Clinical course features of non-alcoholic steatohepatitis on obesity background in comorbidity with chronic obstructive pulmonary disease

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Objective: to elucidate clinical, ultrasonographic, and biochemical features of the course of non-alcoholic steatohepatitis (NASH) for comorbidity with grade 1 obesity, chronic obstructive pulmonary disease (COPD) of 2–3 D stages compared with NASH during obesity without COPD by studying the frequency and intensity of leading clinical and biochemical syndromes of NASH, comparison of ultrasonographic (USG) characteristics of NASH depending on the presence of COPD.Material and methods. 105 NASH patients were examined: 52 NASH patients with grade 1 obesity (1 group) (there were 18 men, 24 women); 53 NASH patients with comorbid grade 1 obesity and COPD of 2–3 D stages (group 2) (there were 28 men, 13 women). In order to determine the dependence of NASH on the presence of COPD, groups of patients were randomized by the age and the degree of obesity. The average age of the patients was (55,7 ± 3,22) years. The functional condition of the liver was determined by the generally accepted lists of enzyme activity, markers of pigment and nitrogen metabolism, proteinograms, lipidograms, ionograms, calculation of de Ritis ratio, and the USG was performed. In order to quantify the changes in liver echogenicity we have used the method of echodensitometry with the calculation of the hepatorenal index.Results. The symptoms of astheno-vegetative syndrome, dyspepsia and feeling of heaviness or pain while palpating in the right hypochondrium were observed in 2,1 times, 1,7 times and 2,5 times (p<0,05) more often in patients of the 2nd group in comparison with patients of the 1st group. Clinically, in NASH patients the syndrome of cholestasis was found in 28.8%, in comparison with NASH patients and COPD (in 62,3%). In patients of the 2nd group, the frequency of splenomegaly exceeded the indicator in the 1st group, respectively, in 2.7 times (p<0.05). Among the biochemical syndromes in the examined patients of the 2nd group was found cytolytic (100,0%), cholestatic (73,6%) syndromes, which exceeded the frequency in the 1st group in 2,3 times (p<0,05), mesenchymal inflammatory, which occurred more often as compared to the 1st group — in 1.9 times (p<0,05), and hepatocellular failure (HF) syndrome (50,9%), which occurred more often in comparison with the 1st group — in 2,6 times (p<0,05).Conclusion. The clinical course of non-alcoholic steatohepatitis for comorbidity with obesity is characterized by a high frequency and intensity of clinical syndromes, the manifestation of which increases significantly with the addition of COPD 2–3 D namely: astheno-vegetative, abdominal pain, portal hypertension, splenomegaly, cholestasis, as well as the frequency and intensity of biochemical syndromes namely: mesenchymal inflammation, cholestasis, hepatocellular failure.

Comorbid COPD may intensify NASH features in obese patients; leaves open need for prospective trials before practice change.