PECULIARITIES OF THE VITAMIN D DEFICIENCY AND ITS INFLUENCE ON LIPID EXCHANGE INDICATORS IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE IN COMBINATION WITH OSTEOARTHROSIS
The analysis of lipid metabolism indicators (total cholesterol (TC), triglycerides (TG), high and low density lipoproteins (HDL, LDL), alanine aminotransferase (ALT) activity, aspartate aminotransferase (AST) and vitamin D level (25 (OH) D) by enzyme immunoassay was carried out ) in 75 patients with non-alcoholic fatty liver disease (NAFLD) in combination with osteoarthritis (OA), depending on the stage of NAFLD. The patients were divided as follows: Group IA - 24 (57.1%) patients with non-alcoholic fatty hepatosis (NAFH), IIB - 18 (42.9%) patients with non-alcoholic steatohepatitis (NASH); Group II (comparison group) - 33 (44.0%) patients with OA without NAFLD. All patients showed a decrease in the level of 25 (OH) D, which is more pronounced, with a combination of NAFLC and OA, especially at the stage of steatohepatitis: insufficiency and deficiency of vitamin 25 (OH) D were found in 46 (61.33%) and 29 (38.66%) cases in both groups of patients, respectively (p <0.05). In patients of group II, the 25 (OH) D level was (26.41 ± 1.04) ng/ml, which was lower than in healthy subjects on 27.18% (p <0.05); deficiency of vitamin D was found in 21 (63.63%) cases, deficiency - in 12 (36.36%) cases. A reduced level of vitamin 25 (OH) D is combined with lipid metabolism disorders, as indicated by inverse correlations between the level of total cholesterol, triglycerides and the level of 25 (OH) D. When assessing the indicators of the lipid spectrum of the blood, a significant increase in the level of TC by 44.08% (group IA), 61.62% (group IB) and 24.88% (group II), respectively, compared with healthy persons (p <0,05). The level of TG in patients with NASH was 2.37 times higher than in healthy people (p<0.05); 2.12 times compared with patients with OA (p1<0.05) and 1.3 times compared with patients with IA group (p2<0.05). The content of low density lipoproteins (LDL) in patients of group IA was 1.8 times higher than in healthy patients; in the IB group - 2.02 times; in the second group - 1.07 times (p<0.05). In patients with IB group with NASH, the level of LDL cholesterol was 89.12% higher than in patients with OA (p1<0.05). In contrast, high density lipoproteins (HDL) were lowest in patients with NASH. Comparing this indicator with the level in healthy people, it was reduced by 35.34% (IA group) (p<0.05); by 42.24% (IB group) (p<0.05) and by 17.24% (group II) (p<0.05). In patients with NAFH and NASH, the level of HDL was reduced by 21.87% and 30.20%, respectively, compared with the level of patients with OA (p1<0.05). In NASH, this indicator tended to decrease compared with patients with NAFL (p2<0.05). We found a significant increase of AST level at 1.7; at 3.8; at 1.3 times in IA; IB and II groups, respectively, compared with healthy persons (p<0.05). In the presence of NASH, the AST level was higher than in patients with OA at 2.8 times (p1<0.05), in the presence of NAFH – at 2.2 times (p1<0.05). A similar direction of changes was found in the analysis of ALT activity, which was more pronounced in patients with NASH (p<0.05). In particular, in patients with NASH, an inverse correlation was found between the level of TC and 25 (OH) D (r = -0.7885, p = 0.0008) and an inverse correlation between the level of TG and 25 (OH) D (r = -0.6814, p = 0.0004). An inverse correlation was established between the serum level of vitamin 25 (OH) D and indicators of the functional state of the liver (AST and ALT) in patients with NAFLD in combination with OA (r = -0.7687, p = 0.0007) і (r = -0, 7882, p = 0.0006), respectively.
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