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Background. In Ukraine, metabolic syndrome remains one of the most important problems of family medicine, it contributes to an increase in the prevalence of digestive diseases. Among the components of metabolic syndrome, researchers consider visceral obesity to be the most prognostically unfavo­rable. The purpose is to optimize diagnostic approaches to the formation of a risk group for the detection of visceral obesity in gastroenterology patients. Materials and methods. Eighty patients with gastrointestinal diseases were examined, 56 men (70.0 %) and 24 women (30.0 %). The age of the patients ranged from 18 to 66 years, with an average of (39.04 ± 1.03) years. TANITA MC-780MA body composition analyzer scales (Japan) were used to assess body structure. In all patients, serum levels of glucose, insulin, leptin, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) were determined, as well as low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), atherogenicity coefficient (AC) and homeostasis model assessment of insulin resistance (HOMA-IR). Results. Gastroenterological patients with visce­ral obesity had more pronounced changes in lipid and carbohydrate metabolism, which were characterized by a decrease in the content of HDL-C by 16.3 % (p

Background. It is known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly infect hepatocytes. At the same time, overweight and obesity are surrogate markers of the adverse effects of coronavirus disease 2019 (COVID-19). The purpose of the study: to evaluate changes in lipid and carbohydrate metabolism and their indices in the serum of patients with non-alcoholic fatty liver disease (NAFLD) with an immune response to SARS-CoV-2. Materials and methods. We studied 37 patients with NAFLD who had IgG to SARS-CoV-2. All patients were divided into two groups: group I consisted of 19 participants who were PCR-negative for SARS-CoV-2, group II included 18 patients who had COVID-19, as confirmed by PCR testing. The content of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), glucose, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol (VLDL-C), atherogenicity coefficient, insulin resistance indices (HOMA-IR), TG to glucose (TG/Gly) and TG to HDL-C (TG/HDL-C) ratio were assessed in all patients. Results. Among patients with NAFLD with an immune response to SARS-CoV-2, dyslipidemia manifested by a probable increase in the median TG content in groups I and II by 2.5 and 3.4 times (р = 0.0001), respectively; TC — by 1.2 times (р = 0.0425) in both groups, with a tendency to increase; VLDL-C — by 1.8 (р = 0.010) and 2.5 times (р = 0.0022), respectively, and a decrease in the median content of HDL-C by 1.7 (р = 0.0016) and 1.9 times (р = 0.0008), respectively, in blood serum. The identified changes led to a statistically significant increase in the median atherogenicity coefficient in groups I and II — by 2.2 (р = 0.0036) and 2.5 times (р = 0.007). An increase in the HOMA-IR did not have a statistically significant difference between the groups: in group I, this index increased by 3.1 times (p

Background. Nonalcoholic fatty liver disease (NAFLD) is often accompanied by comorbid conditions such as obesity, type 2 diabetes, and cardiovascular diseases, which are risk factors for severe coronavirus disease (COVID-19). The latter is characterized by respiratory failure and hyperinflammation with the risk of further multiorgan failure, and disorders in the hemostasis system. Purpose: to determine the clinical manifestations and features of hemostasis in NAFLD in patients with an immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Materials and methods. Thirty-seven patients with NAFLD were under observation, and immunoglobulins G to SARS-CoV-2 were detected in them. Group I consisted of 19 patients who did not suffer from COVID-19. Group II included 18 patients with COVID-19 confirmed by a polymerase chain reaction. Patients of groups I and II were vaccinated against coronavirus. Clinical symptoms, the state of hemostasis in the vascular-platelet link, the state of coagulation, the content of fibrinogen and plasminogen activator inhibitor-1 (PAI-1) were assessed in all patients. Results. Patients with NAFLD and an immune response to SARS-CoV-2 reported a pain syndrome in 70.3 % of cases: group I more often complained of pain in the right (68.4 %) and left (52.6 %) hypochondria, group II — of epigastric pain (66.7 %). Among manifestations of dyspeptic syndrome observed in 28 (75.7 %) patients, in group I complaints of abdominal distension (31.6 %) and stomach rumble (21.1 %) prevailed, in group II — of abdominal distension (50.0 %) and bitter taste in mouth (27.8 %). Concomitant cardiovascular pathology was detected in 32.4 % of cases. The synthetic function of the liver in terms of coagulation factors was almost preserved, but a probable increase in the content of coagulation factor II was observed in patients of group I (p 0.05). Meanwhile, among patients with COVID-19, abdominal bloating (by 1.6 times) and bitter taste in mouth (by 2 times) prevailed, and in the hemostasis system, a decrease in the number of platelets was noted compared to the controls (p > 0.05). Patients of both groups had an increase in the average number of platelets by 10 % (p > 0.05). A significant increase by 20 % (p

Background. Chronic alcohol use leads to alcoholic liver fibrosis. Today, a sufficient number of scientific studies are focused on the pathometabolic mechanisms of liver fibrosis development and formation in animal models. The purpose of our study was to investigate structural changes and liver stiffness, biochemical markers of fibrosis in rats with chronic alcoholic liver injury (CALI) modeling and to evaluate the changes of these parame­ters with different types of treatment. Materials and methods. Eighty-nine rats were divided into experimental groups depending on the duration of alcohol exposure (4 and 12 weeks) and the corresponding type of correction (metadoxine and prebiotic). Results. When modeling CALI at week 4, morphological studies revealed moderate large-droplet fatty hepatosis and mild fibrosis in the central venule of the liver lobes. After 12 weeks of forced alcoholization, with more pronounced general intoxication, hepatocytes have dystrophic changes such as appearance of single or grouped dystrophic cells in the parenchyma. A combination of protein and fatty dystrophy was more common. Elastography allowed to detect structural changes in the liver at the early stages of fibrosis formation when modeling CALI for 12 weeks. There were also changes in the levels of biochemical parameters: free and protein-bound hydroxyproline, glycosaminoglycans. According to the results of elastography, liver stiffness in rats increased maximally after prebiotic correction in all approaches compared to the controls. After correction of CALI, both early- and long-term, fibrosis markers normalized in rat liver homogenate after administration of metadoxine and prebiotic. After prebiotic correction at week 12 of alcoholization, we observed a 12% decrease in liver parenchymal stiffness in the CALI modeling group and a 19% decrease (p

