The Mutual Influence of the State of the Lipid Spectrum of Blood and Content of Adipokines on the Clinical Course of Non-Alcoholic Fatty Liver Disease in the Presence of Comorbid Chronic Kidney Disease
Authors:   Higher State Educational Establishment of Ukraine Bukovinian State Medical University. 2, Theatralna Sq., Chernivtsi 58002, Ukraine, Antoniv A. A. , Khukhlina O. S. , Kotsiubiychuk Z. Ya. , Vivsyannuk V. V. , Kaniovska L. V. , Mandryk O. Ye. 
Published: June 2021

The purpose of the study was to find out the probable mutual influence of the state of the lipid spectrum of blood and content of adipokines in blood: leptin, adiponectin on the clinical course of non-alcoholic fatty liver disease against the background of obesity depending on its form and the presence of comorbid chronic kidney disease. Materials and methods. 444 patients were examined: of which 84 patients with non-alcoholic fatty liver disease with grade I obesity (group 1), which contained 2 subgroups: 32 patients with non-alcoholic hepatic steatosis and 52 patients with non-alcoholic steatohepatitis; 270 patients with non-alcoholic fatty liver disease with comorbid obesity of the I degree and chronic kidney disease of the I-III stage (group 2), including 110 patients with non-alcoholic steatosis of the liver and 160 patients with non-alcoholic steatohepatitis. The control group consisted of 90 patients with chronic kidney disease stage I-III with normal body weight (group 3). The mean age of patients was (45.8±3.81) years. Results and discussion. The study showed that patients with non-alcoholic steatohepatitis and obesity without concomitant chronic kidney disease are characterized by the following changes in the blood lipid spectrum: maximum increase in blood triacylglycerols (by 2.1 times, p <0.05), a probable increase in total cholesterol (by 1.4 times, p <0.05) and proatherogenic low-density lipoproteins (by 1.6 times, p <0.05), a probable decrease in anti-atherogenic high-density lipoproteins (by 1.6 times, p <0.05), which with the addition of comorbid chronic kidney disease are likely to deepen (within 1.5-1.8 times, p <0.05), in addition to hyper triacylglycerol. According to the results of the study, the content of leptin in the blood was significantly increased by 1.4 times (p <0.05) compared with almost healthy individuals, which differed significantly from patients with non-alcoholic steatosis of the liver with chronic kidney disease and non-alcoholic steatohepatitis with chronic kidney disease (p <0.05). The content of adiponectin in the blood was significantly reduced by 1.4 times compared with almost healthy individuals (p <0.05) and also differed significantly from patients with non-alcoholic hepatic steatosis with chronic kidney disease and non-alcoholic steatohepatitis with chronic kidney disease (p <0.05). Conclusion. Based on the results, it was found that significant metabolic prerequisites for the development of non-alcoholic steatohepatitis against the background of obesity and chronic kidney disease are probable postprandial hyperglycemia, hyperinsulinemia, increased glycosylation of hemoglobin. Hyperleptinemia and hypoadiponectinemia are also factors in the burden of non-alcoholic steatohepatitis and obesity due to the progression of mesenchymal inflammation and cytolysis of hepatocytes