Individual Correction of the Treatment of Patients With Hepatosplenomegaly Syndrome, Taking Into Account the Parameters of Lipid and Protein Metabolism

Abstract

Summary. Purpose: to identify the features of lipid metabolism in patients with hepatosplenomegaly syndrome (HSS) of various origins to develop an individualized approach to the treatment of patients with this pathology.
 Materials and methods: blood serum of 73 patients with HSS on the background of liver cirrhosis complicated by portal hypertension, divided into 3 groups 1) with the etiological factor of hepatitis viruses HCV / HBV, 2) with autoimmune hepatitis with the etiological factor of the herpes group viruses CMV / VEB, 3) against the background of liver hepatosis and fermentopathies.
 Results and its discussion. In patients with HSS, multidirectional changes in the synthesis of lipid fractions were observed, also associated with impaired protein metabolism, namely:
 - with HSS against the background of viral hepatitis B and C, hypocholesterolemia and hypobetacholesterolemia were observed due to a decrease in cholesterol synthesis in hepatocytes; a decrease in the concentration of HDL is also associated with a violation of the process of cholesterol esterification due to a deficiency of the enzyme lecithin cholesterol acyltransferase, and an increase in the concentration of LDL is associated with a deficiency of the enzyme lipoprotein lipase in viral damage to hepatocytes.
 - with HSS against the background of autoimmune hepatitis, no significant changes were observed in the synthesis of lipid fractions;
 - in hepatosis (fermentopathies), type 5 hyperlipidemia with hypercholesterolemia and hypotriglyceridemia was found, which are a consequence of impaired formation and excretion of lipids from the liver, probably as a result of a decrease in the synthesis of apoproteins and indicate the accumulation of fat in hepatocytes and the formation of hepatosis.
 Conclusion:
 
 Surgical or endovascular treatment of HSS against the background of liver cirrhosis or hepatosis needs to be supplemented with individualized metabolic drug therapy, including lipid-lowering therapy.
 When detecting hypocholesterolemia and hypobetacholesterolemia in the first group, lipid-lowering therapy is not indicated, whereas if type 5 hyperlipidemia with hypercholesterolemia and hypotriglyceridemia is detected in the group of patients with fatty hepatosis, lipid-lowering therapy is necessary.

Perspective Chapter: Specific predictors of the autoimmune reactions formation in case of immunocompetent organs damage in patients with myasthenia gravis and hepatosplenomegaly

“…The response of patients to infectious antigens was heterogeneous. We also detected in patients with liver cirrhosis and hepatosplenomegaly, autoantibodies to carotene-containing root crops were detected, which can be regarded as a trigger factor for this condition [65].…”