NON-ALCOHOLIC STEATOHEPATITIS IN PATIENTS WITH OBESITY: INTERCONNECTION BETWEEN BODY MASS, CHANGES OF LIPID METABOLISM AND CONCOMITANT PATHOLOGY OF BILIARY TRACT
Aim – to study the main indices of lipid blood spectrum, which changes lead to DL formation, depending of body mass index (BMI) and concomitant pathology of biliary tract in patients with NASH and obesity.
Materials and methods. There were examined 100 patients with NASH in combination with obesity and BT pathology, in which during sonographic or morphological study of bioptat of the liver were revealed the signs of hepatic steatosis. Among patients were 40 men and 60 women. The mean age of patients – (54,68±1,15) years old. The control group included 20 practically healthy persons (PHP).
BMI was determined by Quetelet formula. Depending of the degree of BMI increase all patients with NASH and obesity were divided into three groups: 1 group – with BМI 25-29,9 kg/m2 – EBM; 2 group – with BMI 30-34,9 kg/m2 – obesity of I degree; 3 group – with BMI 35-39,9 kg/m2 – obesity of ІІ degree. All examined patients had concomitant pathology from BT side. Depending on BT pathology all patients were also divided into 3 groups: NASH with chronic non-calculous cholecystitis (CNC); NASH with chronic calculous cholecystitis (CCC); NASH in patients after laparoscopic cholecystectomy (LCE) with concomitant postcholecystectomical syndrome (PCES). For characteristic of lipid exchange were determined the general cholesterol (GCS), general lipids (GL), triglycerides (TG), lipoproteins of the low density (LDL), lipoproteins of the high density (HDL). DL phenotype was determined by D.S. Fredrickson classification with modern additions.
Results. Analysis of lipid changes in patients with NASH demonstrated the reliable increase of GCS with parallel rise of TG, GL, LDL, fixed at increase of BMI relative to PHP (р<0,05, р<0,001) and to patients of other groups (р<0,05). Maximal values of GCS, TG, GL and also LDL were determined in 2 and 3 groups of observation at obesity of I and II degrees. There was registered the reliable decrease of HDL content in most patients of 3 group relative to the ones of 2 group, (р<0,01) and of 1 one.
The level of GCS, TG, GL and LDL was almost equally increased in all groups of observation of NASH: with concomitant CNC, CCC and in patients with PCES relative to PSP, (р<0,001). HDL indices were equally decreased at concomitant CNC and CCC relative to the patients with PCES background with HDL level within physiological norm (р<0,001, рF=0,009).
There are separated two main phenotypes of DL: IIa and IIb that were typical for patients with NASH and obesity with BT pathology. It was established, that IIb phenotype of dyslipidemia was most often observed in patients with BMI 30-34,9 kg/m2 and 35-39,9 kg/m2.
Discussion. There were determined the features of changes of lipid blood spectrum of in this category of patients that are manifested by variability of disorders from hypercholesterolemia and hypertriglyceridemia on the background of increase of GCS, TG, GL, LDL and decrease of HDL. The progression of lipid disorders in patients with NASH in combination with obesity and BT pathology depends on increase of BMI parameters.
The concomitant pathology from BT side partially influenced the indices of lipid blood spectrum. Thus, the low level of HDL in patients with NASH in combination with obesity and concomitant CNC and CCC can be explained by the intense inflammatory processes in BT, attended with disorder of indices of lipid profile with decrease of HDL and increase of GCS, TG, GL, LDL.
Conclusion. Progression of intensity of lipid disorders in patients with NASH in combination with obesity and BT pathology depends on increase of BMI parameters.
The concomitant BT pathology partially influences the parameters of lipid blood spectrum. HDL was equally decreased in all patients with NASH at CNC and CCC relative to patients with concomitant PCES and HDL level within physiological norm. At NASH in combination with obesity at increase of BMI the DL phenomena more often appear in patients. There are separated two main phenotypes of dyslipidemias: IIa and IIb.
Bobronnikova, L. R., Zhuravlyova, A. K. (2013). The mechanisms of progression of dyslipidemia in patients with nonalcoholic fatty liver disease. Ukrainian therapeutical journal, 2 (37), 83–88.
Stepanov, Yu. M., Filippova, A. Yu. (2013). Nonalcoholic fatty liver disease and atherogenic dyslipidemia (modern approaches to diagnosis and treatment). Kyiv: Metodicheskie rekomendatsii, 36.