Background. It is important to search for biological markers with high specificity and sensitivity as a non-invasive method for accurate diagnosis of inflammatory bowel disease (IBD), in particular, differentiation of ulcerative colitis (UC) and Crohn’s disease (CD), which is important for both prognosis and treatment. The purpose of the study was to determine the titer of anti-Saccharomyces cerevisiae antibodies (ASCA) IgG, IgA, perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) and their clinical significance in patients with ulcerative colitis and Crohn’s disease. Materials and methods. The study included 49 patients with IBD who were treated at the Department of Intestinal Di­seases of the State Institution “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”. All patients were divided into two groups: 33 individuals with UC and 16 with CD. In addition, the patients were divided into groups depending on the severity of UC course: mild — 3, moderate — 26, and 4 individuals had severe UC. Among patients with CD, severity was moderate in 13 cases and severe CD was detected in 3 cases. p-ANCA IgG were determined by an indirect immunofluorescence assay. The serum level of ASCA IgA and IgG was evaluated by the enzyme-linked immunosorbent assay. The results were statistically processed using the Statistica 6.1 software package. Results. Most patients with UC appeared to have p-ANCA, and in patients with CD, an increased level of ASCA IgA and IgG was found. Among patients with CD, the level of ASCA IgA and IgG depended on the severity of the disease, which was confirmed by the revealed correlation between their level and the severity of the disease (r = 0.608; p = 0.012). Analysis showed that the p-ANCA IgG test for confirming the diagnosis of UC has a sensitivity of 63 % and a specificity of 86 %, whereas the presence of an elevated level of ASCA IgA or IgG for the diagnosis of CD has a sensitivity of 72 % and a specificity of 82 %. The combination of positive p-ANCA IgG and negative ASCA IgA, IgG in patients with UC showed a sensitivity and specificity of 75.6 and 68.8 %, respectively, with a diagnostic accuracy of 68.8 %. For combination of positive ASCA IgA, IgG and negative p-ANCA IgG in patients with CD, the sensitivity was 81.3 % and the specificity was 80 % with a diagnostic accuracy of 80.8 %. Therefore, the simultaneous determination of ASCA IgA, IgG and p-ANCA IgG increases the positive predictive accuracy in the differential diagnosis of UC and CD among patients with IBD. Conclusions. It was found that the separate assessment of ASCA IgA, IgG and p-ANCA IgG for the differentiation of UC and CD has lower sensitivity and specificity, but when the two tests are combined, the predictive value of a positive result and specificity can be significantly increased.

Background. The purpose of the study is to analyze the content of free fatty acids (FFA) in the blood serum of overweight and underweight patients with gastrointestinal diseases. Mate­rials and methods. Thirty-one patients with gastrointestinal diseases were examined, 19 (61.3 %) men and 12 (38.7 %) women with a median age of 39 (27; 48) years. Depending on the results of the body composition study with the multifunctional monitor TANITA MC-780MA (Japan), they were divided into the following groups: overweight patients (body mass index (BMI) more than 25.0 kg/m2) and underweight persons (BMI below 18.5 kg/m2). Determination of the FFA spectrum in the blood serum was carried out using a gas chromatograph with a flame ionization detector Chromatek-Crystal 5000. The control group consisted of 16 practically healthy people. Statistical processing of the results was carried out using the Statistica 6.1 application program package. Results. Patients with a change in body weight reported a statistically significant decrease in the median total content of short-chain saturated FFA (C4:0) mainly due to a decrease in the butyric acid content by 67 times (p = 0.001) with increased BMI and by 114 times (p = 0.002) with decreased BMI compared to controls. At the same time, the analysis of the serum spectrum of saturated FFA with an average carbon chain length showed a probable increase in the content of capric acid by 14 times (p 0.05) compared to underweight patients. The total content of monounsaturated FFA in the blood serum of patients with increased and decreased BMI increased significantly by 32 times (p

Background. The prevalence of non-alcoholic fatty liver disease (NAFLD) is currently increasing worldwide and is a serious problem that causes interest in its study, especially in patients with an immune response to severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). In recent years, studies have been investigating the influence of microflora on the development and progression of NAFLD. The purpose of the study was to determine the level of dysbiotic disorders of the colonic microbiocenosis in patients with NAFLD with an immune response to SARS-CoV-2. Materials and methods. We examined 34 patients with NAFLD who were found to have IgG to SARS-CoV-2. All examined patients were divided into two groups: group I consisted of 17 patients with no history of SARS-CoV-2 according to the polymerase chain reaction (PCR) data; group II — 17 patients with a history of SARS-CoV-2 by PCR. The control group consisted of 10 practically healthy individuals. Chromatographic determination of the content of short-chain fatty acids, species and quantitative composition of the colonic microflora was performed. Results. The microbiological studies revealed changes in the qualitative and quantitative composition of the colonic microflora in 88.2 % of patients with NAFLD, with a predominance of dysbiosis II in 41.2 % of patients in group I and dysbiosis I in 70.6 % of patients in group II. These changes were due to a decrease in the number of bifidobacteria and lactobacilli, an increase in the concentration of opportunistic pathogens, fungi of the genus Candida spp. The intestinal microbiome of patients with NAFLD who had SARS-CoV-2 showed impaired biosynthesis of short-chain fatty acids in the coprofiltrate, which was manifested by an increase in the median acetic and propionic acids and a decrease in the median butyric acid in patients of group I. The median anaerobic index had a statistically significant decrease in patients of group I by 1.5 times (p

Background. The purpose of the study is to investigate the peculiarities of lipid and carbohydrate metabolism in patients with gastrointestinal diseases depending on the body mass index (BMI). Materials and methods. Forty patients with digestive disorders were examined, 13 women (32.5 %) and 27 men (67.5 %) whose median age was 37 (24; 51) years. The patients were divided into 3 groups: I — 20 people with BMI exceeding the norm; II — 11 patients with a BMI below the norm; III — 9 patients with normal BMI. The control group for evaluating the results of laboratory tests consisted of 15 practically healthy people. Total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), glucose and insulin serum levels were evaluated. The atherogenic index (AI) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were calculated. Statistical processing of the results was carried out using the Statistica 6.1 software package. Results. In patients with digestive diseases who had an increased BMI, the development of atherogenic dyslipidemia was detected, as indicated by a probable decrease in serum content of HDL-C by 1.7 times (p = 0.003) and an increase in TG by 1.9 times (p = 0.002), VLDL-C by 1.4 times (p = 0.05), AI by 2 times (p = 0.03) compared to the controls. No significant signs of the development of atherosclerotic processes were found in patients with reduced and normal BMI. Carbohydrate metabolism disorders were observed in 47.5 % of patients with gastrointestinal diseases, and HOMA-IR in patients with increased BMI was 2.9 times higher (p

Background. Pathogenetic factors that cause the deve­lopment of inflammatory bowel diseases (IBD) remain poorly understood, namely, the peculiarities of saturated fatty acids (SFAs) in the blood serum at different degrees of disease severity, which is quite an important task. Objective: to evaluate serum level of SFAs depending on IBD severity. Materials and methods. Thirty-seven patients with IBD were examined, their average age was (38.5 ± 2.1) years. Depending on the severity of the disease, the patients were divided into 2 groups: group I — with IBD of moderate severity (n = 24) and group II — with severe IBD (n = 13). The control group consisted of 16 healthy people. The quantitative content of SFAs in the blood serum of the examined patients was determined by gas chromatography. Median (Me), lower (25%) and upper (75%) quartiles were used to describe the data. Results. Biochemical analysis revealed a tendency to decrease in the level of short-chain SFA (butyric acid; p > 0.05) and a significant increase in the total content of medium- and long-chain SFAs (MCSFAs and LCSFAs; p 0.05) in group I against group II of patients. The content of LCSFAs, namely: tridecylic acid (p ≤ 0.012), myristic acid (p

