Clinical features of non-alcoholic steatohepatitis in patients with different glycemic status

Abstract

Introduction. NAFLD is an urgent health problem, its prevalence reaches 45%. NAFLD increases the risk of cardiovascular diseases by 3 times, the risk of death from them by 2 times and increases the risk of developing diabetes by 5 times. NAS occupies up to 20% of the structure of NAFLD and has a high potential for progression, and the violation of endogenous glycemic regulation and the development of DM2 accelerates the rate of disease progression.The goal was to determine the frequency of development of prediabetes (PD) and type 2 diabetes mellitus (T2DM) in NASH patients and the effect of impaired glycemic status on the clinical features of NASH.Materials and methods: 211 NASH patients were examined: 148 (70.1%) men, 63 (29.9%) women, 48.3 ± 10.2 years old. The diagnosis was established on the basis of clinical, laboratory, ultrasound and histological data. By enzyme immunoassay were determined: TNF-α, cytokeratin-18 fragments (CKF-18), insulin; were calculated HOMA-IR and NAFLD fibrosis score (NAFLD FS).Results and discussion. PD was detected in 39 (18.5%) patients, T2DM - in 33 (15.6%) patients. In PD patients, in contrast to patients with normoglycemia, the following indicators were significantly higher: waist circumference (WC), body mass index (BMI), cholesterol levels (Ch), LDL, ESR, TNF-α, NAFLD FS and lower albumin and platelet levels. In patients with T2DM, in contrast to those with normoglycemia, the following indicators were significantly higher: WC, BMI, alanine aminotransferase, alkaline phosphatase (APh), Ch, ESR, CKF-18 and NAFLD FS. In T2DM patients in contrast to those with PD, the following indicators were significantly higher: aminotransferases, APh and lower albumin level.Conclusions. Prediabetes and T2DM were detected with almost the same frequency among patients with NASH – in 18.5% and 15.6%, respectively. Disturbance of glycemic status was associated with a significance increase in waist circumference, markers of inflammation, dyslipidemia, fibrosis, hepatocytic necrosis, apoptosis, intrahepatic cholestasis and a decrease in albumin level.