The relevance of studying clinical and laboratory manifestations and liver inflammatory activity in patients with non‑alcoholic fatty liver disease (NAFLD) and arterial hypertension (HTN) is high, as it determines the aspects of preliminary diagnosis in patients from risk groups and allows to adjust of the diagnostic and therapeutic tactics of managing these patients. Objective — to study the ways of cytokine‑determined immune reactions implementation in patients with NAFLD and concomitant HTN. Materials and methods. The study involved 120 patients with NAFLD, from them 49 patients (67.3 % women and 32.7 % men) had concomitant HTN (the main group); 51 patients (58.5 % women and 41.2 % men) had isolated NAFLD (comparison group). The control group consisted of 20 relatively healthy subjects (55.0 % women and 45.0 % men). Body mass index (BMI) was calculated, and several biochemical indices were evaluated. The standard kinetic method was used to define levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The enzymatic colorimetric method was used to measure γ‑glutamylpeptidase levels, and levels of alkaline phosphatase, total protein and albumin were measured with colorimetric method. The de Ritis index was calculated. The interleukins 8 and 10 levels were determined using the immunofluorescence method with ElabScience (USA) reagents. Ultrasound examination of the liver was performed according to the standard method on an empty stomach using the device Samsung (Medison) SonoAce X8 (South Korea). To compare the data in the study groups, the liver oblique‑vertical dimension (CVD) was used. Results. The BMI increase was determined in both groups: with NAFLD and concomitant HTN and with isolated course (respectively 27.8 [26.6; 28.5] and 27.3 [24.2; 28.3] kg/ m2) compared to the control group (24.3 [21.9; 26.0] kg/ m2, p < 0.001 and р = 0.004). The presence of concomitant HTN in patients with NAFLD was associated with the significant (p < 0.001) deviations in the functional liver state, which was manifested by the prevalence of ALT levels (45 [43.0; 47.5] U/ L), AST levels (53 [51.0; 56.0] U/ L), alkaline phosphatase levels (285.7 [217.6; 321.1] U/ L) and gamma‑glutamine transpeptidase levels (96.2 [75.0; 108.9] U/ L) in comparison with the isolated NAFLD levels (respectively 36 [34.0; 39.0] U/ L, 41 [40.0; 45.0] U/ L, 215.5 [183.2; 246.7] U/ L and 65.5 [51.5; 76.8] U/ L) and control group levels (respectively 25.5 [24.0; 30.8] U/ L, 23 [19.3; 26.0] U/ L, 129.2 [116.9; 140.6] U/ L and 22.6 [16.1; 31.7] U/ L). A significantly (p < 0.001) higher de Ritis index was determined in the main (1.16 [1.11; 1.24]) and comparison groups (1.14 [1.08; 1.21]) as compared to the control group (0.87 [0.76; 0.99]). Such changes in the liver functional activity correlated with the changes in cytokine‑determined immune reactions, which were manifested by a significant (p < 0.001) predominance of interleukin‑8 and interleukin‑10 levels in patients with NAFLD and HTN (respectively, 29.4 [25.6; 34.9] and 20.3 [17.1; 24.4] pg/ mL) and isolated NAFLD (22.5 [19.1; 25.8] and 12.1 [10.5; 13.7] pg/ mL) compared to the control group (7.4 [6.7; 8.9] and 3.6 [2.8; 5.0] pg/ mL). Conclusions. The course of NAFLD is associated with the development of cytokine imbalance. A systematic increase in blood pressure can lead to an increase of cytokine‑mediated immune reactions activity in patients with NAFLD and concomitant HTN.

Objective — to determine the relationship between the activity of pro‑ and anti‑inflammatory cytokines and liver functional parameters in patients with non‑alcoholic fatty liver disease (NAFLD) and hypertension (HTN), depending on the degree of liver parenchyma damage. Materials and methods. The study included 120 people, divided into 3 groups: 49 patients (67.3% women) with NAFLD and concomitant HTN (main group); 51 patients (58.5% women) with isolated NAFLD (comparison group) and 20 relatively healthy individuals (55.0% women and 45.0% men) of the control group. In the main group, 55.1% of patients had steatosis, 44.9% had steatohepatitis. In the comparison group, 58.8% had steatosis, 41.2% had steatohepatitis (χ2=0.141, p=0.707). The assessments included body mass index (BMI), levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), γ‑glutamine transpeptidase, interleukin 8 and 10 (IL‑8, IL‑10), alkaline phosphatase (ALP), De Ritis index (AST/ALT ratio). The diagnosis of NAFLD and HTN was established in accordance with the local and international recommendations. Ultrasound examination of the liver was performed according to the standard method in fasting condition. Results. Body mass index corresponded to the normal or increased body weight: in the main group — 27.8 [26.6; 28.5] kg/m2 and 27.3 [24.2; 28.3] kg/m2 in the comparison group, in the control group — 24.3 [21.9; 26.0] kg/m2 (p<0.001 and p=0.004 respectively). The results of the biochemical analysis showed a significant (p<0.001) predominance of AST and ALT in patients with steatohepatitis compared to patients with steatosis, both in the main/group (AST=56.5 [54.0, 57.0] U/l and ALT=47.0 [44.5; 49.0] U/L, respectively), and in the comparison group (AST=45.0 [43.0; 48.0] U/l and ALT 39.0 [35.0; 42.0] U/L, respectively). The analysis of correlational relationships in patients with steatohepatitis, stronger relationships were found, both between the systemic increase in blood pressure, and between the cytokine’s levels and liver functional parameters. Thus, in patients of the main group with steatohepatitis, an inverse relationship was determined between the levels of AST and anti‑inflammatory IL‑10 (r=–0.588, p=0.004), the levels of GGTP (r=–0.407 p=0.060) and the levels of albumin (r=– 0.466, p=0.069). In patients of the comparison group and steatohepatitis, an inverse correlation was determined between the levels of diastolic blood pressure and GGTP (r=0.490, p=0.024). GGTP levels were also inversely correlated with AST levels (r=–0.508, p=0.019) and directly with IL‑8 and IL‑10 levels (r=0.438, p=0.049 and r=0.373, p=0.096). IL 10 demonstrated a strong negative correlation with albumin levels (r=–0.604, p=0.004). IL‑8 levels showed a direct correlation with IL‑10 (r=0.431, p=0.051) in this subgroup of patients. Conclusions. The presence of concomitant hypertension in patients with NAFLD was associated with more active progression compared to patients with isolated NAFLD. Correlation analysis showed gradual exhaustion of anti‑inflammatory protection and increase of pro‑inflammatory activity as changes in liver parenchyma progressed, especially in patients with comorbid NAFLD and HTN course. That allows us to consider HTN as a prognostically unfavorable risk factor for the development and progression of the liver parenchyma fibrosis.