The aim of our research was to obtain new minimally invasive serum markers of fibrotic changes of liver in patients with chronic diffuse liver diseases of different etiology and compare them with traditional markers. 364 patients aged 30 to 66 years were examined: 221 women (60.7%) and 143 men (39.3%). Depending on the etiological factors, all patients were divided into 4 groups: group I consisted of 108 patients with non-alcoholic fatty liver disease (NAFLD), group II – 143 patients with chronic hepatitis associated with virus C (CHC), group III – 56 patients with alcoholic liver disease (ALD), group IV – 57 patients with toxic drug-induced hepatitis (TH). The control group consisted of 30 practically healthy people. Using correlation and ROC-analyzes, we obtained minimally invasive diagnostics markers that show the risk of developing liver fibrosis. For patients with NAFLD these were the levels of HOMA-IR, TNFα/IL-10 and α1-acid glycopeptide content, which are better in quality of the diagnostic model than the traditional Forns index, APRI, FIB-4, AAR. For patients with CHC, these were the protein-bound hydroxyproline (HPp/b) /HPf ratio, phospholipids content, and IL-6, CD4+ levels, which are better diagnostic models than the traditional Forns index, APRI, FIB-4, AAR. The following markers were obtained for patients with ALD – TNFα levels, HPp/b and glycosaminoglycans content, which are better diagnostic models than the traditional Forns index, APRI, FIB-4, AAR. For patients with TH, these were medium molecular weight peptides content, IL-6/IL-10 ratio and CD4+/CD8+, which are better diagnostic models than the traditional Forns index, APRI, FIB-4, AAR. Thus, new minimally invasive markers of fibrosis in patients with chronic diffuse liver diseases have been obtained.

Background. Insulin resistance indices, in particular homeostatic model assessment of insulin resistance (HOMA-IR), and circulating cytokines are promising markers for noninvasive assessment of hepatocyte damage and metabolic risk in non-alcoho­lic fatty liver disease (NAFLD) in children and can be used to select pediatric patients at risk of adverse disease course. The purpose was to determine the diagnostic accuracy of insulin resistance markers and circulating cytokines in non-alcoholic fatty liver disease in children. Materials and methods. One hundred and seventy patients aged 6–17 (average of 12.15 ± 2.51) years were included in the study. Hepatic steatosis was determined by transient elastography. Patients were divided into 4 groups according to the presence of hepatic steatosis, non-alcoholic steatohepatitis (NASH) and obesity: group 1 — 37 obese children with NASH, group 2 — 53 patients with simple steatosis, group 3 — 65 obese children without steatosis, group 4 (controls) — 15 patients with normal weight without NAFLD. Anthropometric parameters, carbohydrate metabolism with the HOMA-IR calculation, cytokine profile were evaluated. Results. An increase in serum interleukin (IL) 6 and tumor necrosis factor (TNF) α levels in NAFLD children compared to the control group (p

The article deals with the study on the content of fecal short-chain fatty acids (SCFA) and their association with insulin resistance in obese children. It was found that intestinal microflora in obese children is characterized by changes in the qualitative composition and increased metabolic activity of the intestinal microflora. A moderate increase of HOMA-IR is accompanied by elevated concentration of anti-inflammatory cytokines, the content of which correlates with that of acetic, propionic acid and a decrease in the metabolic activity of intestinal microflora. The progression of insulin resistance is accompanied by a further increase in the concentration of anti-inflammatory cytokines, the level of HOMA-IR correlates with the level of propionic SCFA. Thus, modulation of SCFA content may be a promising way of therapeutic influence to correct insulin resistance and obesity in children.

Background. Today most of the scientists are studying the processes of hepatocyte damage under the influence of free fatty acids (FFA) in vitro conditions. Therefore, in vivo studies of the spectrum of FFA in liver pathologies of different genesis, including toxic ones, are of considerable interest. Materials and methods. Toxic liver damage was simulated by subcutaneous injection of CCl4 solution in olive oil into rats. The following groups were formed: control (healthy; n = 15); I — CCl4-induced liver damage without drug correction (n = 6); III — CCl4-induced liver damage + metadoxin (Liveria IC; n = 8); III — CCl4-induced liver damage + metabiotic (Hilac forte) (n = 7). For morphological assessment of steatosis and fibrosis we used three-color qualitative staining of liver samples by Mallory-Slinchenko. Quantitative content of monounsaturated fatty acids (MUFA) in liver homoge­nate was determined by gas chromatography. Results. Evaluation of hepatobioptates in group I rats revealed tissue disorganization with macrovesicular steatosis in the cytoplasm of hepatocytes, the formation of interparticle multiple fibrous septa and inflammatory cell infiltration. The use of metadoxin (group II) and metabiotic (group III) improved the morphological picture of the liver, which was damaged by CCl4. Total MUFA content increased significantly in 118 (p

Background. The pathogenesis of chronic inflammatory bowel disease (IBD) is still not fully clarified. Modern research is aimed at studying the state of humoral immunity, production and intestinal absorption of short-chain fatty acids (SCFA). The purpose was to assess the state of the humoral part of immunity, cytokine regulation and the content of short-chain fatty acids in the feces of patients with IBD. Materials and methods. The study, which was carried out at the Department of Intestinal Diseases of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine, involved 34 patients with IBD: group I — those with ulcerative colitis (UC) (n = 25), group II — individuals with Crohn’s disease (n = 9). Determination of fecal SCFA, level of CD22+ lymphocytes, immunoglobulins A, M, G, interleukin-10 and TNF-α was determined. Results. There was a decrease in the humoral level of immunity, increase in the content of propionic (C3) acid (p

