DISORDERS OF HEMOSTASIS AND FIBRINOLYSIS IN PATIENTS WITH CO-MORBID NON-ALCOHOLIC FATTY LIVER DISEASE, CHRONIC KIDNEY DISEASE AND OBESITY
DOI:
https://doi.org/10.32782/health-2024.1.1Keywords:
Nonalcoholic fatty liver disease, nonalcoholic steatosis, nonalcoholic steatohepatitis, chronic kidney disease, diabetic kidney disease, obesity, diabetes, homeostasis, fibrinolysisAbstract
The aim of the work was to find out changes in the system of homeostasis and fibrinolysis during the combined course of nonalcoholic fatty liver disease (NAFLD), depending on its form and stage of chronic kidney disease (CKD) with obesity. To achieve the goal, 444 patients were examined, including 84 patients with NAFLD with obesity of the first degree (group 1), which included 2 subgroups: 32 patients with nonalcoholic steatohepatitis (NASH) and 52 patients with nonalcoholic steatohepatitis (NASH) and 270 patients with NAFLD with degree I obesity and stage I-III CKD (group 2), including 110 patients with NASH and 160 patients with NASH. The control group included 90 patients with CKD stage I–III with normal body weight. Based on the obtained results, it was established that the maximum decrease in the prothrombin time (PTT) indicator was observed in patients with NASH and CKD – 1.9 times compared to the indicator in practically healthy persons (PНР) (p<0.05) with the presence of an intergroup difference; in patients with NASH without accompanying CKD, the PTC was 1.6 times lower than the indicator in PНР (p<0.05). In patients with non-alcoholic steatosis of the liver (NASPH), less intense changes were observed: in the group without comorbidity, the PTT was 1.2 times lower than in nonalcoholic fatty liver disease (p<0.05), in patients with NASH with CKD – by 1.4 times (p<0.05).Thus, metabolic intoxication, oxidative stress, which accompany the course of NAFLD under conditions of obesity and CKD, contribute to the activation of the kallikrein-kinin system, the formation of plasmin and thrombin with subsequent disruption of the balance between them, the development of stasis, the sludge phenomenon, the formation of platelet and erythrocyte aggregates in circulatory system.
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