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Ursodeoxycholic acid as a means of preventing atherosclerosis,steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2021年第10期27卷 959-975页

作者： Maria Nadinskaia Marina Maevskaya Vladimir Ivashkin Khava Kodzoeva Irina Pirogova Evgeny Chesnokov alexander nersesov Jamilya Kaibullayeva Akzhan Konysbekova Aigul Raissova Feruza Khamrabaeva Elena Zueva Department of Propaedeutics of Internal Diseases Gastroenterology and HepatologySechenov First Moscow State Medical University(Sechenov University)Moscow 119991Russia Vasilenko Clinic of Internal Diseases Propedeutics Gastroenterology and HepatologyUniversity Clinical Hospital№2Sechenov First Moscow State Medical University(Sechenov University)Moscow 119991Russia LLC MC“Lotus” Center for Gastroenterology and HepatologyChelyabinsk 454092Russia Department of Hospital Therapy with the Course of Endocrinology and Clinical Pharmacology Tyumen State Medical UniversityTyumen 625003Russia Department of Gastroenterology S.Asfendiyarov Kazakh National Medical UniversityAlmaty 050000Kazakhstan Functional and Ultrasound Diagnostics Scientific and Research Institute of Cardiology and Internal DiseasesAlmaty 050000Kazakhstan Department of Internal Diseases Scientific and Research Institute of Cardiology and Internal DiseasesAlmaty 050000Kazakhstan Faculty of Therapy Tashkent Institute of Advanced Medical StudiesTashkent 100007Uzbekistan Department of Therapy№1 with Training General Practitioners Tashkent Medical AcademyTashkent 100109Uzbekistan

BACKGROUND Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of mortality in patients with nonalcoholic fatty liver disease(NAFLD).Weight loss is a key factor for successful NAFLD and CVD therapy.Ursodeoxycholic acid(UDCA),which is one of the first-line therapeutic agents for treatment of NAFLD,is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties.AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests,lipid profile,hepatic steatosis and fibrosis,atherogenesis,and ASCVD risk in men and women with NAFLD,as well as to assess the impact of>5%weight reduction on these parameters.METHODS An open-label,multicenter,international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise.The efficacy criteria were liver enzymes,lipid profile,fatty liver index(FLI),noninvasive liver fibrosis tests(nonalcoholic fatty liver disease fibrosis score and liver fibrosis index),carotid intima-media thickness(CIMT),and ASCVD risk score.To test statistical hypotheses,the Wilcoxon test,paired t-test,Fisher’s exact test,and Pearson's chi-squared test were used.RESULTS The alanine aminotransferase(ALT)level changed by-14.1 U/L(-31.0;-5.3)from baseline to 3 mo and by-6.5 U/L(-14.0;0.1)from 3 to 6 mo.The magnitude of ALT,aspartate transaminase,and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo(P<0.001,P<0.01,P<0.001,respectively).At 6 mo,in the total sample,we observed a statistically significant decrease in body weight and levels of FLI:84.9±10.4 vs 72.3±17.6,P<0.001,total cholesterol:6.03±1.36 vs 5.76±1.21,Р<0.001,lowdensity lipoprotein:3.86±1.01 vs 3.66±0.91,Р<0.001,and triglyceride:3.18(2.00;4.29)vs 2.04(1.40;3.16),Р<0.001.No effect on nonalcoholic fatty liver disease fibrosis score or liver fibrosis index was foun

关键词： Ursodeoxycholic acid Nonalcoholic fatty liver disease Liver function tests Fatty liver index Carotid intima-media thickness Atherosclerotic cardiovascular disease

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An Assessment of Awareness of Specialists in Adequate Diagnostics of Chronic Pancreatitis in Kazakhstan

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Open Journal of Epidemiology 2020年第4期10卷 446-462页

作者： Jamilya Kaibullayeva alexander nersesov Almagul Jumabayeva Zhanna Romanova Aliya Ualiyeva Nurailym Abu Aisulu Gainutdin Department of Gastroenterology and Hepatology Kazakh National Medical University Almaty Kazakhstan Department of Epidemiology Biomedstatistics and Evidence-Based Medicine Al-Farabi Kazakh National University of Almaty Almaty Kazakhstan

Our national center of gastroenterology provides highly specialized care, including chronic pancreatitis. Another area of our activities is educational programs, including postgraduate and fellows’ courses. Thereby, we have noted significant gaps in the knowledge of the specialists that involved in the chronic pancreatitis management. The most critical downsides are related to insufficient attention to etiology and risk factors, using outdated classifications, the lack of knowledge in arsenal of diagnostic techniques, polypharmacy or application of low level of evidence treatment methods. Finally, we have made amendments in the National Clinical Protocol in Chronic Pancreatitis [1], updated the State Educational Standard for residents of the gastroenterological profile [2]. The aim of the study was the analysis of the basic knowledge among different specialists in the management of chronic pancreatitis (CP) around the country. This qualitative study consists of two parts, including focus group interviews followed by interviews with the specialists across the country, which was conducted during the period 2015-2018. In this paper, we present results of diagnostic approaches at the different levels of medical care. The general practitioners have noted the absence of modern methods of laboratory and visual diagnostics in their routine practice, therefore explaining the plenty of the complicated forms. Another issue is the low specialist’s adherence to clinical guidelines, poor knowledge of the risk factors and overestimation of the clinical presentation value except malnutrition symptoms. On the other hand, surgeons and other specialists are not ready to implement modern diagnostic tools and methods in their practice. Obviously, in accordance with the results of our study, our educational center should conduct a number of training activities, as well as develop new algorithms for medical care specialists.

