Clinical features of non-alcoholic steatohepatitis in patients with different glycemic status
A. A. Shipovskaya,
I. V. Kurbatova,
P. V. Selivyorstov,
V. N. Marchenko,
V. G. Radchenko,
O. P. Dudanova https://doi.org/10.21518/2079-701X-2021-5-68-74
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.
About the Authors
A. A. Shipovskaya
Petrozavodsk State University
Russian Federation
Russian Federation
Assistant of the Department of Propaedeutics of Internal Diseases and Hygiene,
33, Lenin St., Petrozavodsk, 185910
I. V. Kurbatova
Karelian Research Centre of the Russian Academy of Sciences
Russian Federation
Russian Federation
Cand. Sci. (Biol.), Senior Research Associate in the Laboratory for Genetics, Institute of Biology,
11, Pushkinskaya St., Petrozavodsk, 185910
P. V. Selivyorstov
North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Russian Federation
Cand. Sci. (Med.), Associate Professor of the Department of Internal Diseases, Сlinical Pharmacology and Nephrology,
41, Kirochnaya St., St Petersburg, 191015
V. N. Marchenko
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, professor of the Department of Hospital Therapy with a course of Allergology and Immunology named after Acad. M.V. Chernorutsky,
6–8, Lev Tolstoy St., St Petersburg, 197022
V. G. Radchenko
Military Medical Academy named after S.M.Kirov
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor of 2nd Therapy Department of Postgraduate Education,
63, Suvorovsky Prospekt, St Petersburg, 191015
O. P. Dudanova
Petrozavodsk State University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Professor, Head Department of Propaedeutics of Internal Diseases and Hygiene,
33, Lenin St., Petrozavodsk, 185910
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Review
For citations:
Shipovskaya AA, Kurbatova IV, Selivyorstov PV, Marchenko VN, Radchenko VG, Dudanova OP. Clinical features of non-alcoholic steatohepatitis in patients with different glycemic status. Meditsinskiy sovet = Medical Council. 2021;(5):68-74. (In Russ.) https://doi.org/10.21518/2079-701X-2021-5-68-74
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