Background. Despite some progress in addressing gastric cancer, a marked reduction in morbidity in all developed countries, the search for changes that precede carcinogenesis remains relevant and far from complete. The purpose of the study: to assess the content of aggressive and protective factors of gastric juice and oral fluid in comparison with morphological changes in patients with chronic atrophic gastritis. Materials and methods. The study included 56 patients: group I included 12 patients with atrophic changes of the gastric mucosa of varying severity, group II — 24 patients with atrophic changes diagnosed with intestinal metaplasia only in the antrum of the stomach, in group III group — 20 patients with intestinal metaplasia in the body and antrum of the stomach. The control group consisted of 16 healthy individuals. Assessment of the degree of atrophy and inflammation in the gastric mucosa was performed with the subsequent determination of integral indicators — stage and degree of atrophy according to the OLGA system and metaplasia — according to the OLGIM system. According to the morphometric study of sections using a light microscope XSP-139TP (“Ulab“, Ukraine) calculated indicators: nuclear-cytoplasmic ratio, the ellipticity of the nuclei. The content of glycoproteins, sialic acids, fucose, hexosamines was determined in gastric juice and oral fluid. Results. Morphometric study showed a significant decrease in the nuclear-cytoplasmic ratio to (0.12 ± 0.04) % in patients of group III. The coefficient of ellipti­city of the nuclei of native cells decreased with the development of intestinal metaplasia: in group I it was equal to (0.76 ± 0.04) %, for group II it was (0.65 ± 0.11) %, and for group III — 0.41 ± 0.12) %. In patients with intestinal metaplasia in 82 % of cases with a 3-fold increase in the content of sialic acids in gastric juice was diagnosed with an increase in hexosamines by 35 %, while patients with only atrophic changes in the stomach showed a decrease in hexosamines 2 times compared to controls (p

Background. Non-alcoholic fatty liver disease (NAFLD) ranks first among chronic liver diseases and covers almost a quarter of the population. Enough data have been accumulated on the mutual influence of metabolic changes and steatosis of the liver of varying degrees on the existence and progression of each other. The coexistence of non-alcoholic steatohepatitis (NASH) with various comorbidal conditions has already been recorded in many studies, a direct relationship has been determined between the presence of fatty degeneration and various components of the metabolic syndrome — arterial hypertension, type 2 diabetes, obesity and dyslipidemia. The purpose was to determine the relationship between carbohydrate and fat metabolism in patients with NAFLD depending on the degree of fat accumulation in the liver. Materials and methods. Data were obtained from 72 patients with NAFLD, who were divided into two groups according to the degree of steatosis. The I group included 46 patients with moderate steatosis (the proportion of hepatocytes containing fatty is 33–66 %). The indicator of the controlled parameter of ultrasonic attenuation (CAP) ranged from 232 to 256 dB/m. The II group consisted of 26 patients with severe steatosis (the proportion of hepatocytes containing fatty inclusions more than 66 %), with CAP more than 256 dB/m. The trophological status, the parameters of carbohydrate and fat metabolism were determined. A statistical analysis of the data was carried out — the mean values in the groups were compared and the contribution of variables to the value of CAP was estimated ­using the method of multiple regression analysis. Results. The level of insulin and HOMA-IR in patients with severe fatty degeneration of the liver was (22.7 ± 9.7) and (5.4 ± 2.7) μU/ml, respectively. These indicators were higher than the corresponding indicators of group I (p

Background. The pathogenesis of chronic inflammatory bowel disease (IBD) is still not fully clarified. It is known that disorders of the intestinal microbiota lead to an increased intestinal permeability, activation of mucous and adaptive immunity, impaired production and intestinal absorption of short-chain fatty acids (SCFA). The ratio of acetic, propionic, butyric acids is an important indicator of the integrity of the intestinal microbial community. Thus, the study of the composition of the intestinal microbiota and the concentrations of fecal SCFA is a very promi­sing approach to broadening the understanding of IBD pathoge­nesis. The purpose of our study was to determine the features of the production of fecal SCFA and the composition of colon microbiota in patients with IBD. Materials and methods. The study, which was carried out at the Department of Intestinal Diseases of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine, involved 74 patients with IBD with an average age of (43.2 ± 1.8) years, who according to nosology were divided into 2 groups: group I — those with ulcerative colitis (UC) (n = 66), group II — individuals with Crohn’s disease (CD) (n = 8). The diagnoses of CD and UC were established accor­ding to generally accepted diagnostic standards in gastroenterology. Determination of fecal SCFA was carried out by chromatographic method with the use of hardware-software complex for medical researches on the basis of the gas chromatographer Chromateс Crystal 5000. The intestinal microflora was evaluated using a microbiological study of the colon content. Results. Patients with IBD had significant changes in the spectrum of SCFA, which were similar in both UC and CD: a decrease in acetic acid in the UC group by 5.7 times, in the CD group by 10.5 times (p

Background. Inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn’s di­sease (CD) remain one of the most difficult and challenging gastroenterology problems. The impact of intestinal microflora and its changes on the development and progression of IBD has not been studied enough. The most dominant etiological hypothesis is that IBD is the result of an abnormal immune response to an altered intestinal microbiota caused by an environmental factor or pathogenic microorganisms in a genetically predisposed host. Altered gut microbiota dysbiosis in IBD is generally recognized, but the dependence of this change on the age still needs to be studied. The purpose of the study is to investigate the peculiarities of intestinal dysbiosis and the frequency of small intestinal bacterial overgrowth (SIBO) in patients with IBD depending on nosology and age. Materials and methods. One hundred and twenty patients with IBD aged 19 to 79 years (average (43.90 ± 1.40) years) were examined; among them 83 patients had UC, and 37 ones had CD. All patients were divided into two groups according to nosology and age. The patients underwent a hydrogen breath test to detect SIBO, bacteriological examination of feces, and short-chain fatty acid (SCFAs) chromatography in coprofiltrate. Results. The profound qualitative and quantitative changes of the colon microflora and high frequency of SIBO in patients with IBD were revealed. The dependence of changes in the microflora composition of the small and large intestine in a patient on age and nosology was discovered. The decrease in the concentration of Bifidobacteria in the content of the colon was found mostly in young patients with CD, while the decrease in the number of Lactobacilli was mostly found in elderly patients in both groups. The frequency of hemolytic biovars of Escherichia coli, opportunistic enterobacteria, and fungi of the genus Candida in the colon increased with age. There were changes in both the total content and indices of some SCFAs in patients of both groups versus healthy persons that indicated the suppression of the metabolic activity of normal microflora in patients. Decreased levels of acetic and butyric acid indicated the seve­rity of suppression of the production of these metabolites. Conclusions. The elderly patients were found to have a greater tendency to develop SIBO, a decrease in the colon Lactobacilli concentration, as well as an increased frequency of detection of conditionally pathogenic flora and fungi of the genus Candida. In young patients, there is mainly a subcompensated form of dysbiosis with a decrease in the concentration of Bifidobacteria. With age, there is also suppression of acetic and butyric acid production. The results of this study will allow clinicians to select therapeutic tactics in these patients more carefully, namely, will influence the choice of drugs that modulate the intestinal microbiota, taking into account not only the nosology but also the patient’s age.

