DOI: https://doi.org/10.26641/2307-0404.2016.1.63478

Clinical characteristics of patients with hepatic steatosis and non-alcoholic steatohepatitis combined with obesity and disorders of the biliary tract, depending on the body mass index.

A. Yu. Filippova

Abstract


Nonalcoholic fatty liver disease is now considered as a part of comorbidity pathology. About third part of general population suffers from hepatic steatosis and non-alcoholic steatohepatitis (NASH), which is a serious problem of the XXI century, considering the growth of prevalence of obesity, which leads to fat accumulation in the liver. The aim of our study was to investigate the clinical and functional manifestations of hepatic steatosis and NASH in patients with obesity and disorders of the biliary tract (BT), depending on the body mass index. The study involved 200 patients with nonalcoholic fatty liver disease (NAFLD) (100 patients with hepatic steatosis and 100 NASH) in combination with obesity and BT disorders. Middle age of those examined was 42,1±2,02 years (range from 24 to 73 years). The control group consisted of 30 healthy persons. Each group was divided into subgroups according to body mass index (BMI): overweight (BMI 25-29.9 kg/m2), first degree of obesity (BMI 30-34,9 kg/m2), second degree of obesity (BMI 35-39,9 kg/m2). We evaluated the main clinical and biochemical syndromes (pain, dyspeptic, asthenia, cholestatic, cytolytic, mesenchymal-inflammatory, liver-cell deficiency). It is found, that the most reliable clinical and functional parameters were observed already at the first stage of NAFLD, at the stage of steatosis with fat deposition in the liver. It indicates that the majority of clinical parameters could be considered as early markers of hepatic steatosis formation and its further progression up to the level of steatohepatitis in patients with NAFLD in combination with obesity and BT disorders. Thus, in patients with NAFLD in combination with obesity and BT pathology an active clinical picture of the disease was observed, the severity of which was increasing together with BMI increasing.


Keywords


steatosis; non-alcoholic steatohepatitis; obesity; body mass index; biliary tract; clinical findings; diagnostics

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References


Kamyishnikov VS. [Clinical and laboratory diag-nosis of liver diseases] Moscow: MEDpress-inform 2-e izd; 2014. Russian. 2. [Order of HM of Ukraine from 13.06.2005 N 271. On approval of the protocols of medical care to patients in specialty Gastroenterology]. Kiev; 2005. Ukrainian. 3. [Protocols of care for patients with obesity (Ap-proved by the Academic Council Ukrainian Research Center of Endocrine Surgery, Transplantation of endo-crine organs and tissues HM of Ukraine from 5.09.2011, Protocols N 124]. Ukrainian. 4. [Order of HM of Ukraine from 06.08.2014 N 826. Unified clinical protocols of primary, secondary (spe-cialized) medical care "Nonalcoholic steatohepatitis"]. Kiev; 2014. Ukrainian. 5. Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol. 2010;53(2):372-84. 6. Rasenack J. Diagnosis and therapy of chronic liver and biliary diseases. Universitätsklinikum Freiburg (Germany). Publisher dr.Falk pharma GmbH. 2013;1-56. 7. Lee J, Hong SW, Chae SW. Exendin-4 improves steatohepatitis by increasing Sirt1 expression in highfat diet-induced obese C57BL/6J mice. PloS One. 2012;7(2):63-72. 8. Filippova Aleksandra. Non-alcoholic and alcoholic fatty liver disease in patients suffering from biliary tract pathology and obesity: clinical and functional aspects. Modern Science Moderni Vĕda. 2015;4:134-49. 9. Bedogni G, Miglioli L, Masutti F, Castiglione A. Incidence and natural course of fatty liver in the general population: The Dionysos Study. Hepatology. 2007;46:1387-91. 10. Toouli James, Fried Michael, Ghafoor Khan Aamir. Obesity World Gastroenterology Organisation Global Guideline. 2009:1-30. Available from: http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/22_obesity.pdf 11. Promrat K, Kleiner DE, Niemeier HM, Jackvony E. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51:121-29.


GOST Style Citations


1. Камышников В.С. Клинико-лабораторная ди-агностика заболеваний печени / В.С. Камышников. – 2-е изд. – Москва: МЕДпресс-информ, 2014. – 96с. 2. Про затвердження протоколів надання медич-ної допомоги хворим за спеціальністю Гастроенте-рологія: Наказ МОЗ України від 13.06.2005 № 271. – Київ, 2005. 3. Протокол надання медичної допомоги хворим на ожиріння (Затверджено Вченою радою Ук¬раїнсь-кого науково-практичного центру ендокринної хі-рургії, трансплантації ендокринних органів і тканин МОЗ України від 5.09.2011р., протокол № 124). 4. Уніфікований клінічний протокол первинної, вторинної (спеціалізованої) медичної допомоги «Не-алкогольний стеатогепатит»: Наказ МОЗ України від 06.08.2014 № 826. – Київ. 2014. 5. A position statement on NAFLD/NASH based on the EASL 2009 special conference / V. Ratziu, S. Bel-lentani, H. Cortez-Pinto, C. Day [et al.] // J. Hepatol. – 2010. – Vol. 53, N 2. – P. 372-384. 6. Diagnosis and therapy of chronic liver and biliary di¬seases / J. Rasenack // Universitätsklinikum Freiburg (Ger¬many), Publisher dr.Falk pharma GmbH, 2013. – Р.1-56. 7. Exendin-4 improves steatohepatitis by increasing Sirt1 expression in highfat diet-induced obese C57BL/6J mice / J. Lee, S.W. Hong, S.W. Chae [et.al.] // PloS One. – 2012. – Vol. 7, N 2. – P. 63-72. 8. Filippova A. Non-alcoholic and alcoholic fatty liver disease in patients suffering from biliary tract pathology and obesity: clinical and functional aspects / A. Fi¬lippova // Modern Science Moderni Vĕda. – 2015. – N 4. – P. 134-149. 9. Incidence and natural course of fatty liver in the general population: The Dionysos Study / G. Bedogni, L. Miglioli, F. Masutti, A. Castiglione [et.al.] // Hepa-tology. – 2007. – Vol. 46. – P. 1387-1391. 10. Obesity World Gastroenterology Organisation Global Guideline / James Toouli, Michael Fried, Aamir Ghafoor Khan // 2009. – Р. 1-30. Available from: http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/22_obesity.pdf 11. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis / K. Promrat, D.E. Kleiner, H.M. Niemeier, E. Jackvony [et al.] // He-patology. – 2010. – Vol. 51. – P. 121-129.




 

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