CORRELATION OF APOPTOSIS MARKERS LEVELS WITH THE DEVELOPMENT OF HEPATIC FAILURE IN MALIGNANT OBSTRUCTIVE JAUNDICE.

Obstructive jaundice (OJ) is a common diagnosis in everyday clinical practice, which requires a thorough understanding of pathophysiological changes occurring in the liver to plan ongoing treatment and predict its effectiveness in the postoperative period. The study aimed to determine the dynamics of changes in the levels of apoptosis markers (caspase-3 and BCL-2) at the time of preoperative biliary decompression (PBD) and major surgery depending on the severity of the hepatic failure (HF) and to evaluate their correlation with the severity grade of HF in patients with malignant obstructive jaundice (MOJ).

Materials and methods: The study included 104 patients with MOJ who underwent PBD. All patients were diagnosed with HF of moderate severity (n = 65) or severe HF (n = 39). During PBD and main surgical intervention, the levels of caspase-3 and BCL-2 were determined in blood serum and bile by the Sandwich-ELISA method.

Results: The values of apoptosis markers in patients with moderate and severe HF were significantly different at the time of PBD and major surgery (p < 0.001). PBD significantly reduced the levels of caspase-3 and increased the levels of BCL-2 in sera of patients with MOJ and HF, which was confirmed by further intraoperative values of the indicators, p < 0.001. Imbalance of serum caspase-3 (R2 Nagelkerke = 0.553, p = 0.013) and BCL-2 (R2 Nagelkerke = 0.327, p = 0.003) levels was associated with severe HF.

Conclusions: The indicators of apoptosis after PBD can serve as additional markers of the effectiveness of a patient's treatment in the preoperative period and can be included in the diagnostic and therapeutic algorithm for patients with MOJ.