Background. The TLR4 non-synonymous single nucleotide polymorphism (SNPs) changes the spatial structure and, probably, the sensitivity of the receptor to its ligands, determines the certain functional aberrations that can affect the nature and activity of inflammation. The purpose of the study was to exa­mine the associations of the SNP Asp299Gly rs4986790 of the TLR4 gene with liver structural changes, innate immunity, and carbohydrate metabolism parameters in children with NAFLD. Materials and methods. The study included 76 children with overweight and obesity aged 9 to 17 years. The presence of liver steatosis was determined using transient elastometry. According to the presence of liver steatosis, the children were divided into 2 groups; following the presence of SNP Asp299Gly (rs4986790) of the TLR4 gene, each group was divided into two subgroups: children with normal (Asp299Asp) and polymorphic (Asp299Gly) variants of the TLR4 gene. The blood serum content of insulin, IL-6, IL-10, TNF-α was determined by enzyme immunoassay, the HOMA-IR index was calculated. Results. The SNP Asp299Gly rs4986790 of the TLR4 gene detection rate in the heterozygous state among all children was 15.8 %, in children with NAFLD — 20.0 %, and in children without steatosis — 11.1 % (p > 0.05). Significant differences in the stiffness and degree of fatty liver in patients with AA and AG SNP rs4986790 genotypes were not found (p > 0.05). In children with NAFLD with the Asp299Gly variant of the TLR4 gene, the level of IL-10 was significantly higher compared to patients with the Asp299Asp variant of the TLR4 gene. At the same time, in children with the Asp299Asp variant without liver steatosis, a significantly higher level of IL-6 concentration was observed (p < 0.05) compared with individuals with the TLR4 gene Asp299Gly polymorphic variant. A moderate direct correlation was found between the Asp299Gly variant of the TLR4 gene and IL-10 level (r = 0.459, p < 0.05). In children with the Asp299Asp variant of the TLR4 gene with NAFLD, higher HOMA-IR values were observed compared to patients with the Asp299Asp variant of the TLR4 gene (p > 0.05). A direct correlation was found between the level of IL-6 and insulin (r = 0.398; p < 0.01), the HOMA-IR index (r = 0.364; p < 0.05) in children with NAFLD. Conclusions. Children with NAFLD and SNP Asp299Gly rs4986790 TLR4 are characterized by significantly higher levels of IL-10 production and lower levels of insulin and HOMA-IR, which may indicate the protective properties of the SNP Asp299Gly rs4986790 TLR4 in the NAFLD development and progression.

Background. The article considers the problem of chronic constipations. The results of our own studies have been shown to determine the content of short-chain fatty acids (SCFA) and the status of microbiocenosis in patients with chronic constipations before and on the background of EasyDo treatment. Materials and methods. The study involved 10 patients aged 18 to 65 years with an average duration of chronic constipation of 10 years. Patients took the combination laxative EasyDo 3 capsules a day. In order to assess the level of SCFA and the microbial landscape in patients (6 women, 4 men), a stool analysis was performed twice: before EasyDo was administered and 2 weeks after treatment. SCFA content was determined by means of a chromatographic method using hardware and software system based on the Chromateс Crystal 5000 gas chromograph. Results. A significant increase in the content of SCFA and a decrease in lactobacilli before treatment were found. After treatment, the content of acetic acid decreased significantly — by 3.9 times, to an average value of (0.011 ± 0.005) µl/ml (p

Background. Changes in the intestinal microbiome trigger the development and progression of non-alcoholic fatty liver disease (NAFLD). Adverse fluctuations in intestinal microbiota are associated with increased intestinal permeability, activation of mucosal and adaptive immunity, increase in production and intestinal absorption of short-chain fatty acids (SCFA). The ratio of acetic, propionic, butyric acid is an important indicator of the integrity of the microbial community of the intestine. Thus, the study of the gut microbiota composition and short-chain fatty acids production represents a very appealing approach to increasing our knowledge about the mechanisms leading to NAFLD in children. The purpose of the study was to determine the features of the fecal short-chain fatty acids (fSCFA) content and the colonic microbiota composition in children with NAFLD. Materials and methods. A comprehensive examination of 102 children was provided in the Department of Pediatric Gastroenterology of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine. According to the presence of obesity, transient elastography data and alanine aminotransferase levels the patients were divided into four groups: I group — children with simple hepatic steatosis (n = 24); II group — children with nonalcoholic steatohepatitis (NASH) (n = 14); III group — children with obesity without steatosis (n = 48), IV group — children with normal weight (n = 16). Chromatographic study of fSCFA was conducted using gas chromatograph Chromatec-Crystal 5000. The microorganisms were identified using a microbiological study of the colon content. Diagnosis of NAFLD was established with FibroScan 502 Touch (Echosens, France) with the determination of the controlled attenuation parameter. Results. Significant changes in the spectrum of fSCFA were observed in children of the III group with acetic acid content increased by 4.8 times (р

The article presents the issues related to gut microbiota and short-chain fatty acids in patients with irritable bowel syndrome. It was found that the faecal concentration of acetic, propionic, butyric acids is higher in patients with irritable bowel syndrome with diarrhea, compared with the patients without diarrhea syndrome. 83.3–88.9% of patients with various forms of irritable bowel syndrome presented with dysbiotic changes. The reduced concentration of Bifidobacterium species, mainly lactic acid bacteria, is more often registered in patients with diarrheal form. There is a certain correlation between the concentration of short-chain fatty acids and the content of Bifidobacterium, Lactobacillus, Candida and opportunistic bacteria.

Background. The purpose was to determine the relationship of immunity indicators with the main biochemical parameters in patients with chronic diffuse liver diseases, depending on the etiological factors of steatosis and liver fibrosis. Materials and methods. We examined 120 patients with chronic diffuse liver diseases. They were divided according to the etiological factor of steatosis and liver fibrosis: group I — 24 patients with non-alcoholic fatty liver disease (NAFLD), group ІІ — 37 persons with non-alcoholic steatohepatitis (NASH); group III — 21 people with chronic viral hepatitis associated with C virus; group IV consisted of 18 patients with alcoholic liver disease (ALD), group V — 20 individuals with toxic drug-induced hepatitis (TDIH). To characterize the metabolism of lipids in serum, total cholesterol, low-density lipoproteins were determined. Serum lipids were evaluated by determi­ning the content of triacylglycerols (TG), high-density lipoproteins (HDL), atherogenic index (AI) was calculated. The processes of fibrosis were assessed by the content of hydroxyproline free (HPf) and hydroxyproline protein-bound, hexosamine and hyaluronic acid. The presence of endogenous intoxication was determined by the content of medium molecular peptides (MMP). The content of cellular immunity parameters, the level of circulating immune complexes (CIC), interleukins (IL) 6, 10, tumor necrosis factor α (TNF-α), insulin and HOMA-IR were determined. A correlation analysis was made of biochemical and immunological parameters in the examined patients. Results. The data obtained in patients with chronic diffuse liver disease show active inflammatory processes. This is indicated by increased levels of pro-inflammatory cytokines (IL-6 and TNF-α), MMP. IL-6 overproduction is accompanied by a decrease in total phospholipids (PL) in the blood serum of patients with NAFLD, NASH and TDIH — an average correlation was found between IL-6 and PL (r = –0.44, p

The article deals with the concepts of irritable bowel syndrome. A brief analysis of probable factors of irritable bowel syndrome development was performed. The role of intestinal microflora and the contribution of short-chain fatty acids to the processes occurring in the irritable bowel syndrosme are considered in detail. There were analyzed the studies of different authors concerning short-chain fatty acids. The results of own studies evaluating fecal content of short-chain fatty acids in patients with irritable bowel syndrome are shown. There was revealed a significant increase in the level of short-chain fatty acids, especially in diarrheal form of irritable bowel syndrome.

