EFFECT OF THE AUTONOMIC NERVOUS SYSTEM ON THE CARDIOVASCULAR SYSTEM IN VIRAL HEPATIC CIRRHOSIS

Abstract

Today it is known that cirrhosis of the liver can be accompanied by a violation of the functions of the heart, latent at rest, and manifested under the influence of stress factors. Physiological, physical, pharmacological and other causes can serve as stressors. In 2005, a working group consisting of reputable hepatologists and cardiologists adopted the definition of cirrhotic cardiomyopathy. Cirrhotic cardiomyopathy, according to experts, is one of the forms of chronic cardiac dysfunction and is characterized by a decrease in contractility in response to stress and/or a change in diastolic function with electrophysiological features in the absence of other known heart diseases. [4]. In liver diseases, including cirrhosis of the liver, vegetative liver disorders develop. Where there is a decrease in the influence of the parasympathetic nervous system and an increase in the influence of the sympathetic nervous system.

      In liver diseases, including viral ones, vegetative disorders develop, leading to various complications from the internal organs. Violation of the autonomic nervous system leads to a decrease in the functions of the parasympathetic nervous system and an increase in the sympathetic nervous system. [1;2;5]. In violation of the autonomic nervous system, changes are observed from the gastrointestinal tract, symptoms such as rapid overflow of the stomach, nausea, vomiting, pain in the epigastric areas. In recent years, studies have begun to appear aimed at studying cardiac arrhythmias in liver diseases [3.].

      The study of changes in cardiac activity depending on disorders of the autonomic nervous system leading to cirrhotic cardiomyopathy is the main goal of our study.

      For the study, 146 patients aged 18 to 60 years were recruited, who were diagnosed with cirrhosis of the liver against the background of viral hepatitis, who were treated at the clinic of the Andijan State Medical Institute. Of these, 70 people had HCV, 76 had HBV, 5 of them had serological markers B and D. The control group consisted of 42 healthy people. Initially, the complaints of all patients, anamnesis and objective clinical condition were evaluated. Also, general clinical, biochemical, blood coagulation and enzyme immunoassays and instrumental studies (ECG, ECG Holter monitoring, ExoCG, Dopplerography of the liver and portal vein - UTT) were performed.

      In B and C viral cirrhosis of the liver, an increase in the short-chain peptide cholecystokinin-8 was observed due to impaired utilization in pseudonormokinetic and decompensated portal circulation types than in hyperkinetic portal circulation types (respectively 2.86±0.26 ng/ml, 2.87±0.25 ng/ml, 0.72±0.08 ng/ml P<0.01), in as a result of an increase in short-chain peptide in the blood, there is a long-term effect on the activity of the sympathetic nervous system, which leads to a violation of the control of beta-adrenoreceptors, that is, a deterioration in systolic and diastolic activity, a violation of the electrical activity of the myocardium, prolongation of the QT interval, which ultimately leads to the development of cirrhotic cardiomyopathy.