Questions of metabolic therapy of a biliary pathology are of a great importance today. One of the metabolic preparations is levocarnitine, a synthetic analogue of the natural L-stereoisomer carnitine (L-3-hydroxi-4-N-(3-methylammonium) butanoic acid). Its metabolic functions include fatty acid transport in mitochondrion, where they oxidize and emit adenosine triphosphate (ATP) energy; modulation of intercellular homeostasis of coenzyme А in mitochondrial matrix and a mediated effect on protein synthesis.
We aimed to study the influence of the levocarnitine-based pharmacological preparation on the lipid and protein metabolism at patients with non-calculous chronic cholecystitis.
Our test group consisted of patients with non-calculous chronic cholecystitis (n=47), control group included practically healthy persons (n=33). The study was conducted according to the Helsinki Declaration standards (2000), all the patients signed an informational agreement. All patients received 20%-levocarnitine solution per os during 21 days (preparation «Elcar», R№ LS-000184, 15.04.05 trademark certificate № 162966, LLC «PIK-PHARMA»). The following values of blood serum were determined: total cholesterol, high-density lipoprotein cholesterol, triglycerides, total protein and protein fractions, biochemical markers of biliary functional status. Very low- and low-density lipoprotein cholesterol was estimated by the Friedewald formula. The obtained data were evaluated by methods of the descriptive statistics using software Statistica 6.0. The difference reliability was assessed by the Student´s t test. Differences were regarded as reliable when p<0,05.
65,9 % of the patients with non-calculous chronic cholecystitis had dislipidemia and 100 % of them had disproteinemia. In 42,5% of the patients were observed disturbances of liver function, caused by moderate cytolytic and cholestatic syndromes. These patients had stronger metabolic disturbances, than patients with a normally functioning liver.
The study results proved, that levocarnitine has a complex effect on lipid metabolism at patients with chronic cholecystitis. It had a lipidmodulating effect on the patients with dislipidemia, who did not any signs of a disturbed functional status of liver. After the treatment course, atherogenic fraction content in their blood reduced statistically reliably. The triglyceride level reduced two-fold, low-density lipoprotein cholesterol reduced by 22,4 %, total cholesterol - by 17,8 % and did not differ from the values in control group. Tendency to a higher content of high-density lipoprotein cholesterol and weaker atherogenic properties of blood serum was observed. Hypolipidemic effect of levocarnitine could possibly result in the intensified lipid utilization by means of enzymatic degradation and activation of fatty acid transport in mitochondrion, where they enter the β-oxidation cycle. Patients with dislipidemia and disturbed functional status of liver showed no definitive dynamics of blood lipid values. A possible reason for this could be the fact, that these patients had a more intense dislipidemia, and in order to achieve a hypolipidemic effect they probably need a longer treatment course. Among the positive results, we could observe regressing cholestatic and cytolytic syndromes and a better biliary function. This was indicated by the activated hepatic protein synthetic function, which is proved by a statistically reliable grow of total protein and albumin fraction content, which increased by 15-17%.
To sum up, levocarnitine has a lipidmodulating effect under the conditions of non-calculous chronic cholecystitis with no disturbances of the biliary functional status; it improves liver function at patients with cytolytic and cholestatic syndromes. The obtained data prove, that levocarnitine is worth using for correction of the metabolic disturbances at patients with chronic cholecystitis.
The work is submitted to Scientific Conference "Basic and applied research in medicine", France (Paris), October 13-20, 2009. Came to the Editor´s Office on 13.08.2009.