Non‑alcoholic fatty liver disease (NAFLD) remains the leading nosology among hepatic diseases around the world. Its complex pathogenesis is not still clearly understood. Besides metabolic changes one of potential mechanisms of NAFLD development is changes in hepatokines, fetuin‑A in particular, secretion and metabolism. Objective — to determine the role of fetuin‑A in the development and progression of NAFLD. Materials and methods. The study enrolled 78 NAFLD patients with metabolic disorders and 30 volunteers as a control group. Additionally to routine examination serum concentration of fetuin‑A was determined. Statistical processing was carried out using SPSS 21. Results. The results showed a statistically significant increase in fetuin‑A concentrations in NAFLD patients with concomitant MS (p < 0.05). There was a direct correlation between fetuin‑A levels and parameters of abdominal (WC and WHR, p < 0.05) and visceral obesity (VAT %, p < 0.05). Concentrations of fetuin‑A were higher in polymorbid patients, especially in the combination of NAFLD with type 2 diabetes mellitus and obesity. Fetuin‑A levels was associated with changes in carbohydrates and lipids parameters. Fetuin‑A positively correlated with glycated hemoglobin (r = 0.32, p < 0.05) and index HOMA (r = 0.36, p < 0.05). There was a positive correlation between fetuin‑A level and TG (r = 0.44, p < 0.05) and LDL cholesterol (r = 0.37, p < 0.05). Furthermore, an increase in fetuin‑A was associated with an increase in activity of ALT (r = 0.39, p < 0.05) and elevation of the level of TNF‑a (r = 0.33, p < 0.05). NAFLD patients with advanced stages of steatosis and fibrosis also demonstrated higher levels of fetuin‑A (p < 0.05). Conclusions. The obtained data indicate a significant pathogenetic role of fetuin‑A in the development and progression of NAFLD.

Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases, with pathogenetic mechanisms involving complex factors, in particular changes in the intestinal microbiota. The development and evaluation of the effectiveness of NAFLD treatment regimens, affecting intestinal microbiota disturbances, presents an urgent issue in modern medicine. Objective — to determine effects of combined therapy, including ursodeoxycholic acid (UDCA) and probiotic preparation (strains of Lactobacillus acidophilus, L. rhamnosus, Streptococcus salivarius subsp. thermophilus, L. delbrueckii subsp. Bulgaricus) on the metabolic disorders and inflammatory processes in liver tissue of patients with NAFLD. Materials and methods. The study included 108 patients with NAFLD with metabolic disorders and 30 people of the control group, who were examined on the basis of the Department of Gastroenterology and Therapy and outpatient department of the GI «L. T. Mala National Institute of Therapy of the NAMS of Ukraine». Women prevailed in both groups. The mean age of patients was 54.6 ± 11.7 years. The patients were randomized into two groups, comparable by gender and age ratio. Both groups received non‑drug therapy. The comparison group (48 patients) received UDCA preparation only, the main group (60 patients) received additional probiotic preparation «Yogurt capsules» (Pharmascience Inc., Canada).  The treatment lasted 12 weeks. Patients were examined at the beginning and end of treatment with additional determination of pro‑inflammatory markers: C‑reactive protein CRP and TNF‑α. Statistical analysis was performed with the package Statistica 13.1 using nonparametric methods. Results. Patients’ examination in the dynamics of treatment showed an improvement in NAFLD course due to a decrease in the levels of alanine aminotransferase, aspartate aminotransferase and γ‑glutamyl peptidase (ALT, AST and GGT) in both groups. Moreover, against the background of treatment, the tendency was observed to the decrease of visceral fat percentage, as well as the visceral obesity index, which in group I significantly decreased in almost 1.6 times. In contrast to the carbohydrate metabolism indicators, the dynamics of which did not differ significantly between the groups, a significant effect of the developed therapy on the lipid profile was determined. The triglycerides (TG) levels in the main group decreased 1.3 times, and LDL cholesterol 1.6 times. In addition, the significant decrease in TNF‑alpha levels by 57.51 % was observed under the influence of treatment with the addition of probiotic yogurt. Conclusions. Combined therapy which includes lifestyle modification by means of non‑drug therapy, UDCA with the additional use of a complex probiotic preparation yogurt capsules, has a pathogenetic focus and proven effectiveness in the treatment of NAFLD.