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ASSESSMENT WITH CORRECTION OF LIPID PEROXIDATION
SYNDROME AND LIVER FUNCTIONAL STATUS IN RHINOSINUSITIS
WITH COMORBIDITY OF CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
Saliakhunova Kh.O.
1
Shaikhova Kh.E.
2
Usmanova N.A.
1
1
Andijan State Medical Institute. Andijan, Uzbekistan.
2
Tashkent Medical Academy, Tashkent, Uzbekistan
https://doi.org/10.5281/zenodo.14033331
Relevance.
Analysis of modern literature data confirms the concept of
interaction between ENT organs and lower respiratory tract. However,
assessment and correction of endogenous intoxication syndrome, lipid
peroxidation and functional status of the liver against the background of
comorbidity of chronic obstructive pulmonary disease (COPD) in rhinosinusitis
remains insufficiently studied. Additional studies are needed to deeply
understand the pathogenesis, the impact of comorbidity of the upper and lower
respiratory tract on each other, as well as on the detoxification potential of the
div to develop optimal interdisciplinary approaches to diagnosis and
treatment.
Aim.
Assessment and correction of lipid peroxidation levels and functional
status of the liver in rhinosinusitis with comorbidity of chronic obstructive
pulmonary disease (COPD).
Materials and methods of the study.
The work was carried out
according to the research plan of the Andijan State Medical Institute at the
clinical base of the Otolaryngology Department for the period from 2020 to
2023. In accordance with the inclusion/exclusion criteria, at the first stage of the
study of the incidence rate, COPD was detected in 64 (36%) patients out of 178
patients with rhinosinusitis. The incidence of COPD in patients with acute
rhinosinusitis (ARS) was 13.5% - 24 patients, and in 40 patients with chronic
rhinosinusitis (CRS) - 22.5%. For further study of lipid peroxidation in patients
with rhinosinusitis, we identified 2 study groups and one group from the
pulmonology department of the institute's clinic with isolated COPD for
comparative analysis. Group 1: 24 (25.5%) patients with acute rhinosinusitis
with COPD; Group 2: 40 (42.6%) patients with chronic rhinosinusitis and COPD;
Group 3: 30 (31.9%) patients with COPD. Depending on the methods of
treatment, the fight against lipid peroxidation syndrome, all study groups were
divided into the following subgroups: Group 1 was divided into subgroups A and
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B, 12 (12.76%) patients each, in which standard therapy was carried out in
subgroup A, and in subgroup B, sorption-antioxidant therapy was included in
the complex of standard treatment measures. Group 2 (patients with CRS and
COPD) was also divided into subgroups A and B, 20 (21.28%) patients each, and
in these subgroups, standard and sorption-antioxidant treatment were also
carried out. The condition of patients, biochemical blood parameters, lipid
peroxidation level, and results of dynamic treatment assessment were compared
with the control group (3rd group, n=30) of patients with isolated COPD. In all
three study groups, the main clinical, functional, instrumental, laboratory
examinations and treatments were carried out according to the
recommendations, GOLD 2020, EPOS 2020 and the approved protocol of the
Ministry of Health of the Republic of Uzbekistan.
Results and discussion.
Scientific interest in the process of lipid
peroxidation has increased especially in connection with the clarification of their
role in the pathogenesis of many diseases. Damage to biomembranes and
associated functions of most integral and near-membrane proteins, including
receptors, transport and structure-forming proteins, enzymes and enzyme
systems of both the plasma membrane and membranes of various subcellular
organelles, disrupt the course of many cellular processes and the functioning of
the cell as a whole. The effectiveness of complex combined therapy using
sorption-antioxidant therapy can also be traced by the dynamics of lipid
peroxidation indices. Upon admission to hospital, in patients with ARS with
COPD, the level of MDA in the blood plasma in the 1-B subgroup of patients
exceeded normal values by 3.6 times. Under the influence of sorption-
antioxidant therapy in the complex of standard treatment, the level of this
indicator in this subgroup of patients on the 3rd day of the treatment period
decreased by 45.2% and was significantly lower than the initial indicator (p <
0.05). A significant decrease in this indicator in patients with CRS with comorbid
COPD was also noted on the 3rd day of treatment by 46.0%. In patients with ARS
and CRS with COPD, as well as in patients with COPD without rhinosinusitis, a
significant decrease in the MDA concentration was noted on the 7th day of the
treatment period by 49%, 47.2% and 46.3%, respectively. By this time, in
patients with ARS and CRS with COPD, who underwent sorption-antioxidant
therapy, it was 1.6 and 1.9 times lower than in subgroups 1-A and 1-B, and 1.6
and 1.8 times lower in group 3, respectively. This once again confirms the
advantage of sorption-antioxidant therapy in comparison with standard
treatment methods.
