Correlation of immunological and biochemical indicators in patients with chronic diffuse liver diseases depending on the etiological factors of steatosis and liver fibrosis

摘要

Background. The purpose was to determine the relationship of immunity indicators with the main biochemical parameters in patients with chronic diffuse liver diseases, depending on the etiological factors of steatosis and liver fibrosis. Materials and methods. We examined 120 patients with chronic diffuse liver diseases. They were divided according to the etiological factor of steatosis and liver fibrosis: group I — 24 patients with non-alcoholic fatty liver disease (NAFLD), group ІІ — 37 persons with non-alcoholic steatohepatitis (NASH); group III — 21 people with chronic viral hepatitis associated with C virus; group IV consisted of 18 patients with alcoholic liver disease (ALD), group V — 20 individuals with toxic drug-induced hepatitis (TDIH). To characterize the metabolism of lipids in serum, total cholesterol, low-density lipoproteins were determined. Serum lipids were evaluated by determi­ning the content of triacylglycerols (TG), high-density lipoproteins (HDL), atherogenic index (AI) was calculated. The processes of fibrosis were assessed by the content of hydroxyproline free (HPf) and hydroxyproline protein-bound, hexosamine and hyaluronic acid. The presence of endogenous intoxication was determined by the content of medium molecular peptides (MMP). The content of cellular immunity parameters, the level of circulating immune complexes (CIC), interleukins (IL) 6, 10, tumor necrosis factor α (TNF-α), insulin and HOMA-IR were determined. A correlation analysis was made of biochemical and immunological parameters in the examined patients. Results. The data obtained in patients with chronic diffuse liver disease show active inflammatory processes. This is indicated by increased levels of pro-inflammatory cytokines (IL-6 and TNF-α), MMP. IL-6 overproduction is accompanied by a decrease in total phospholipids (PL) in the blood serum of patients with NAFLD, NASH and TDIH — an average correlation was found between IL-6 and PL (r = –0.44, p < 0.05; r = –0.45, p < 0.01; r = –0.44, p < 0.05, respectively). In patients with NASH, an increase in CIC level is accompanied by impaired lipid metabolism, namely, an increase in serum AI — CIC/AI (r = +0.39, p < 0.05) and a decrease in the anti-atherogenic fraction of CIC/HDL (r = –0.36, p < 0.05), as evidenced by the established average correlation. It was shown that an increase in the level of TNF-α in parallel is associated with phenomenon of endotoxemia in patients with NAFLD, as evidenced by the average correlation between TNF-α and MMP (r = +0.54, p < 0.05). An increase in T-cytotoxic lymphocytes was accompanied by a decrease in serum HDL and TG, as evidenced by an average correlation: between CD8+ lymphocytes and HDL (r = –0.53, p < 0.05) and TG (r = –0.53, p < 0.05), respectively, in patients with ALD. In addition, in this group of patients, there was no activation of IL-10 production in response to inflammation, which was associated with a decrease in the degradation of mature insoluble collagens, as indicated by the average correlation between IL-10 and HPf (r = –0.64, p < 0.01). Conclusions. The data obtained indicate the relationship between immunological and biochemical para­meters in patients with chronic diffuse liver diseases depending on the etiological factors of steatosis and liver fibrosis.