phases of xenobiotic biotransformation, can become a key factor of susceptibility to toxic effect of xenobiotics
and development of a pathological process in the liver [4, 5].
Recently modern approaches of personalized medicine have been developed, e.g. assessment of the gene
activity on the basis of studying the matrix RNA and drug metabolism [4]. Pharmacologic and kinetic research
of pharmaceuticals is being conducted in many countries to evaluate the modes of drug dosing, considering
individual variability of phenotypes of genetically determined biotransformation systems [5]. These studies will
help not only to select the optimum doses of pharmaceuticals but to predict possible complications of the
primary disease as well.
The aim of study was to identify some pathogenetic mechanisms and unify prediction factors for the development of
complications after portosystemic shunting.
MATERIAL AND METHODS
Ethical approval
The review board and ethics committee of RSSPMCS named after acad. V.Vakhidov approved the study
protocol and informed consents were taken from all the participants.
The results of examination of 45 patients with viral liver cirrhosis complicated by portal hypertension
(PH) have been analyzed. Morphological examination revealed large-nodule liver cirrhosis (LNLC) in over half of
them (26 patients; 57.8%); 19 patients (42.2 %) had small-nodule liver cirrhosis (SNLC). In 39 patients, cirrhotic
transformations of the liver were caused by viral hepatitis B, and in 6 patients it developed after viral hepatitis
C. At the time of examination, antibodies to HCV were found in all 6 patients, and 39 patients had positive HBs-
Ag. The patients were examined before and after central portosystemic shunting (PSS) with spleen preservation
and after selective distal splenic-renal anastomosis (DSRA). The clinical course after the surgery was severe in 3
(6.7 %) patients, rather satisfactory in 5 (11.1 %) and uneventful in 37 (82.2 %) patients.
In addition to standard tests, the examination included evaluation of the level of reopirin metabolites,
namely 4-amino-antipirin (4ААP) and N-acetyl-4-amino-antipirina (N-ac-4ААP) in urine. The latter method is
specific because 4-AAP discharged with urine is a direct product of N- demethylation performed with
microsomal monooxygenase system, while N-ac-4ААP is a product of further acetylation. The acetylating
ability of the body was assessed by the method of Prebsting-Gavrilova modified by Anilova and Tolkachevsky. It
was interpreted as slow if it did not reach 50%, and rapid when it made 50 % and more.
Before the surgery, a considerable decrease in excretion of reopirin metabolites was observed in all
patients under study. For instance, in the SNLC patients, the level of 4 ААP in daily urine specimen was 3.6
times below the controls, and the level of the same metabolites in the LNLC patients was 7.36 times lower. The
SNLC patients had 3-times lower N-ac-4ААP level, and that one in LNLC patients was 5.74 times lower. Rapid
acetylation was revealed in 7 (15.6 %) patients, while slow acetylation was found in 38 patients (84.4 %).
RESULTS AND DISCUSSION
According to our findings, slow acetylation prevailed in patients with morphological variants of liver cirrhosis.
For instance, the slow acetylation phenotype (SAcP) was found in 38 of 45 liver cirrhosis patients (84.4 %), while
7 (15.6 %) patients had the rapid acetylation phenotype (RAcP).
The comparative analysis of the basic blood biochemical parameters of patients with various types of
acetylation made before and during the postoperative period has shown that an increase in the basic
biochemical indicators of the liver did not depend on the type of acetylation. However, the values of these
indicators were different in the compared groups. For instance, if a cytolytic component manifested itself as an
increase in the levels of ALT and aspartate aminotransferase (AST) in blood of the patients before the surgery
was almost identical in both groups, the postoperative indicator in the group of patients with RAcP was a little
lower, than in the ones with SAcP.
The basic biochemical tests of blood before and after the postoperative period in patients with various
morphological forms of cirrhosis demonstrated aggravation of these indicators depending on the liver cirrhosis
form. As Figure 1 shows, a more favorable liver cirrhosis course in patients with rapid acetylation is obvious.
For instance, if the ALT level increased from 212.7±46.5 nmol\l to 383.4±127.2 nmol\l in slow acetylation (i.e. a
gain made 74.4 %), in the rapid type, the gain appeared to be considerably smaller: 29.5 % (P <0.05). After surgery
the total bilirubin level in the blood of patients with SAcP increased from 25.4±6.7 to 53.8±19.7 mcmol/l that
To cite this paper: Ibadov RA, Omonov OA, and Ibragimov SKh 2018. Acetylation Phenotype Impact on Early Postoperative Period in Viral Liver Cirrhosis. J. Life