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The level of concentration of DK in the blood of patients with ARS with
COPD (1-A and 1-B subgroups) upon admission to the hospital exceeded the
normal values by an average of 1.9 and 2 times, respectively. Under the influence
of complex treatment with the use of sorption-antioxidant therapy, the level of
concentration of DK in the 1-B subgroup of patients already on the 3rd day of
the treatment period decreased to 3.53 ± 0.12 μmol / l (by 29.1%) and
significantly differed from the initial data. As a result of the complex treatment
using sorption-antioxidant therapy in patients with CRS with COPD, on the 3rd
day of treatment, the level of DK in the blood plasma decreased by 43.8% (1.6
times lower than in the 2-A subgroup of patients by this time) and reached
normal values - 2.68 ± 0.09 μmol / l., whereas in the 3rd group of patients the
level of this indicator still remained high. The effectiveness of the use of
sorption-antioxidant therapy against the background of standard treatment can
be traced by the dynamics of a number of indicators of the functional state of the
liver.
In patients with ARS with comorbid COPD (subgroup 1-B), the total
bilirubin content in the blood upon admission reached 53.4±2.3 μmol/l, and in
patients with CRS with comorbid COPD (subgroup 2-B), this indicator increased
to 51.5±2.1 μmol/l. Against the background of complex combination therapy, the
level of total bilirubin in both subgroups significantly decreased on the 3rd day
(27.5±1.3 μmol/l, 24.4±1.3 μmol/l), which is 48.5% and 52.6% (p<0.05) relative
to the baseline data, respectively. In subgroups 1-B and 2-B of patients, the level
of total bilirubin normalized on the 7th day. By this time, the level of this
indicator in COPD patients decreased by 48.4%, and in subgroup 1-A by 43.5%
relative to the initial data, but had not yet reached normal values. The level of
alkaline phosphatase in patients of subgroup 1-B on day 3 decreased by 18.8%,
and in patients of subgroup 2-B it decreased by 21.8% and was significantly
lower than the initial level (p<0.05). In the following days, the level of this
indicator continued to decrease and on the 7th day of complex treatment it
reached normal values (in subgroup 1-B - 89.6±1.2 U/L; in subgroup 2-B -
87.2±1.1 U/L). This is 1.7 and 1.8 times less than on admission (p<0.05). In the
3rd group of patients with isolated COPD, the alkaline phosphatase level was
normalized on the 7th day, but still remained at the upper limits of the normal
value. A significant decrease in the activity of liver enzymes (AST/ALT) was also
noted on the 3rd day (by 63.5% and 60.7%, respectively) against the
background of sorption-antioxidant therapy in patients with ARS with COPD,
and in patients with CRS with comorbidity of COPD, the level of liver enzymes by
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this time significantly decreased by 56.8% and 57.8%, respectively (p> 0.05). In
patients with COPD (group 3), a significant decrease in the AST/ALT level (by
40.3% and 32.6%) was noted only on the 7th day of treatment. The creatinine
level in patients with ARS with COPD significantly decreased on the 3rd day of
treatment (by 45.6%), and in patients with CRS with COPD by 47.4% and almost
reached normal values. In group 3, a significant decrease in this indicator was
noted on the 7th day of the treatment process by 8.5% (114.7±3.5 μmol/l)
relative to the initial data. The urea level against the background of complex
therapy with sorption-antioxidant therapy in patients with acute and chronic
rhinosinusitis with comorbidity of COPD on the 3rd day decreased by 34.8% and
36.8%, respectively, relative to the initial data (p<0.05).
Prothrombin (INR) is one of the criteria for assessing the functional state
of the liver. In patients with ARS with comorbid COPD against the background of
standard therapy, the level of this indicator was reduced compared to the initial
data on the 3rd day of the treatment period by 6.25%, and in patients with CRS
with COPD by 6.7%. Against the background of complex treatment with
sorption-antioxidant therapy, the INR level by this time in patients 1-B and 2-B
significantly decreased by 11.8% and 16.7% (p <0.05), respectively. On the 7th
day of treatment, the difference in the decrease in the INR level between
subgroups A and B was reliable by 23.1% and 30.8%, and with group 3 of
patients with COPD - by 16.7% and 25%, respectively.
Conclusions.
Lipid peroxidation in rhinosinusitis with comorbid COPD is caused
by the development of systemic inflammation with an increase in the level of
endogenous intoxication markers and excessive accumulation of lipid
peroxidation products (MDA - increased by 3.6 times; DK - increased by 2.0
times). Liver damage occurs, as evidenced by significant changes in the studied
indicators of its functional status upon admission of patients to the hospital. At
the same time, it is noteworthy that the restoration of the functional status of the
liver in the chronic form of rhinosinusitis against the background of complex
therapy occurs comparatively faster than in the acute form of this disease with
COPD. The obtained data indicate that the use of the method of sorption-
antioxidant therapy in the complex of standard treatment is rational and,
mutually complementing each other, has a pronounced hepatoprotective and
antihypoxic effect, significantly reduces the intensification of endogenous
intoxication and lipid peroxidation processes in the div, the functional load on
the liver and kidneys, and allows for a more complete use of their detoxification
potential.
