Визначення показників мінеральної щільності кісток у пацієнтів із фіброзними змінами паренхіми печінки

Abstract

The purpose of the study was to determine the features of the development of osteoporotic changes in bones in patients with liver fibrosis against the background of non-alcoholic steatohepatosis. Materials and methods. 79 patients with non-alcoholic steatohepatosis and liver fibrosis were examined. 38 surveyed persons were women, 41 were men. The average age of the patients was 42.5±5.8 years. All patients were excluded from comorbidities for inclusion in the study. For female patients, it was imperative to maintain menstrual function. The degree of liver fibrosis was established based on 2D shear wave elastometry in SWE mode. The patients included to study have liver fibrosis F1 - F3 according to METAVIR. Determination of bone mineral density was performed using a DEXXUM T X-ray densitometer by dual energy absorptiometry. Results and discussion. In patients with fibrotic changes in the liver, a decrease in bone mineral density was found in 49.3%. Osteopenia and osteoporosis in women occurred in 47.4%, which was significantly more frequent than among men – 26.8%, p = 0.014. There was a significant relationship between the duration of the presence of steatohepatosis and the incidence of osteoporosis and osteopenia: among patients with a duration of steatohepatosis of less than 7 years, a decrease in bone mineral density was noted in 62.5% of cases, and with a duration of more than 7 years – already in 89.3% of patients (χ2 = 5.5; p = 0.011). Among patients with liver fibrosis F3 METAVIR, a decrease in bone mineral density was observed in 85.7%. Among patients with liver fibrosis F1-2 METAVIR, osteoporosis and osteopenia were found in 46% (p = 0.0008). In patients with METAVIR F3 fibrosis, osteoporotic changes were observed in 85.2% of cases. An isolated decrease in the mineral density of the lumbar spine was diagnosed in 12 (30.7% of patients with a decrease in bone mineral density). In 9 patients (23%), there was a combination of a decrease in mineral density of the spine with a decrease in mineral density of the hip, the mean T score of the vertebrae was -2.5±0.2, the mean T score of the femoral neck was 2.1±0.3. In patients with F1-F2 fibrosis METAVIR, bone mineral density decreased mainly to the level of osteopenia, isolated osteopenia of the lumbar spine was diagnosed in 18 (46%) patients, there was no decrease in hip mineral density in this group of patients, the mean criterion of T vertebrae was 1.5±0.15. Conclusion. Patients with steatohepatosis and hepatic fibrosis are characterized by a high prevalence of osteoporosis and osteopenia. The risk of developing this complication is higher in patients with fibrosis stages F3 METAVIR; the decrease in bone mineral density in patients with steatohepatosis and liver fibrosis is influenced not only by population risk factors, but also by the duration of the presence of steatohepatosis; the severity of liver fibrosis METAVIR affects the localization of changes in the bone tissue. In patients with degrees of fibrosis F1 - F2, trabecular bone tissue is affected, and in patients with degrees of fibrosis F3, trabecular and cortical bone tissue is equally affected