Стратификация сердечно-сосудистого риска у пациентов с неалкогольной жировой болезнью печени и желчнокаменной болезнью

Abstract

Aim: to increase the efficacy of patient management, to assess the risk of developing cardiovascular diseases (CVD) with the fatal outcome for 10 years in patients with comorbid cholelithiasis (C) and non-alcoholic fatty liver disease (NAFLD). Patients and Methods: 183 patients with NAFLD participated in an open comparative study. The main group (n=88) consisted of subjects with comorbid NAFLD and C, of which 53 patients have a history of cholecystectomy (CE). The comparison group consisted of patients with NAFLD only (n=95). The risk of CVD with fatal outcome in the comorbid course of NAFLD and C was assessed according to the SCORE 2019 scale for regions with an increased risk. A scale of relative total CVD risk was used for people under 40 years of age. Results: the detection rate of CHD, is positively correlated with comorbid course of NAFLD and C (25% — in the main group, and 9.47% — in the comparison group, χ2=7.83, p<0,01, rs=0,207, R<0.01), and the correlation increases among people with CE (rs=0,258, R<0,01). In the comparison group, prediabetes was significantly more commonly detected (χ2=8.24, p<0.01, r s=-0.212, p<0,01). Patients after CE had a higher level of LDL cholesterol (rs=0.228, p≤0.01). Patients with NAFLD are characterized by hyperleptinemia and leptin resistance along with insulin resistance. Patients after CE have the highest level of leptin (p<0.001). Subjects with a comorbid course of NAFLD, C and CE in the history have a significantly higher risk of CVD with the fatal outcome for 10 years (43.4%) (χ2=9.4140, p<0,01). A correlation of mean level between CE and high CVD risk was revealed (r=-0,4341, p≤0.01). Conclusion: the factors causing the comorbid course of NAFLD and C are also concerning the CVD progression. Stratification of patients by CVD risk groups and metabolic status can become an indispensable tool in the clinicians’ arsenal. KEYWORDS: cardiovascular risk, non-alcoholic fatty liver disease, cholelithiasis, cholecystectomy. FOR CITATION: Krolevets T.S., Livzan M.A., Cherkashchenko N.A. et al. Cardiac risk stratification in patients with non-alcoholic fatty liver disease and cholelithiasis. Russian Medical Inquiry. 2021;5(6):377–384 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-377-384.