关键词： Non-Interventional Diagnostic Methods Chronic Pancreatitis Symptoms Clinical Guidelines Specialist’s Awareness

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Consensus on management of hepatitis C virus infection in resource-limited Ukraine and Commonwealth of Independent States regions

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World Journal of Gastroenterology 2019年第29期25卷 3897-3919页

作者： Massimo Giuseppe Colombo Erkin Isakovich Musabaev Umed Yusupovich Ismailov Igor A Zaytsev alexander V nersesov Igor Anatoliyevich Anastasiy Igor Alexandrovich Karpov Olga A Golubovska Kulpash S Kaliaskarova Ravishankar AC Sanjay Hadigal Research and Clinical Center Department of Medicine Humanitas Hospital Rozzano 20089 MI Italy Research Institute of Virology Scientific Research Institute of Virology Tashkent 100194 Uzbekistan Hepatoсenter Research Institute of Virology Scientific Research Institute of Virology Tashkent 100194 Uzbekistan Department of Therapy Infectious Diseases and Dermatology Bogomolets National Medical University Kyiv 01601 Ukraine Department of Gastroenterology and Hepatology National Research Institute of Cardiology and Internal Diseases Almaty 050000 Kazakhstan Department Infectious Diseases Bogomolets National Medical University Kyiv 01601 Ukraine Department Infectious Diseases Belarus State Medical University Minsk 220116 Belarus Hepatology Ministry of Health Astana 010000 Kazakhstan Medical Affairs Mylan Pharmaceuticals Private Limited Kadubeesanahalli Bengaluru 560103 India

Globally, 69.6 million individuals were infected with hepatitis C virus (HCV) infection in 2016. Of the six major HCV genotypes (GT), the most predominant one is GT1, worldwide. The prevalence of HCV in Central Asia, which includes most of the Commonwealth of Independent States (CIS), has been estimated to be 5.8% of the total global burden. The predominant genotype in the CIS and Ukraine regions has been reported to be GT1, followed by GT3. Inadequate HCV epidemiological data, multiple socio-economic barriers, and the lack of regionspecific guidelines have impeded the optimal management of HCV infection in this region. In this regard, a panel of regional experts in the field of hepatology convened to discuss and provide recommendations on the diagnosis, treatment, and pre-, on-, and posttreatment assessment of chronic HCV infection and to ensure the optimal use of cost-effective antiviral regimens in the region. A comprehensive evaluation of the literature along with expert recommendations for the management of GT1-GT6 HCV infection with the antiviral agents available in the region has been provided in this review. This consensus document will help guide clinical decision-making during the management of HCV infection, further optimizing treatment outcomes in these regions.

关键词： Antiviral agents Commonwealth of Independent States Genotype Hepatitis C virus Sustained virologic response Ukraine

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Epidemiological Investigation of Fatty Liver Disease and Abnormal Liver Function in the Republic of Kazakhstan

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Open Journal of Epidemiology 2019年第4期9卷 309-320页

作者： alexander V. nersesov Aigul M. Raissova Jamilya A. Kaibullayeva Almagul E. Jumabayeva Mariya S. Novitskaya Department of Gastroenterology and Hepatology National Research Institute of Cardiology and Internal Diseases Almaty Kazakhstan Unit of Internal Diseases National Research Institute of Cardiology and Internal Diseases Almaty Kazakhstan

Aim: Little is known about the epidemiology of fatty liver disease (FLD) among high-risk primary care subjects in Kazakhstan. We investigated the prevalence of FLD (alcoholic liver disease [ALD] and non-alcoholic fatty liver disease [NAFLD]) and abnormal liver function tests (LFTs) in high risk adults in Kazakhstan during their routine visit to the general practitioner. Methods: This multicenter, cross-sectional epidemiological study was carried out at 75 clinical sites in the Republic of Kazakhstan. The full analysis set population consisted of 5109 subjects. Results: Among type 2 diabetes mellitus (T2DM) subjects, established metabolic syndrome (MetS) and/or obese subjects, the prevalence of FLD was 30.8%. LFT abnormalities were found in 53.2% subjects with FLD and 40.0% without FLD. FLD subjects had significantly higher levels of alanine transaminase (ALT;p p p p = 0.021) compared to those without FLD. LFTs increases were significantly higher in subjects with FLD compared to those without FLD and were also significantly higher in ALD subjects compared to those with NAFLD. Conclusion: This study provides insights into the prevalence of FLD and abnormal LFTs in subjects with T2DM and/or established MetS and/or who are obese in primary care settings in Kazakhstan. These findings can help healthcare providers in Kazakhstan and elsewhere to better recognize and manage patients at risk of liver disease, which will improve clinical outcomes.

关键词： FLD Kazakhstan Liver NAFLD Prevalence

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