NON-ALCOHOLIC STEATOHEPATITIS IN PATIENTS WITH OBESITY: INTERCONNECTION BETWEEN BODY MASS, CHANGES OF LIPID METABOLISM AND CONCOMITANT PATHOLOGY OF BILIARY TRACT

Abstract

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.