases
119435, Moscow, Pogodinskaya street, 1, build. 1
V. D. Lunkov
Chaika Clinics Ltd.
Russian Federation
gastroenterologist
125171, Moscow, Leningrad Highway, 16A, build. 3. Business Center METROPOLIS
Russian Federation
gastroenterologist
125171, Moscow, Leningrad Highway, 16A, build. 3. Business Center METROPOLIS
I. Yu. Pirogova
LLC MC “Lotus” Center for Gastroenterology and Hepatology
Russian Federation
Russian Federation
Dr. Sci. (Med.), Head
454092, Chelyabinsk, Vorovskogo str., 43, apt. 5
E. V. Chesnokov
Tyumen State Medical University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Prof., Department of Hospital Therapy with the course of Endocrinology and Clinical Pharmacology
625023, Tyumen, Odesskaya str., 54
Kh. B. Kodzoeva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
medical resident, Department of Propaedeutics of Internal Diseases
119435, Moscow, Pogodinskaya str., 1, build. 1
V. T. Ivashkin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Dr. Sci. (Med.), RAS Academician, Prof., Head of Department, Department of Propaedeutics of Internal Diseases
119435, Moscow, Pogodinskaya str., 1, building 1
References
1. Maevskaya M.V., Ivashkin V.T., Ivashkin K.V. et al. Non-alcoholic fatty liver disease as the cause and effect of cardiometabolic complications. Features of pharmacotherapy. Place ursodeoxycholic acid. Therapeutic Archive. 2019;91(2):109–17 (In Rus.) DOI: 10.26442/00403660.2019.02.000122
2. Ivashkin V.T., Mayevskaya M.V., Pavlov C.S., Tikhonov I.N., Shirokova Y.N., Buyeverov A.O., Drapkina O.M., Shulpekova Y.O., Tsukanov V.V., Mammayev S.N., Mayev I.V., Palgova L.K. Diagnostics and treatment of non-alcoholic fatty liver disease: clinical guidelines of the Russian Scientific Liver Society and the Russian gastroenterological association. Ross z gastroenterol gepatol koloproktol. 2016;26(2):24–42. (In Rus.) DOI: 10.22416/1382-4376-2016-26-2-24-42
3. Drapkina O.M., Ivashkin V.T. Epidemiological features of non-alcoholic fatty liver disease in Russia (results of open multicenter prospective observational study, DIREG L 01903). Ross z gastroenterol gepatol koloproktol. 2014;24(4):32–8 (In Russ)
4. Akhmedov V.A. The relationship of cardiovascular complications and non-alcoholic fatty liver disease. Breast cancer. 2018;1(II):86–8 (In Rus.)
5. Pais R., Giral P., Khan J.F. et al. Fatty liver is an independent predictor of early carotid atherosclerosis. J Hepatol. 2016;65(1):95–102. DOI: 10.1016/j.jhep.2016.02.023
6. Bedogni G., Bellentani S., Miglioli L. et al. The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol. 2006;6:33. DOI: 10.1186/1471-230X-6-33
7. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63(1):237–64. DOI: 10.1016/j.jhep.2015.04.006
8. Engelen L., Ferreira I., Stehouwer C.D., Boutouyrie P., Laurent S. Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors. Eur Heart J. 2013;34(30):2368–80. DOI: 10.1093/eurheartj/ehs380
9. Goff D.C., Lloyd-jones D.M., Bennett G. et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S49–73. DOI: 10.1161/01.cir.0000437741.48606.98
10. Lonardo A., Nascimbeni F., Mantovani A., Targher G. Hypertension, diabetes, atherosclerosis and NASH: Cause or consequence? J Hepatol. 2018;68(2):335–52. DOI: 10.1016/j.jhep.2017.09.021
11. Kim H.C., Nam C.M., Jee S.H., Han K.H., Oh D.K., Suh I. Normal serum aminotransferase concentration and risk of mortality from liver diseases: prospective cohort study. BMJ. 2004;328(7446):983. DOI: 10.1136/bmj.38050.593634.63
12. Lee T.H., Kim W.R., Benson J.T., Therneau T.M., Melton L.J. Serum aminotransferase activity and mortality risk in a United States community. Hepatology. 2008;47(3):880–7. DOI: 10.1002/hep.22090
13. Ruhl C.E., Everhart J.E. Elevated serum alanine aminotransferase and gamma-glutamyltransferase and mortality in the United States population. Gastroenterology. 2009;136(2):477–85. DOI: 10.1053/j.gastro.2008.10.052
14. Kwo P.Y., Cohen S.M., Lim J.K. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18–35. DOI: 10.1038/ajg.2016.517
15. Pais R., Giral P., Khan J.F. et al. Fatty liver is an independent predictor of early carotid atherosclerosis. J Hepatol. 2016;65(1):95–102. DOI: 10.1016/j.jhep.2016.02.023
16. Ozel coskun B.D., Yucesoy M., Gursoy S. et al. Effects of ursodeoxycholic acid therapy on carotid intima media thickness, apolipoprotein A1, apolipoprotein B, and apolipoprotein B/A1 ratio in nonalcoholic steatohepatitis. Eur J Gastroenterol Hepatol. 2015;27(2):142–9. DOI: 10.1097/MEG.0000000000000264
Review
For citations:
Mayevskaya M.V., Nadinskaia M.Yu., Lunkov V.D., Pirogova I.Yu., Chesnokov E.V., Kodzoeva Kh.B., Ivashkin V.T. An Effect of Ursodeoxycholic Acid on Inflammation, Steatosis and Liver Fibrosis and Atherogenesis Factors in Patients with Non-Alcoholic Fatty Liver Disease: Results of the USPEH Study. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2019;29(6):22-29. (In Russ.) https://doi.org/10.22416/1382-4376-2019-29-6-22-29
Views:
9335
Email this article 
