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[Clinical and prognostic value of metabolic disorders in non-alcoholic fatty liver disease]
Y M Vakhrushev1, E V Suchkova1, А Р Lukashevich1
1Izhevsk State Medical Academy.
Aim:
A comprehensive assessment of metabolic parameters in patients with non-alcoholic fatty liver disease and based on them the development of prognostic criteria for the development of liver fibrosis.
Materials And Methods:
288 patients with non-alcoholic fatty liver disease at the stage of steatosis were examined. The patients underwent ultrasound examination of the hepatobiliary system using the SONIX OP apparatus (Canada), the FibroMax test, and liver elastography using the AIXPLORER apparatus (France). The parameters of anthropometry, lipid spectrum, protein and pigment metabolism, cytolysis, cholestasis, bilirubin, insulin in the blood serum were evaluated. The methods of statistical forecasting are used.
Results:
The clinical picture in patients with non-alcoholic fatty liver disease at the stage of steatosis was nonspecific and was due to the presence of concomitant diseases of the digestive system and the cardiovascular system. A kettle index of up to 30 was observed in 26.5% of patients, from 30 to 34.9 in 37.5%, from 35 to 39.9 in 29.7% of patients, more than 40 in 6.3% of patients. The results obtained during the biochemical analysis of blood serum indicate the presence of atherogenic dyslipidemia, an increase in the level of total protein, bilirubin, transaminases, gamma-glutamyl transpeptidase and a decrease in alkaline phosphatase in relation to the control group. Against the background of elevated glucose levels, an increase in basal insulin levels was observed (p=0.001). HOMA-IR insulin resistance was increased in patients (p=0.01). When analyzing the results of the study, the main prognostic criteria (body mass index and atherogenicity coefficient) in the diagnosis of non-alcoholic fatty liver disease in the stage of steatosis with high specificity (97.8%) and sensitivity (96.2%) were determined. In determining the risk of progression of non-alcoholic fatty liver disease into liver fibrosis, the model of prognostic criteria included insulin and triglycerides with a specificity of 93.8% and a sensitivity of 85.7%.
Conclusion:
Among many variable factors, we have identified the main prognostic criteria that are highly likely to diagnose non-alcoholic fatty liver disease at an early stage and determine the risk of progression to liver fibrosis.
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