Correlation of inflammation parameters and biochemical markers of cholestasis with the intensity of lipid peroxidation in patients with choledocholithiasis
Authors: Damnjanovic Zoran , Jovanovic Milan , Nagorni Aleksandar , Radojkovic Milan , Sokolovic Dusan , Damnjanovic Goran , Djindjic Boris , Smiljkovic Igor , Kamenov Aleksandar , Damnjanovic Ivana 
Published: February 2013

Background/Aim. During choledocholitiasis inflammatory oxidant stress
involves the promotion of mitochondrial dysfunction through an intracellular
oxidant stress in hepatocytes leading mainly to necrosis and less to
apoptosis. The product of oxidative stress, malondialdehyde (MDA), is
extremely cytotoxic and damages cell membranes and intracellular
macromolecules. The toxicity of MDA is based on its ability to act as a
mutagenic agent in a cell. Therefore, the aim of this prospective study was
to establish correlation of the parameters of inflammation and biochemical
markers of cholestasis with the intensity of oxidative stress in pathogenesis
of liver function disorders. Methods. Seventy adult subjects of either sex
included in the study were devided into two groups: I - 40 patients with
obstructive icterus caused by choledocholithiasis, and II - 30 healthy
individuals. All the participants were subjected to a clinical, laboratory
and ultrasonic check-up at the Internal Department of the Military Hospital
in Nis. The parameters of oxidative stress: MDA, a measure of lipid
peroxidation, and inflammation parameters: C-reactive protein (CRP),
fibrinogen, albumins, number of leukocytes (Leu), granulocytes ( Gr),
lymphocytes (Ly) and monocytes (Mo) and biochemical markers of cholestasis:
activity of ?-glutamyltransferase (?-GT) and alkaline phosphatase (AP)
enzymes, the level of total, direct and indirect bilirubin were determined by
standard biochemical methods. Results. Lower values of albumin (p < 0.001),
and significantly higher values of fibrinogen (p < 0.05) and CRP (p < 0.001)
were found in the blood of the patients with cholestasis due to
choledocholithiasis in relation to the controls. Significantly higher values
of Leu (p < 0.01) and Gr (p < 0.001) with decreasing number of Ly (p < 0.001)
and Mo (p < 0.001) were found in blood of the patients with cholestasis due
to choledocholithiasis in relation to the control. Similarly, higher values
of ?-GT, and AP (p < 0.001), as well as the level of total, direct and
indirect bilirubin (p < 0.001) were found in blood of the patients with
cholestasis due to choledocholithiasis in relation to the controls. The
concentration of MDA (p < 0.001) was increased in the patients with
choledocholithiasis in relation to the controls. There was a significant
positive linear correlation of the number of leukocytes (r = 0.51, p < 0.05)
and the concentration of total (r = 0.87, p < 0.01), direct (r = 0.85, p <
0.01) and indirect (r = 0.88, p < 0.01) bilirubin with the concentration of
MDA in the group of patients with choledocholithiasis. Conclusion.
Neutrophils and the levels of total, direct and indirect bilirubin have a
significant positive linear correlation with the level of lipid peroxidation
in patients with choledocholithiasis. Neutrophilia and hiperbilirubinemia
observed in this way represent important parameters in estimating the level
of liver tissue damage in choledocholithiasis.