Background. The purpose of the present work was to assess the level of circulating immune comple­xes (CIC) and lipid metabolism state in patients with inflammatory bowel disease (IBD). Materials and methods. We examined 80 patients with IBD: 53 with ulcerative colitis (UC) and 27 with Crohn’s disease (CD). Depending on the gender, they were divided into two groups: 40 womеn and 40 men. Also, depending on the age, all patients were divided into three groups: young (45 individuals — 28 with UC and 17 with CD); middle-aged (15 persons — 10 with UC and 5 with CD); elderly (20 patients — 15 with UC and 5 with CD). The control group included 20 appa­rently healthy individuals. In patients’ blood serum, the levels of CIC, total cholesterol, triglycerides, phospholipids, high-density, low-density and very low-density lipoprotein cholesterol were determined, as well as atherogenic index. Results. Serum level of CIC significantly exceeded the normal values in women with IBD — by 1.57 times (p < 0.05), which can be considered as an indicator of inflammation intensity, involvement of the immune system in the pathological process. In women with UC, the content of CIC was significantly increased — by 1.62 times (p

The study analyzes morphological features of the development and progression of hepatic steatosis in non-alcoholic fatty liver disease, chronic hepatitis C and alcoholic fatty liver disease. Depending on etiological factor, the important difference was noted in steatosis nature and degree, localization of lipid droplets, which proves the discrepancy between some biochemical mechanisms of lipid accumulation in the hepatocytes. The role of serum free fatty acids has been considered in these diseases, an increase of their content in the blood serum has been detected, as well as deficiency of certain fractions that may be one of the causes of non-alcoholic fatty liver disease and other diseases associated with lipid metabolism. It was proved that linoleic (C18:3) and arachidonic (C20:0) free fatty acids can be considered as inflammatory markers. The indices of the fatty acids ratio have been proposed, which allows for better characterization and analysis of metabolic pathways responsible for the development and progression of fatty liver diseases. All this plays an important role in differentiated approaches to the diagnosis and treatment of liver diseases.

Актуальність. Визначення ендотеліальної функції за допомогою неінвазивних методів відіграє основну роль у прогнозуваннi перебігу різних захворювань, ризику розвитку ускладнень та оцінцi лікування. Мета: оцінка ендотеліальної функції в пацієнтів iз хронічними запальними захворюваннями кишечника (ХЗЗК) залежно від їхнього нутритивного статусу шляхом визначення стану судинного ендотелію в пробі з реактивною гіперемією та вмісту метаболітів оксиду азоту (МОА) в сироватці крові. Матеріали та методи. Сто двадцять пацієнтів iз ХЗЗК (81 — iз неспецифічним виразковим колітом (НВК) та 39 пацієнтів із хворобою Крона (ХК)) були розподілені на групи залежно від антропометричних характеристик: І — зі зниженим нутритивним статусом (n = 70); ІІ — iз нормальним (n = 20); ІІІ — iз підвищеним нутритивним статусом (n = 30). У сироватці крові пацієнтів вимірювали рівень МОА за В.А. Метельською. Для оцінки ендотеліальної функції визначали ендотелійзалежну вазодилатацію плечової артерії в пробі з реактивною гіперемією. Результати. На основі проведених досліджень встановлено вірогідне зниження вмісту МОА в сироватці крові: у пацієнтів iз НВК — у 1,7 раза (р < 0,01) та з ХК — в 1,9 раза (р < 0,001). Зниження вмісту МОА в сироватці крові не залежало від нутритивного статусу пацієнтів iз ХЗЗК. Порушення функції судинного ендотелію виявлено в 76,7 % випадків: зниження функції ендотелію — у 49,2 %, дисфункція — у 27,5 %. Зміни функції судинного ендотелію зареєстровано в 75,7 % пацієнтів І групи, 75 % — ІІ та у 83,4 % пацієнтів ІІІ групи, переважно внаслiдок зниження функції ендотелію. Висновки. Показано, що в 71 % пацієнтів iз ХЗЗК відбувається вірогідне зниження вмісту МОА в сироватці крові, що не залежить від їхнього нутритивного статусу. У хворих iз НВК спостерігалися більш виражені зміни у частотi виявлених порушень та більш значне зростання діаметра плечової артерії порівняно iз пацієнтами з ХК. Зниження нутритивного статусу супроводжувалося змінами функції судинного ендотелію в 75,4 % випадків.

Background. Non-alcoholic fatty liver disease (NAFLD) is a chronic diffuse liver pathology that includes simple steatosis, non-alcoholic steatohepatitis with the risk of progression to cirrhosis or even hepatocellular carcinoma. There are many causes of hepatic steatosis, but NAFLD is associated primarily with insulin resistance and metabolic syndrome, which gave grounds for considering NAFLD as a hepatic manifestation of the last one. The liver plays a key role in the metabolism of fatty acids and trigly­cerides, providing synthesis, accumulation, secretion and oxidation of fatty acids. With abdominal obesity inherent to metabolic syndrome, an excessive flow of fatty acids from visceral fat through the portal vein into the liver is noted, with the development of steatosis. The accumulation of lipids in the liver triggers a cascade of prooxidant hepatotoxic events that lead to the development of non-alcoholic steatohepatitis and its possible progression. The purpose was to establish the features of metabolic changes at different stages of NAFLD. Materials and methods. The study included patients with NAFLD, who underwent examination and treatment at the department of liver and pancreatic diseases of the Institute of Gastroenterology of the NAMS of Ukraine. All patients underwent ultrasonography of the abdominal organs, standard biochemical tests and evaluation of blood serum level of total cholesterol, b-lipoproteins, triglycerides, low-density lipoproteins, very-low-density lipoproteins, high-density lipoproteins, glucose, insulin and C-peptide. The HOMA index was used to assess insulin resistance. Results. Metabolic changes in the form of insulin resistance and proatherogenic changes pn the lipidogram, which are characteristic for all patients with NAFLD, were more significant in liver steatosis. Conclusions. Results of our study necessitate the mandatory study of lipid and carbohydrate metabolism in patients with NAFLD for timely correction of disorders, which will reduce the progression of this disease.

