DOI: https://doi.org/10.22141/2308-2097.53.3.2019.181469

Diagnostic significance of arterial wall stiffness in patients with chronic liver diseases

Yu.M. Stepanov, I.S. Konenko

Abstract


Background. Diagnosis of chronic diffuse liver diseases, among which the most common ones are nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis associated with hepatitis C virus, remains topical issue not only for gastroenterologists, but also for family physicians. NAFLD is closely associated with obesity or excessive body weight, insulin resistance, atherogenic dyslipidemia, and type 2 diabetes, the frequency of which now reaches the level of epidemic. Fatty liver dystrophy, both nonalcoholic and as a result of fatty degeneration under the influence of hepatitis C virus, can itself be the cause of so-called hepatic insulin resistance. In recent years, the close link between steatohepatitis and the state of arterial vessels has been demonstrated. Thus, it is shown that insulin resistance leads to atherosclerotic changes in the latter due to the development of dyslipoproteinemia. The diameter of vessels changes, elastin fragmentation and collagen deposition in the wall increase, which leads to an increase in arterial stiffness, resulting in changed elastic properties of the arteries. Obviously, the progression of fibrosis changes liver morphology and influences its internal and external blood flow. Purpose of the study: to identify the distinguishing features of local arterial wall stiffness in patients with NAFLD and hepatitis C and correlation of these indicators with liver fibrosis. Materials and methods. One hundred and ninety-five patients were examined, they were treated at the Department of the Liver and Pancreatic Diseases of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine. Patients were divided into groups depending on the causative agent: viral etiology of illness was confirmed by enzyme immunoassay in 94 persons with chronic hepatitis C, and 101 patients were diagnosed with non-alcoholic fatty liver disease on the basis of objective examination, insulin resistance, and hyperlipidemia. Sonoelastography of the liver and evaluation of local arterial wall stiffness were performed on Soneus P7 scanner (Ukraine). Results. All patients had changes in the parameters of vascular stiffness, namely, in the elasticity modulus, an increase in arterial stiffness index, pulse wave velocity and intima-media thickness (p < 0.05). An increase in pulse wave velocity was detected in 79 (78.2 %) persons (p < 0.05) with NAFLD and in 87 patients (92.5 %) with hepatitis C. The median pulse wave velocity in patients with NAFLD was higher compared to those with hepatitis C: 9.52 and 6.34 m/s, respectively. In persons with NAFLD, a correlation was established between the stiffness of the liver parenchyma and pulse wave velocity (r = 0.68; p < 0.05). In patients with hepatitis C, the association was found between the liver stiffness and intima-media thickness (r = 0.84; p < 0.001). According to the shear wave elastography, shear wave velocity was higher in patients with viral hepatitis — 1.60 (1.44–1.94) m/s vs 1.41 (1.31–1.54) m/s in NAFLD patients (p < 0.05). The median liver stiffness was higher in patients with hepatitis C — 7.77 (6.50–10.11) kPa vs 6.78 (5.49–6.90) kPa in patients with NAFLD (p < 0.05). Conclusions. Regardless of the causative agent, there is an increase in the modulus of arterial wall elasticity in chronic diffuse liver diseases. For patients with hepatitis C, along with increased stiffness of the liver parenchyma, an increase in the carotid artery wall stiffness is most characteristic. The patients with NAFLD have a decrease in distensibility of vascular walls, which naturally leads to an increase in the intima-media thickness and pulse wave velocity.


Keywords


arterial stiffness; carotid intima-media thickness; diffuse liver diseases

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