Peculiarities of hemorrhagic vasculitis coexisting with liver steatosis

Abstract

Our previous study revealed that 73.9 % of patients with adult-onset hemorrhagic vasculitis (HV) - IgA vasculitis have sonographic features of liver involvement and 61.3% of patients have gallbladder pathology, whereas liver functional tests were within normal limits. This study aimed to determine the clinical characteristics of adult-onset HV coexisting with liver steatosis (LS) as a first step of nonalcoholic non-alcoholic fatty liver disease. Methods. We retrospectively reviewed the medical records of 50 adult-onset HV patients, 20 were male and 30 female with a mean age of 46.0±2.0 years. Clinical, echocardiography, electrocardiography, abdominal sonogram and routine laboratory tests data (complete blood count, liver and renal function tests, C-reactive protein (CRP), glucose, uric acid, fibrinogen, serum protein electrophoresis) were analyzed. Patients were divided into two groups in order to evaluate the impact of LS on clinical course of adult-onset HV. In the main group with LS there were 15 male and 16 female with a mean age of 49.4±2.5 years, duration of treatment was 11.5±0.7 days). The control group without LS comprised five male and 14 female (39.0±3.0 years) with treatment duration 12.3±1.2 days. For normally distributed data, means for the two groups were compared using Student's t-test; Pearson's correlation was calculated to examine the association between two continuous variables. Results. In adult-onset HV patients with LS, inflammatory responses with elevated serum CRP level and leukocytosis have been observed. High functional activity of hepatocytes with increased acute-phase protein synthesis (CRP 2.2±0.37 vs 0.71±0.47, р<0.05), uric acid (0.35±0.02 vs 0.28±0.02 mcmol/l, р<0.05), and leakage of alanine aminotransferase (0.33±0.05 vs 0.21±0.02 mmol/g/l, р<0.05) from the mitichondrias of hepatocytes into the blood occurs following a hepatocellular injury. Adult-onset HV patients with LS had a higher frequency of gallbladder disorders (OR 3.43), and significantly larger sizes of left and right ventricles, left atrial and aortic root diameters (all р<0,05).