SOME FEATURES OF THE PATHOGENESIS OF ALCOHOLIC HEPATITIS AND ALCOHOLIC CIRRHOSIS OF THE LIVER IN COMBINATION WITH ARTERIAL HYPERTENSION

Abstract

Purpose - to study the features of the combined course of chronic alcoholic hepatitis (CAH) and alcoholic liver cirrhosis (ALC) with arterial hypertension (AH) by determining the main clinical and laboratory parameters. Material and methods. 13 patients with CAH (group I), 22 patients with CAH in combination with arterial hypertension (group II), 22 patients with ADC (group III) and 40 patients with ADC in combination with arterial hypertension (group IV) were examined. Serum content of C-reactive protein, tumor necrosis factor-α (TNFα), transforming growth factor-β1 (TGFβ1 ), interleukin-10 (IL-10), 8-isoprostane, D-dimer, stable metabolites of nitric oxide (nitrites / nitrates), endothelin-1 (ET-1), intercellular adhesion molecules-1 (ICAM-1); plasma recalcification time (PRT), prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), plasma fibrinogen levels, antithrombin III (ATIII) activity, factor XIII activity, platelet aggregation. Liver function and blood lipid spectrum were also examined. Results. It was found that the manifestations of cytolysis and cholestasis syndromes were mostly more pronounced in patients with alcoholic liver disease (ALD) due to its combination with hypertension. At the same time, there was an increase in the levels of CRP, TNFα, TGFβ1 , IL-10, ceruloplasmin and 8-isoprostane. In the presence of concomitant hypertension, the content of IL-10 (in patients with CAH), CRP (in patients with ALC), as well as the content of 8-isoprostane and ceruloplasmin (in patients with CAH and AlC) probably (p <0.05) exceeded that in patients without hypertension. At the same time, in both CAH and ALC, the presence of endothelial dysfunction was established. Disorders of the endothelial functional state were accompanied by changes in the hemocoagulation of homeostasis and the blood lipid spectrum. When evaluating the quality of the LAL test, it was found that the positive test was in 97.5% of patients with ALC with hypertension compared with CAH with hypertension, where this test was positive in 68.2% of cases. When comparing groups of patients with ALC and CAH, it was found that in 77.2% of cases it was positive in group III and in 38.5% - in group I. In patients with ALC with and without hypertension, this test had the following distribution: 39 patients out of 40 had a positive test in group IV and 17 out of 22 - in group III. Conclusion. The occurrence of cytolytic, cholestatic, mesenchymal-inflammatory syndromes and hepatocellular insufficiency in patients with ALD with hypertension is associated with the direct action of ethanol on the liver, the development of systemic inflammation, oxidative stress, dyslipoproteinemia, endothelial dysfunction with hemocoagulation disorders and endotoxemia..