Журнал "Гастроэнтерология" Том 54, №4, 2020
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Metabolic effects of personified treatment of patients with obesity and non-alcoholic fatty liver disease depending on PPAR-γ2 Pro12Ala (rs1801282) polymorphism
Авторы: V.P. Shypulin, V.V. Chernyavskiy, N.H. Melnyk
Bogomolets National Medical University, Kyiv, Ukraine
Рубрики: Гастроэнтерология
Разделы: Медицинские форумы
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The purpose was to study the features of metabolic changes in the case of personalized treatment of patients with obesity and non-alcoholic fatty liver disease (NAFLD) depending on the polymorphism Pro12Ala (rs1801282) in PPAR-γ2 gene.
Materials and methods. The 12-week study involved 123 patients with 1–3 degrees of obesity in combination with NAFLD. They were divided into two groups (based on the randomization method) according to age and sex. First (1) group patients (n = 61) followed the basic recommendations for thinning and took pioglitazone 15 mg/day, and second (2) group patients (n = 62) — only the principles of non-drug treatment. Molecular genetic (PPAR-γ2 rs1801282 (C > G) polymorphism), anthropometric (body mass index (BMI)), laboratory (ferritin and serum uric acid, glucose tolerance test with simultaneous determination of insulin and C-peptide) and instrumental testing (incl. ultrasound steatometry) were performed before and after 12 weeks of treatment.
Results. Before treatment, 1 group with carriers of the mutant G allele (CG and GG genotypes) (n = 11) PPAR-γ2 Pro12Ala (rs1801282) polymorphism had significantly higher levels of fasting insulin (p < 0.001) compared to 1 (n = 50) and 2 (n = 51) group with carriers of CC genotype, 2 group (n = 11) — levels of fasting C-peptide (p = 0.04), respectively, compared to 2 group with carriers of CC genotype. In addition, 1 and 2 group with carriers of CG and GG genotypes had significantly lower rates of insulin insulin values t = 120 min (p < 0.001) compared to carriers of CC genotype in both groups. After 12-week treatment, in 2 group with carriers of CC genotype were observed significantly the lowest weight loss (p < 0.001) according to the BMI (–2.81 (–3.23; –2.39) kg/m2), and 1 group patients was preferred significantly the lowest hepatic steatosis according to the controlled attenuation parameter, regardless of the PPAR-γ2 gene variant (p < 0.001). Also, in 1 group with carriers of the G allele were found the most significant difference in fasting C-peptide –1.31 (–1.50; –1.13) μg/L (p < 0.001) and serum uric acid –165.30; –147.80 μmol/L (p < 0.001) after treatment, respectively, compared to other groups, and the level of ferritin also (–107.47 (–157.38; –57.56) μg/L) (p = 0.03), respectively, but only compared to 1 group with carriers of CC genotype.
Conclusions. Personalized treatment of patients with obesity and NAFLD with pioglitazone 15 mg/day during 12 weeks in carriers of the mutant G allele more effectively reduces the level of fasting C-peptide and serum uric acid.