Stepanov, Yu. M., Filippova, A. Yu. (2010). Dyslipidaemia pattern in patients with non-alcoholic steatosis and biliary pathology and methods of its correction. Contemporary gastroenterology, 4 (54), 46–51.
Kuryata, O. V., Grechanyk, M. M. (2014). Interrelation of blood lipid spectrum, level of systemic inflammation and mass of body in patients with coronary heart disease in combination with nonalcoholic fatty liver disease and their dynamics in terms of secondary prevention. Medical perspectives, 4 (XIX),103–111.
Drapkina, O. M., Popova, I. R. (2012). The role of obesity in the development of hypertension and non-alcoholic fatty liver disease. Consilium Medicum, 12, 72–76.
Chatrath, H., Vuppalanchi, R., Chalasani, N. (2012). Dyslipidemia in Patients with Nonalcoholic Fatty Liver Disease. Seminars in Liver Disease, 32 (01), 022–029. doi: 10.1055/s-0032-1306423
Hurjui, D. M., Nita, O., Graur, L. I., Micalache, L. (2012). Non-alcoholic fatty liver disease is associated with cardiovascular risk factors of metabolic syndrome. Rev. Med. Chir. Soc. Med. Nat. Lasi., 116 (3), 692–699.
El-Kader, S. M. A. (2015). Non-alcoholic fatty liver disease: The diagnosis and management. World Journal of Hepatology, 7 (6), 846–858. doi: 10.4254/wjh.v7.i6.846
Novakovic, T., Mekic, M., Smilic, L., Smilic, T., Ini, B., Kostic, K. et. al. (2014). Anthropometric and Biochemical Characteristics of Patients with Nonalcoholic Fatty Liver Diagnosed by Non-Invasive Diagnostic Methods. Medical Archives, 68 (1), 22–26. doi: 10.5455/medarh.2014.68.22-26
Dietrich, P., Hellerbrand, C. (2014). Non-alcoholic fatty liver disease, obesity and the metabolic syndrome. Best Practice & Research Clinical Gastroenterology, 28 (4), 637–653. doi: 10.1016/j.bpg.2014.07.008
Kälsch, J., Bechmann, L. P., Kälsch, H., Schlattjan, M., Erhard, J., Gerken, G., Canbay, A. (2011). Evaluation of Biomarkers of NAFLD in a Cohort of Morbidly Obese Patients. Journal of Nutrition and Metabolism, 2011, 1–7. doi: 10.1155/2011/369168
Ilchenko, A. A. (2011). Postcholecystectomy syndrome: a look at the problem from the perspective of the therapist. Annals of surgical Hepatology, 2 (16), 37–44.
Order of HM from Ukraine 13.06.2005 N 271. On approval of the protocols of medical care to patients with a degree in Gastroenterology.
Order of HM from Ukraine 06.08.2014 N 826. Unified clinical protocols of primary, secondary (specialized) medical care "Nonalcoholic steatohepatitis".
Toouli, J., Fried, M., Ghafoor, A. (2009). Obesity World Gastroenterology Organisation Global Guideline, 30.
Hashizume, H., Sato, K., Yamazaki, Y. (2013). A prospective study of long-term outcomes in female patients with non-alcoholic steatohepatitis using age- and body mass index-matched cohorts. Acta Med Okayama, 67, 45–53.
Müller, M. J., Lagerpusch, M., Enderle, J., Schautz, B., Heller, M., Bosy-Westphal, A. (2012). Beyond the body mass index: tracking body composition in the pathogenesis of obesity and the metabolic syndrome. Obesity Reviews, 13, 6–13. doi: 10.1111/j.1467-789x.2012.01033.x
Kamyishnikov, V. S. (2014). Clinical and laboratory diagnosis of liver diseases. 2nd edition. Moscow: MEDpress-inform.
ESC/EAS Guidelines for the management of dyslipidaemias. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherocklerosis Society (EAS) (2011). Eur. Heart J., 32, 1769–1818.
Gromov, A. I., Rybczynski, S. S. (2009). The Value of ultrasound in the diagnosis of fatty hepatosis. Clinical medicine, 8, 64–66.
Hernaez, R., Lazo, M., Bonekamp, S., Kamel, I., Brancati, F. L., Guallar, E., Clark, J. M. (2011). Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta-analysis. Hepatology, 54 (3), 1082–1090. doi: 10.1002/hep.24452
Copyright (c) 2016 Aleksandra Filippova
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the Creative Commons CC BY copyright rights and permissions for open access journals.
Authors, who are published in this journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the journal under the terms of a Creative Commons CC BY, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form in which it has been published by the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.