[Features of the course of gallstone disease in patients with non-alcoholic fatty liver disease]

Liver fibrosis in nonalcoholic fatty liver disease: the role of adipokines and noninvasive assessment of the intestinal barrier

Objective. Intestinal permeability, adipokines, and other clinical and laboratory indicators linked to the advanced stages of fibrosis in individuals with NAFLD were measured in the study. Materials and methods. 216 patients with NAFLD (133 men (61.6%) and 83 women (38.9%), average age 53.5±13.1 years) were included in the open comparative study. A standard laboratory and instrumental examination, including elastography to assess the stage of liver fibrosis, was carried out. Additionally, serum insulin, leptin, leptin soluble receptor, adiponectin, and stool zonulin were determined. The data obtained were analyzed in groups of patients with NAFLD depending on the stage of fibrosis (0—3) using comparative and correlation methods. 104 patients with NASH were identified, and the FIB-4 index averaged 1.29±0.8. According to elastometry data, 44 patients (20.4%) had advanced stages of fibrosis (F2), 12 (5.6%) patients had F3, and 85 patients (39.4%) had F1. Also, 75 patients didn’t have liver fibrosis. Results. All patients were obese or overweight (average BMI 33.47±4.88 kg/m2) and had a higher waist volume than hip volume (ratio WV/HV 1.1). Positive correlations between the stage of fibrosis and abdominal obesity were found (rs=0.510, p≤0.01). Patients with advanced stages of fibrosis had a higher level of the HOMA-IR index (T-criterion= –1.682, p≤0.01), a lower level of insulin (T-criterion= –1.364, p≤0.01) and a lower level of adiponectin (T-criterion=0.988, p≤0.01). The level of stool zonulin was significantly higher in patients with significant fibrosis (T-criterion= –1.293, p≤0.01). Conclusions. Liver fibrosis in patients with NAFLD is associated with abdominal obesity, insulin resistance, and low adiponectin levels. The high level of stool zonulin might be associated with the formation and progression of liver fibrosis among patients with NAFLD.

[Clinical features of the comorbid course of non-alcoholic fatty liver disease and gallstone disease]

AIM

To determine the diagnostic value of clinical features of the comorbid course of non-alcoholic fatty liver disease (NAFLD) and gallstone disease (GD) to improve the effectiveness of patient management.

MATERIALS AND METHODS

183 patients with NAFLD were included into the open comparative study. The main group was represented by patients with NAFLD and GD (n=88), of which 53 patients underwent cholecystectomy (CE). The comparison group was represented by patients with NAFLD without GD (n=95). A standard laboratory and instrumental examinations were performed, including elastometry to assess of the stage of liver fibrosis.

RESULTS

There were more women in the main group (2=8.48; p0.01). There were positive correlations between the age of patients and the duration of NAFLD with the presence of GD and CE (rs=0.135; p0.01 and rs=0.168; p0.01 respectively). Patients of the main group had the general weakness and fatigue (2=11.33, rs=0.234; p0.01 and 2=15.68, rs=0.281; p0.01 respectively), as well as a bitter taste in the mouth (2=11.66; p0.01; rs=0.147; p0.01). Coronary heart disease was diagnosed more often among people suffering from NAFLD and GD (25% vs 9.47% in patients of the comparison group, p0.01). Both of NAFLD and GD were associated with the development of type 2 diabetes (rs=0.164; p0.01). Individuals suffering from GD after CE had higher LDL and GGT values (rs=0.228; p0.01 and rs=0.298; p0.01 respectively). The number of people with advanced fibrosis were significantly higher (26.31%) in the GD group, especially among people after CE (30.18%). The stage of liver fibrosis had a positive significant relationship with CE (rs=0.366; p0.01).

CONCLUSION

Patients suffering from GD and NAFLD had a symptom of dyspepsia and general weakness. High prevalence of type 2 diabetes and сoronary heart disease, high level of LDL and GGT were found in patients with GD and after CE. CE in patients suffering from GD and NAFLD was associated with the formation of progressive stages of liver fibrosis.