Metabolic preconditions for the formation and progression of steatohepatitis of alcoholic, mixed, non-alcoholic aetiology and their comorbidity with obesity and anaemic conditions

Abstract

Background. The urgency of the problem of comorbidity of alcoholic steatohepatitis (ASH) and non-alcoholic steatohepatitis (NASH) with anaemic conditions and the need for their differentiated correction is determined by the significant frequency of these diseases in the world and Ukraine and the presence of the syndrome of the mutual burden. Anaemia is a marker for the progression of steatohepatitis to liver cirrhosis, in which anaemic conditions is often a manifestation of hypersplenism with the increased destruction of red blood cells in the spleen, as well as frequent complications of liver cirrhosis caused by posthemorrhagic anaemia, which occurs due to bleedings from the oesophageal and gastric varices, portal hypertension and decreased biosynthesis of coagulation factors by the liver. The purpose of the study was to find out metabolic prerequisites for the formation and progression of steatohepatitis of alcoholic, mixed and non-alcoholic aetiology and comorbid anaemic conditions. Materials and methods. One hundred and twenty-five patients with steatohepatitis of alcoholic, non-alcoholic and mixed aetiology were examined for comorbidities of anaemic conditions with lipid metabolism and glycemic regulation disorders. Results. The results of investigations demonstrate hyperlipidemia (by 1.35–1.5 times) in patients with steatohepatitis of mixed aetiology and ASH, although in anaemic conditions, the content of blood total cholesterol and low-density lipoprotein (LDL) cholesterol decreased (p < 0.05). Increased blood levels of triglycerides (in the range of 1.6–2.2 times) and decreased blood levels of high-density lipoprotein cholesterol (by 1.45–1.55 times) in all groups of patients with steatohepatitis and comorbidity with anaemic conditions deepened (p < 0.05). In NASH with anaemic conditions, there is an increase in the blood LDL cholesterol and total cholesterol levels, with the rise of the atherogenic index by 2.8 times (p < 0.05). Рatients with NASH and obesity have high values of glucose, insulin and degree of insulin resistance (by 2.6 times, p < 0.05), and with anaemic conditions, insulinemia and degree of insulin resistance are increased (by 2.9 and 3.0 times, respectively; p < 0.05). In patients with ASH and steatohepatitis of mixed aetiology associated with alcohol consumption, insulin deficiency is formed (by 1.4 and 1.2 times, p < 0.05), which develops in addition to anaemic conditions (blood insulin content is below the lower values by 1.8 and 1.6 times). Conclusions. The consequence of metabolic pathology (hyperlipidemia, hyperglycemia, insulin resistance), which developed under the comorbidity of steatohepatitis with anaemic conditions, was an increase in the degree of hepatocyte steatosis (p < 0.05).