State of endogenous intoxication and immune-inflammatory response in patients with alcoholic liver cirrhosis associated with non-alcoholic fatty liver disease
Background. The purpose was to evaluate the state of endogenous intoxication and immune-inflammatory response in patients with alcoholic liver cirrhosis (ALC) associated with non-alcoholic fatty liver disease (NAFLD), depending on the stage of decompensation. Materials and methods. The study included 204 patients. Among them, 78 patients were diagnosed with alcoholic liver disease at the stage of liver cirrhosis (group I) and 126 patients had a combination of ALC and NAFLD (group II). General-clinical and instrumental examinations were performed. The leukocyte index of intoxication (LII), sorption capacity of erythrocytes (SCE), levels of resistin, highly sensitive C-reactive protein (hs-CRP) and tumor necrosis factor α (TNFα) in the blood were determined. Results. Patients with a combination of ALC and NAFLD had a more severe clinical picture with the development of astheno-vegetative, pain, dyspeptic, hepatorenal, hepatopulmonary syndromes, jaundice, portal hypertension, liver encephalopathy. Among severe infectious complications, pneumonia and spontaneous bacterial peritonitis were more common in persons with subcompensation and decompensation. In all patients, SCE, LII, TNFα, hs-CRP and resistin levels increased with increasing decompensation of the disease. Higher SCE, LII, TNFα, hs-CRP and resistin levels were observed in patients with ALC associated with NAFLD due to a more severe course of the pathological condition. Positive correlations were found between resistin level and TNFα, hs-CRP, SCE, and LII. Conclusions. Analyzing the results of the study, it was found that with an increase in ALC decompensation, the degree of endogenous intoxication, which is accompanied by the development of immune-inflammatory response, is increasing, as evidenced by elevated SCE, LII, TNFα, hs-CRP, and resistin levels. Significantly higher SCE, LII, TNFα, hs-CRP, and resistin levels were detected in patients with a combination of ALCs and NAFLD accompanied by a more severe course of the disease. In patients with ALC associated with NAFLD, correlation between the resistin level and SCE, LII, TNFα, hs-CRP was found.
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