THE INTENSITY OF FIBROGENESIS IN THE LIVER IN PATIENTS WITH NON-ALCOHOLIC STEATOHEPATITIS ON THE BACKGROUND OF І-ІІ DEGREE OF OBESITY AND CHRONIC KIDNEY DISEASE
DOI:
https://doi.org/10.11603/1811-2471.2018.v0.i2.8474Keywords:
nonalcoholic steatohepatitis, obesity, chronic kidney disease, liver fibrosis.Abstract
The aim of the study – to investigate the biochemical markers of liver fibrosis in patients with NASH, which developed on the background of obesity of the I-II degree and chronic kidney disease (CKD) of the І-ІІІ stage.
Material and Methods. 98 patients with NASH on the background of obesity of the I-II degree were examined, including: 52 patients with NASH against the background of obesity of I-II degree (1 group) (without comorbid CKD), 46 patients with NASH on the background of obesity of I-II degree and CKD of I-III stage (2 group). The control group consisted of 20 practically healthy persons (PHP) of the corresponding age and sex.
The determination of structural changes in liver and kidney parenchyma was carried out by ultrasonographic (USG) investigation. In order to quantify the changes of echogenicity of the liver the method of echodensitometry with the calculation of the hepatorenal index (HRI) was used. Biopsy of the liver was performed on 32 patients with NASH with comorbid CKD of I-III stage, 28 patients with NASH without CKD. Liver bioptats were obtained by percutaneous or laparoscopic sight biopsy.
The comorbid course of NASH and CKD is characterized by a higher degree of liver steatosis (HRI in 1.3 times higher compared to the group of patients with NASH, p<0.05), and the higher diagnostic threshold of the values of the HRI, which has a strong correlation with the degree of liver steatosis, determined by Steato-test (r = 0.87; p <0.001).
In patients with non-alcoholic steatohepatitis with comorbid obesity and CKD of I-III stage, fibrotic changes in the liver tissue were detected and these changes according to the biochemical index of fibrosis exceeded those in patients with NASH without comorbidity with kidney pathology. In patients with NASH, F0-F1 stages of liver fibrosis were detected, while with NASH on the background of CKH of the І-ІІІ stage, F1-F2 stages of fibrosis of the liver tissue predominated.
In patients with NASH, in the case of obesity, pericellular fibrosis (in 100 % of cases) was observed most frequently, fibrous perisinusoidal type (39.3 %) and centrolobular (35.7 %) were more rarely found, and peripheral and portal fibrosis of the liver was observed in 10.7 %. In patients with NASH on the background of obesity and CKD of I-III stage pericellular fibrosis was also observed in 100 % of cases, a significant percentage was occupied by perisinusoidal (78.1%) and perivenular (68.8 %) fibrosis of the 3rd zone, and also fibrosis of the portal and/or peripartal type with single septa (25.0 %).
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