Background. The differentiation of mild (F1-F2) and advanced fibrosis (F3-F4), as well as the exclusion of fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), are extremely important for prediction of the disease course. Integrative analyses of serum markers have been proposed as promising alternatives to biopsy method. Our study was targeted to develop a new model for determining the stage of fibrosis based on a more efficient combination of serological markers and to compare it with well-established algorithms. Materials and methods. Sixty patients with biopsy-proven NAFLD, including 26 (43 %) men and 34 (57 %) women, with average age of 37.10 ± 12.4 and 44.30 ± 7.25 years, respectively, were recruited for the study. Particularly, advanced fibrosis was diagnosed in 8 patients, 28 had mild fibrosis and 24 didn’t have any fibrosis according to morphological study. The following fibrosis markers were calculated: aspartate aminotransferase and alanine aminotransferase ratio (AAR), aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the 4 factor (FIB-4). Among many variables, hyaluronic acid, α2-macroglobulin, apolipoprotein A1, fibronectin, and haptoglobin were included in comprehensive study. Integrative model have been built up to determine the stage of fibrosis. The models were compared with the area under the receiver operating characteristic (AUROC) curves. Results. The ROC analysis showed that the FIB-4 demonstrated the largest AUROC, for the F2 — 0.72, F3 — 0.8, F4 — 0.82, respectively. Obtained results of the APRI were significantly higher for mild and advanced fibrosis (F2 — 0.74, F3 — 0.82). The AAR values were reliable only for liver cirrhosis (AUROC 0.89). A strong direct correlation was determined between the stage of fibrosis and the level of hyaluronic acid, α2-macroglobulin and fibronectin (r = 0.72, 0.93 and 0.71, p < 0.05, respectively). Whereas, we observed a moderate negative linear correlation between fibrosis stage and the indices of both apolipoprotein A1 and haptoglobin (r = –0.61; r = –0.35, respectively, p < 0.05). The positive correlation was determined between activity of the inflammatory process and the content of hyaluronic acid, α2-macroglobulin and fibronectin (r = 0.54, 0.67 and 0.55 at p < 0.05), while the reverse moderate relation observed for apolipoprotein A1 and hapthoglobin (r = –0.56 and –0.33, p < 0.05). Conclusions. The analysis of obtained results showed that α2-macroglobulin, apolipoprotein A1, hyaluronic acid, and fibronectin had the greatest diagnostic validity among non-invasive markers of fibrosis. Every of them get the AUROC level higher than 0.75 for minimal fibrosis and, moreover, for moderate, significant fibrosis and cirrhosis they had an area more than 0.9.

Background. Nonalcoholic fatty liver disease (NAFLD) includes a spectrum of diseases associated with insulin resistance and metabolic disorders, such as obesity, type 2 diabetes mellitus and dyslipidemia. NAFLD includes simple steatosis, which has a benign course, nonalcoholic steatohepatitis, which can progress to cirrhosis and hepatocellular carcinoma. Liver biopsy is the gold standard for assessing the degree of steatosis, liver inflammation and fibrosis; however, a growing interest in recent years is caused by noninvasive methods, including evaluation of various indices based on serum markers. The purpose of the study was the evaluation of serum markers and noninvasive laboratory indices in identifying morphological changes in the liver of patients with nonalcoholic fatty liver disease. Materials and methods. The study included patients with NAFLD, who underwent examination and treatment in the SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”. The study involved 60 patients with NAFLD, including 26 (43 %) men and 34 (57 %) women, average age of the patients was (37.1 ± 12.4) and (44.30 ± 7.25) years, respectively. All patients had completed the study of serum hyaluronic acid, a2-macroglobulin, apolipoprotein A1, fibronectin, haptoglobin, calculation of noninvasive indices of liver fibrosis: AAR, APRI, FIB-4, percutaneous core needle liver biopsy with subsequent morphological study of tissues. Results. In patients with NAFLD, we have established a high diagnostic accuracy of serum markers of fibrosis, both in differentiation of various stages of fibrosis and the exclusion of fibrosis presence. Conclusions. Determination of serum markers is important in the choice of treatment, and the correspondence of non-invasive markers to the gold standard — morphological study allows to avoid liver biopsy as a method with potential complications due to its invasiveness.

The article shows the role of free fatty acids in the pathogenesis of metabolic and gastroenterological disorders. An expediency of gas chromatography method for determination of free fatty acids pattern in biologic samples (blood serum, urine, feces and other) was substantiated. The role of free fatty acids in the cell structure components formation, energetic homeostasis and signal molecules or their precursor production was shown. So, disorders of regulation of free fatty acids metabolism lead to systemic fails of insulin action, such as glucose metabolism in adipocytes, muscles and liver. Increase in several fractions of lipid pattern takes place in different pathologic states. These changes occur earlier than changes of enzymes activity or other protein markers. For example, short chain fatty acids can be used for identification of syndrome of bacterial overgrowth in the intestines. Increasе in polyunsaturated fatty acid fraction activates inflammation process, immune reactions, blood hypercoagulation, activation of lipid peroxidation. Also, arachidonic (C20:0), dodecanoic (C12:0) and linoleic (C18:3) acids are markers of inflammation processes. In addition, deficiency of free fatty acids is very important aspect of diagnois. It can’t be uncertified by standard laboratory methods. Proven fact is that essential fatty acids can be a cause of metabolic syndrome, non-alcoholic fatty liver disease formation such as other diseases associated with metabolism. So, only chromatography today is a method for determination fatty acid pattern. The advantages of gas chromatography are rapid realization and high accuracy. Thus, identification of trace concentrations (about 10–12 mole) is possible. Implementation of this method into the clinical practice of gastroenterology specialists allows the early diagnosis of pathologies and choice of correct treatment.

Purpose. To investigate peculiarities of lipid metabolism in hepatic steatosis among children with biliary dyskinesia. Material and methods. The study involved 31 children with biliary dyskinesia aged 10–17 years old. Patients were divided into four groups: the 1st group consisted of 8 children with biliary normokinesia without steatosis; the 2nd group consisted of 11 children with biliary hypokinesia without steatosis; 3rd group consisted of 6 children with biliary normokinesia and steatosis and the 4th group involved 6 with biliary dyskinesia and steatosis. Such biochemical parameters as total cholesterol, triglycerides, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, very low density lipoprotein-cholesterol levels and atherogenic coefficient were calculated. Findings. The characteristics of serum lipids pattern in children with liver steatosis and functional disorders of gallbladder were studied. Isolated hypercholesterolemia with IIa type of dislipoproteinemia and combined hypercholesterolemia with IIb type of dislipoproteinemia were the most frequent types of dislipoproteinemia among observed patients. It was revealed that dyslipidemia in children with gallbladder hypokinesia was characterized by elevated serum triglycerides, low density lipoprotein-cholesterol level and atherogenic coefficient. Some patients with steatosis had significant increased high-density lipoproteins and very low density lipoproteins. That caused increasing of atherogenic properties while other lipoprotein fractions remained at normal level. Originality. Existence of different ways of hepatic steatosis development in children with biliary dyskinesia based on alterations of bile genesis and excretion was suggested. Practical value. A regular control of triglycerides, high density lipoproteins and very low density lipoproteins levels in blood serum in children with functional biliary disorders of hypokinetic type and risk of steatosis development was proposed. These biochemical parameters may be additional early markers of the lipid and lipoprotein metabolism disorders.

