Dijagnostički i patogenetski značaj apolipoproteinskih poremećaja kod bolesnika sa alkoholnom masnom jetrom

Bojan I Mladenović; Vesna Brzački; Daniela Benedeto-Stojanov; Nikola Mladenović

doi:10.2298/VSP150619170M

Bojan I Mladenović Faculty of Medicine, University of Niš, Niš, Serbia
Vesna Brzački Clinic of Gastroenterology and Hepatology, Clinical Center Niš, Niš, Serbia
Daniela Benedeto-Stojanov Clinic of Gastroenterology and Hepatology, Clinical Center Niš, Niš, Serbia
Nikola Mladenović Clinic of Gastroenterology and Hepatology, Clinical Center Niš, Niš, Serbia

DOI: https://doi.org/10.2298/VSP150619170M

Ključne reči: liver disease, alcoholic||, ||jetra, bolesti izazvane alkoholom, non-alcoholic fatty liver disease||, masna, infiltracija, nealkoholna, risk factors||, ||faktori rizika, apolipoproteins a||, ||apolipoproteini a, apolipoproteins b||, ||apolipoproteini b, lipids||, ||lipidi, diagnosis||, ||dijagnoza, alcohol drinking||, ||alkohol, pijenje,

Sažetak

Uvod/Cilj. Alkohol je najčešći uzrok masne jetre. Metabolizam alkohola odvija se u jetri posredstvom alkoholne dehidrogenaze do toksičnog acetaldehida sa posledičnom akumulacijom masnih kiselina u jetri. Svakodnevnim unosom količina većih od 80 g/dan za muškarce, odnosno 20 g za žene, postoji rizik od razvoja alkoholne masne jetre. Cilj rada bio je da se utvrdi profil aterogenih faktora u plazmi bolesnika sa alkoholnom masnom jetrom (AFLD) u odnosu na bolesnike sa nealkoholnom masnom jetrom (NAFLD) i odredi njegov dijagnostički značaj. Metode. Studijom je bilo obuhvaćeno 74 bolesnika sa AFLD koji su konzumirali razno alkoholno piće u dnevnoj količini 80 g i više [za muškarce 3–4 jedinice (U) alkhola dnevno, a za žene 2–3 U]; kontrolnu grupu činilo je 70 bolesnika sa ultrazvučno potvrđenom NAFLD. Praćeni su ukupni holesterol (TC), trigliceridi (TG), lipoproteini velike gustine (HDL-C), lipoproteini male gustine (LDL-C) i apolipoproteini (ApoA1 i ApoB) i izračunavan je odnos TC/HDL-C, ApoB/ApoA1 i LDL-C/HDL-C. Rezultati. Studijom su bile obuhvaćene: grupe: I – 74 bolesnika (21% žena i 79% muškaraca) sa AFLD, prosečne starosti 42,65 ± 9,73 godina, koji su svakodnevno konzumirali alkoholne napitke u količini većoj od 80 g, tokom prosečno 2,31 ± 0,96 godina, i grupa II – 70 bolesnika sa NAFLD (37% žena i 63% muškaraca) prosečne starosti 41,3 ± 4,1 godina. Nije registrovana značajnija razlika u starosti i polu između ispitivanih grupa. Registrovane su značajno više vrednosti TG 9,94 ± 2,94 mmol/L, TC 14,53 ± 2,81 mmol/L, LDL-C 8,57 ± 2,15 mmol/L i Apo B 3,97 ± 0.28 g/L a niže vrednosti HDL-C 0,43 ± 0,11 mmol/L, Apo A1 0,49 ± 0,09 g/L i odnosa ApoB/ApoA1 2,43 ± 1,27, u grupi AFLD u odnosu na grupu NAFLD, (TG 8,74 ± 2,54 mmol/L, TC 9,87 ± 2,36 mmol/L, LDL-C 6,72 ± 1,98 mmol/L, Apo B 2,38 ± 0,16 g/L, HDL-C 0,78 ± 0,09 mmol/L, Apo A1 0,98 ± 0.04 g/L i ApoB/ApoA1 7,81 ± 1,42). Nije nađena značajna razlika u koncentraciji albumina, vrednostima international normalized ratio (INR), hemoglobina i hemotokrita između grupa. Zaključak. Vrednosti lipidnih frakcija i odnosa ApoB/ApoA1 uz markere hepatocelularnog oštećenja, mogu poslužiti kao dijagnostički kriterijum prisustva AFLD i biti dobar pokazatelj aterogenog rizika.

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