[Pathogenetic variants of liver steatosis: diagnostic approach using serum lipid levels]

Hepatic steatosis may develop secondary to abnormalities in lipid and/or glucose metabolism. We presume that a phenotype of lipid profile may represent pathogenetic variant of steatosis. liver steatosis had been diagnosed on ultrasonography in 108 patients (27 with alcoholic liver disease, 28 with chronic HCV hepatitis and 21 with chronic HBV hepatitis; 34 patients with chronic viral hepatitis (CVH) had alcohol abuse). Serum levels of total cholesterol (TC), its fractions and triglycerides (TG) were assessed by standard tests. chi2 (chi-square) criterion was used to assess reliability of the lipid parameters deviation, alcohol-induced (AI), virus-induced (VI) and mixed pathogenetic variants of liver steatosis had been identified. TC level >200 mg/dL, LDL-cholesterol >120 mg/dL, TG >150 mg/dL, and normo- or hypoglycemia were typical, while TC level<180 mg/dL and hyperglycemia were not found in patients with AI steatosis. TC level<180 mg/dL, LDL-cholesterol<100 mg/dL and TG<150 mg/dL were typical for VI steatosis. 46,4% of patients with HCV hepatitis and 19% of patients with HBV hepatitis had TC level<140 mg/dL and LDL-cholesterol<70 mg/dL. In patients with CVH and alcohol abuse a mixed variant of liver steatosis has been diagnosed, their serum lipid levels were lower than those in patients with alcoholic liver disease, and insignificantly higher than those in patients with CVH. Conclusions. Determination of pathogenetic type of steatosis in patients with fatty infiltration of the liver is adjunctive to the diagnosis and is a screening test for patients with CVH. Serum levels of HDL-cholesterol below normal values were frequently seen in patient with III grade steatosis.