У дослідженні проведено оцінку ефективності застосування есенціальних фосфоліпідів у хворих на хронічний вірусний гепатит С. Досягнута позитивна динаміка клінічної симптоматики, функціональних проб печінки, показників ліпідного обміну і даних еластографії, що підтверджує протизапальний, мембраностабілізуючий, репаративний та антифібротичний ефекти есенціальних фосфоліпідів.

There were studied the features of changes in the factors of aggression and protection in the gastric juice of 91 patients with gastroesophageal reflux disease (GERD) combined with sphincter of Oddi dysfunction. It was determined the pH, concentration of pepsin, glycoproteins, bile acids, sialic acids, fucose, hexosamines, the level of nitric oxide metabolites. It has been found that increased levels of nitric oxide metabolites and bile acids in gastric juice enhances the inflammatory processes in the gastric mucosa irrespective of the functional state of the sphincter of Oddi. Aggressive properties of gastric contents were increased in patients with GERD associated with both hypertonic and hypotonic sphincter of Oddi. The deficit and imbalance of protection factors in most patients in all groups were manifested by reduction in the concentration of carbohydrate terminal residues of glycoproteins as compared to the control group.

Peculiarities of blood lipids were studied in children with functional disorders of the biliary tract (FDBT) and liver steatosis. We have examined 28 children aged 10 to 17 years, who sought medical help in the department of pediatric gastroenterology of State institution «Institute of gastroenterology of National academy of medical sciences of Ukraine». The presence of steatosis was determined by means of liver transient elastography with the study of controlled parameter of ultrasonic attenuation. According to the findings, we have formed two groups: I group — 17 children with FDBT without steatosis; II group — 11 children with FDBT and steatosis. As research markers of serum lipids, we have used the content of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, and atherogenic factor was calculated. It was found that children with FDBT are characterized by dyslipidemia, which manifests itself in the reduction of very low-density lipoprotein cholesterol, increase of low-density lipoprotein cholesterol and atherogenic factor. Signs of metabolic syndrome are characteristic of the blood lipids of children with steatosis.

Nonalcoholic fatty liver disease (NAFLD) — a metabolic-related disease resulting from insulin resistance, which is characterized by fatty liver degeneration of varying degrees in the absence of other factors of liver injury. Insulin resistance leads to enhanced lipolysis of adipose tissue with excessive release of fatty acids and their accumulation in the liver. The clinical significance of NAFLD consists in the possibility of simple steatosis progression to liver cirrhosis. There was studied the influence of individual care containing preparation of essential phospholipids enerliv on cytolysis indicators, blood lipids and morphostructural changes of the liver in patients with NAFLD. Examination of patients after the treatment showed reduced activity of transaminases, increased blood content of phospholipids fraction and decreased atherogenic factor. According to the findings of control sonographic studies, a reduction in the size of the left lobe of the liver was observed.

Study concerning the influence of additional damaging factors and chronic alcoholisation on the phospholipid composition of liver homogenate has been carried out on 42 white laboratory rats using biochemical, pathomorphological and pathophysiological methods. Chronic hepatosis with three degrees of prevalence (microvesicular, macrovesicular and globular fatty degeneration) and activity associated with corresponding changes in the permeability of the hepatocyte membranes and the dynamics of membrane protein and lipid peroxidation has been achieved in experiment and described in detail.

It was found that 7 days after four-time administration of carbon tetrachloride (CCl4), acute hepatitis develops in the liver of rats, the basis of it was predominantly common fatty degeneration which occupies 40–80 % of the whole area of biopsy sample and is always localized around the portal area with the largest lesion of I–II acinal area. Morphological changes in the I group were accompanied by increased activity of arginase (AR) in rat liver homogenates by 50.0 % (p < 0.01), and the content of nitric oxide metabolites (NOx) were reduced by 20.0 % (p < 0.01) compared to controls. Also, there was a decrease in the number of external squares, visited by rats, by 79.4 %, and internal ones — by 78.3 % compared with the control group (p < 0.001). Seven days after a single administration of CCl4 (II group), we observed morphological pattern, similar to that of in the I group, but in some cases the changes were characterized by a lower intensity. The development of experimental hepatitis on the background of a lack of nitric oxide in 100 % of cases was characterized by a significant sinusoidal dilatation throughout the plane of biopsy sample. Destruction of hepatocytes due to fatty degeneration was more localized. In the rats of the III group AR activity was inhibited by 22.1 % (p < 0.05) and NOx content was reduced by 21.5 % compared with the control group. The development of acute hepatitis on a background of nitric oxide excess in 75.0 % of the animals was accompanied by a less common, but more severe fatty degeneration with local foci of necrosis. AR activity tended to increase by 9.9 % compared with the controls, a trend towards reduction of NOx by 16.1 % was noted, which is similar to biochemical parameters of the I group. Animals from group of single CCl4 administration on the background of 5-day NO excess were characterized by reduced motor and orienting-investigative activity. The findings indicate that we have created a model of hepatitis by a single CCl4 injection on the background of NO excess. This was confirmed by morphological changes, characteristic for hepatitis, and compensatory response of the organism in the form of increased arginase activity and by a decrease in the content of nitric oxide metabolites in the liver homogenate. A single injection of CCl4 on a background of NO excess led to disorder of both motor and orienting-investigative activity in experimental animals.

Article presents parameters of iron metabolism and cytokines (IL-6 and TNF-α) in patients with chronic inflammatory bowel diseases (CIBD). The material for the study was the blood of 69 patients with CIBD and anemia and 26 — without anemia. We have studied the features of main ferrokinetic parameters — iron, total iron-binding capacity of serum, transferrin saturation, ferritin, transferrin receptor, erythropoietin, hepcidin depending on hemoglobin level and the type of anemia. The relationship of iron metabolism disorders with the level of proinflammatory cytokines (IL-6 and TNF-α) is shown.

The article deals with the morphological features of the liver tissue and changes in the metabolism of extracellular matrix components during progression of chronic hepatitis C. There has been carried out the comparison of computer morphometry of histological liver samples as an additional method of objectification of morphological study and and non-invasive markers of fibrosis.