Markers of liver damage in comorbidity of nonalcoholic liver disease and hypertension
Date
2020
Authors
Babak, Oleg
Prosolenko, Kostyantyn
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Objective: to study the features of liver damage and to study the
main factors of influence on this process with comorbidity between non-alcoholic
fatty liver disease and essential hypertension or renoparenchymal arterial
hypertension.
Materials and methods. The object of the study was 269 patients, included
in three groups: group 1 - patients with non-alcoholic fatty liver disease (60 patients),
group 2 - patients with comorbidity of non-alcoholic fatty liver disease and essential
hypertension (121 patients), group 3 - patients with comorbidity of non-alcoholic
fatty liver disease and renoparenchymal arterial hypertension (88 patients). The
control group consisted of 20 healthy individuals of the same age and gender
categories. Clinical examination of patients included an assessment of the parameters
of an objective examination: in particular, anthropometric data and blood pressure
according to standard methods. We studied both laboratory and instrumental markers
of liver damage. To diagnose the condition of the liver and blood vessels in all
patients, an ultrasound method was used. Some patients (212 people) underwent the
Fibromax test. To assess the severity of insulin resistance, the HOMA index was
calculated. Glomerular filtration rate was determined by the formula CKD-EPI. The
level of cytokeratin-18 in blood plasma was determined by ELISA.
Results and its discussion. A highly significant difference was found for
most indicators between the groups of patients and the control group. The greatest
difference was found in levels of transaminases (ALT and AST), gamma-glutamyl
transpeptidase, as well as cytokeratin-18 (p <0.001). The most pronounced increase
in transaminases was observed in patients of group 3. The levels of gammaglutamyltranspeptidase in patients of all three groups significantly exceeded the
corresponding parameters of the control group, were the highest in group 3 - 68.10 ±
33.31 U/l. Moreover, this the indicator did not significantly differ between groups 2
and 3 (p> 0.05). Cytokeratin-18 was significantly increased in patients with nonalcoholic fatty liver disease, and was significantly different between all groups.
Fewer patients with no hepatic fibrosis were recorded in group 1. We found
significant correlation between the duration of non-alcoholic fatty liver disease and
all markers of liver damage in group 1. Also, markers of liver damage positively
correlated with body mass index, which indicates an important role obesity in the
pathogenesis of non-alcoholic fatty liver disease. Given the correlations with the
indicators of adiponectin, malondialdehyde, tumor necrosis factor-alpha, HOMA, we
can state the important role of inflammation, oxidative stress, insulin resistance in the
pathogenesis and development of non-alcoholic fatty liver disease. A strong negative
correlation between cytokeratin-18 and glomerular filtration rate of - 0.402 (p
<0.001) was also found. Important in our opinion were the positive relationships
between indicators of hepatic damage and blood pressure in groups 2 and 3, which
may indicate a relationship within comorbidity. In general, the largest number of
strong correlation bonds were found for cytokeratin-18, and the smallest for gammaglutamyltranspeptidase. The profile of the correlation between the main indicators did
not differ much from group 2. Using ANOVA dispersion analysis, we found a close
relationship between the degree of liver steatosis and the main markers of liver
damage ALT, AST, GGT, cytokeratin-18, fibrotest, and actitest. The highest Fisher
coefficient was recorded for cytokeratin-18 - F = 118.58 (p <0.001), actitest - F =
102.18 (p <0.001), fibrotest - F = 95.03 (p <0.001), gamma-glutamyltranspeptidase -
F = 26.6 (p <0.001). Such data indicate a close relationship between the processes of
fat accumulation, inflammation, and apoptosis in the liver with non-alcoholic fatty
liver disease in the presence or absence of comorbidity with essential hypertension or
renoparenchymal arterial hypertension.
Conclusions. For patients with non-alcoholic fatty liver disease, in the
presence of its comorbidity with essential hypertension or renoparenchymal arterial
hypertension, a more pronounced increase in gamma-glutamyl transpeptidase,
cytokeratin-18 and actitest was characteristic, which may indicate the presence of
more active processes of inflammation and hepatic apoptosis. A negative effect of
comorbidity with essential hypertension or renoparenchymal arterial hypertension on
liver fibrosis was also found. Markers of liver damage are associated with the
duration of non-alcoholic fatty liver disease activity, body mass index, adiponectin,
markers of inflammation and oxidative stress, kidney function. The degree and list of
correlation relationships differ with non-alcoholic fatty liver disease depending on the
presence or absence of comorbidity with essential hypertension or renoparenchymal
arterial hypertension. Severe liver steatosis strongly affects the processes of hepatic
inflammation, fibrosis and apoptosis with the comorbidity of non-alcoholic fatty liver
disease with essential hypertension or renoparenchymal arterial hypertension.
Description
Keywords
liver lesions, cytokeratin-18, non-alcoholic fatty liver disease, hypertension
Citation
Babak O. Y. Markers of liver damage in comorbidity of nonalcoholic liver disease and hypertension / O. Y. Babak, K. O. Prosolenko // East European Science Journal. – 2020. – Vol.52 , № 12.– P. 39–45.