The peculiarities of liver damage markers and lipid blood spectrum in patients with nonalcoholic steatohepatitis, osteoarthritis and obesity

Abstract

Objective — to reveal the peculiarities of the course of nonalcoholic steatohepatitis (NASH) in comorbidity with osteoarthritis (OA) and obesity (OB) based on the study the blood lipid profile effects on the diseases’ course.Material and methods. The investigations involved 90 patients, who were divided into three groups: group I (n = 30) consisted of patients suffering from OA II—III stages according to Kellgren and Lawrence classification with normal body mass (BMI = 21—25 kg/m2), group II (n = 30) — patients with NASH and OB without OA (BMI > 30 kg/m2), group III (n = 30) included patients with OA with NASH and OB (BMI more than 30 kg/m2). The control group consisted of 30 healthy individuals of the corresponding age. The average age of patients was (62.3 ± 5.7) years.Results and discussion. The peculiarity of the NASH clinical course against the background of OB and OA is the highest among the comparing groups growth of the activity of AlAT and AsAT in 2.1 and 3.0 times (p < 0.05) compared with the normative ones; with a growth of the de Ritis factor in 1.45 times (p < 0.05) against its decrease in patients with comorbidity of NASH and OB in 1.21 times (p < 0.05); higher intensity of cholestasis syndrome (p < 0.05); more pronounced manifestations of protein synthesizing liver dysfunction, with a decrease in the average of blood albumin content in 1.26 times (p < 0.05). In addition, there was a tendency for a possible decrease in the total protein content in the blood in 1.18 times (p < 0.05). The presence of mesenchymal-inflammatory syndrome of higher intensity indicated: an increase in the level of globulins in 1.29 times, an increase of the thymol test in 1.46 times, as well as a decrease in the albumin-globulin coefficient in 1.62 times (p < 0.05).For patients with nonalcoholic steatohepatitis, osteoarthritis and OB, the following changes in the lipid profile of the blood are: the increase in the content of triacylglycerols in the blood (in 1.78 times, p < 0.05), the probable increase in the content of total cholesterol (1.38 times, p < 0.05) and low-density proatherogenic lipoproteins (1.7 times, p < 0.05), probable reduction of high-density anti-atherogenic lipoproteins (1.66 times, p < 0.05), which are likely to deepen with the addition of comorbid osteoarthritis (within 1.5—2.0 times, p < 0.05). For the comorbid flow of NASH and OB and OA, the maximum growth of the index of atherogeny was established (3.32 times against 2.91 times due to course of NASH with OB, p < 0.05).Conclusions. Thus, the course of NASH with OB and OA in comparison with the course without OA is characterized by a significantly higher degree of biochemical activity with increasing de Ritis coefficient, intensity of cholestasis syndrome, manifestations of dysfunction in the protein synthesis function, increased activity of mesenchymal-inflammatory syndrome, higher degree of hyperlipidemia, proatherogenic and decreased antiatherogenic fractions lipoproteins which can contribute to the progression of fibrotic changes in the liver.