Liver parenchyma damage is associated with significant activation of oxidative stress. Correction of oxidative stress can be a promising direction in the treatment of arterial hypertension. It has been established that in patients with hepatopathies, lower concentrations of selenium are found in blood and erythrocytes, which gives reason to consider selenium as a potential therapeutic agent in patients with liver pathology. Objective — to determine the therapeutic potential of sodium selenite in patients with non‑alcoholic fatty liver disease in combination with hypertension. Materials and methods. 100 patients with nonalcoholic fatty liver disease (NAFLD) were included in the study: the main group — 49 patients (67.3% women, median age is 51.0 years) with concomitant NAFLD and arterial hypertension (HTN), the comparison group — 51 patients (58.8% women, median age is 52.0 years) with NAFLD isolated course. The control group included 20 practically healthy people (55.0% women, median age is 51.0 years). Among the patients of the main group, the first degree of HTN was diagnosed in 28.6% of patients (14 people), the second degree — 71.4% (35 people). Among these patients, 32.7% (16 people) had the first stage of HTN, 67.3% (33 people) had the second stage. In the main group, 55.1% of patients had steatosis, 44.9% had steatohepatitis. In the comparison group, 58.8% had steatosis, 41.2% had steatohepatitis (χ2=0.141, p=0.707). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured according to the standard method (kinetic method). Gamma‑glutamine transpeptidase (GGTP) was measured by the enzymatic colorimetric method, alkaline phosphatase (AP) by the colorimetric method. Selenium and selenoprotein P (Sel  P) levels were determined using the immunofluorescence method. Ultrasound examination of the liver was performed according to the standard method on an empty stomach. Results. Body mass index corresponded to normal or increased body weight: in the main group — 27.8 [26.6; 28.5] kg/ m2 and 27.3 [24.2; 28.3] kg/ m2 in the comparison group, in the control group — 24.3 [21.9; 26.0] kg/ m2. In patients of the main group was determined a significant (p <0.001) predominance of ALT levels (45 [43.0; 47.5] U/ L), AST levels (53 [51.0; 56.0] U/ L), AP levels (285.7 [217.6; 321.1] U/ L) and GGTP levels (96.2 [75.0; 108.9] U/ L) opposite to comparison group (respectively 36 [34.0; 39.0] U/ L, 41 [40.0; 45.0] U/ L, 215.5 [183.2; 246.7] U/ L and 65.5 [51.5; 76.8] U/ L) and control group levels (respectively 25.5 [24.0; 30.8] U/ L, 23 [19.3; 26.0] U/ L, 129.2 [116.9; 140.6] U/ L and 22.6 [16.1; 31.7] U/ L). A two‑fold decrease in selenoprotein P levels was obtained in patients with NAFLD and HTN compared to patients with NAFLD (19.7 [8.0; 26.7] ng/ mL and 43.1 [41.3; 45.4] ng/ mL respectively, p <0.001), and selenium in one and a half times compared to patients with NAFLD (43.5 [39.9; 49.1] g/ L and 67.2 [61.5; 77.4] g/ L respectively, p <0.001). The highest Sel P median levels (71.0 [54.3; 76.1] ng/ ml and selenium levels (108.0 [96.9; 118.8] g/ L) registered in the control group (p <0.001). Evaluating the data on selenium metabolism and liver tests depending on the intake of sodium selenite, a significant increase in the levels of Sel P (53.6 [43.1; 60.4] ng/ ml, p <0.001) and selenium (89.1 [63, 4; 99.5] g/ L, p <0.009), as well as a decrease in AST levels (41.7 [32.6; 43.2] U/ l, p <0.001) in the group with isolated NAFLD, while in the group with NAFLD and HTN comorbid course, no significant changes in the studied parameters were detected. Conclusions. The obtained results provide a basis for sodium selenite use in the therapy of patients with NAFLD. Further research on the duration of such therapy and sodium selenite dosing regimen in patients with a comorbid course of NAFLD and HTN is a promising and relevant direction.