The significance of hepatic transaminases and ultrasound in the diagnosis of non-alcoholic fatty liver disease
AbstractNon-alcoholic fatty liver disease is characterized by fatty liver infiltration without any another common cause of steatosis (severe alcohol, drugs, etc.). Non-alcoholic fatty liver disease is associated with metabolic risk factors, which are diabetes type 2, dyslipidemia, obesity, and in some cases, it has a genetic predisposition as a main cause. The liver biopsy remains the “gold standard” for assessing the degree of steatosis, necrosis and liver fibrosis. However, non-invasive investigations, especially biochemical markers and visualization methods remain the first-line diagnostic analyses, as well as assessment of the response to treatment. In view of this, the aim of our research was to evaluate the validity of biochemical parameters of liver function and ultrasound in the diagnosis of non-alcoholic fatty liver disease. Patients diagnosed with non-alcoholic fatty liver disease were studied in this research Every patient underwent to both an examination and treatment in the Department of Liver and Pancreatic Diseases at the Institute of Gastroenterology, NAMS of Ukraine. All patients were exposed to ultrasound visualization of the abdominal organs, standard biochemical studies (content analyses of alanine aminotransferase, aspartate aminotransferase, total bilirubin and its fractions, activity of alkaline phosphatase, gammaglutamyltranspeptidase, X-lipoproteins, total protein, albumin, fibrinogen, international normalized ratio) were performed in the blood serum . Increased echogenicity of the liver and distal decrement of ultrasound, as the main ultrasonographic symptoms of liver steatosis, were determined with high incidence in all patients with non-alcoholic fatty liver disease. A number of symptoms (heterogeneity of the echo-structure of the liver of medium and coarse-grained nature, roundness of the lower edge of the liver, inequalities in the liver contour), the frequency of which is more closely related to the severity of inflammatory, as well as fibrotic changes, were observed more often in patients with non-alcoholic steatohepatitis and cirrhosis compared with steatosis. The deterioration in the visualization of small branches of the liver veins was determined as a result of the smoothness of the vascular pattern and its depletion. Moreover, the results showed an increment of the spleen volume, along with the enlargement of the splenic vein of patients with cirrhosis. All observed changes were considered as a component of portal hypertension and were induced with fibrotic transformation of the liver. The lack of correlation of the degree of fibrosis with the content of transaminases confirms the low diagnostic significance of these indicators. Nevertheless, the moderate direct correlation of the determined ultrasonographic indexes with degree of the fibrosis in the liver indicates the possibility of using this method for screening non-alcoholic fatty liver disease.
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