The liver cell apoptosis in alcoholic liver disease
The purpose of the study was to determine the clinical and diagnostic role of hepatocyte apoptosis in various forms of alcoholic liver disease (ALD). Materials and methods. 98 patients with ALD were examined: 11 (11.2%) with liver steatosis (LS), 17 (17.3%) with seatohepatitis (SH), 70 (71.4%) with liver cirrhosis (LC). Among patients with LC, 13 (13.2%) had class A, 24 (24.5%) - class B, and 33 (47.1%) had class C on the Child-Pugh scale. The diagnosis of ALD was established on the basis of generally accepted criteria: anamnestic data, clinical, laboratory, instrumental (abdominal sonography, Doppler sonography of the hepatic blood flow, esophagogastroduodenoscopy). The level of fragments of cytoceratin-18 (CK-18) was determined by ELISA (test systems "TPS ELISA", "Biotech", Sweden). Statistical data processing was performed using the «StatGraphics» 2.1 software, the Mann-Whitney and Spearman methods. Results. The level of CK-18 in all forms of ALD exceeded that in the control group (60.1±18.2 U/l) and significantly differed between different forms of ALD: in SP - 98,2±17.8 U/l (p<0.05), in SH - 335.9±38.6 U/l (p<0.05), in LC - 1236.5±80.1 U/l (p<0.05). Traditional markers of hepatocellular death - aminotransferases - were: in LS - ALAT - 28.5±9.2 U/l, ACAT - 25.2±8.7 U/l; in SH - ALAT - 93,4±44,1 U/l (p<0.05), ACAT - 320.9±11.2 U/l (p<0.05); in LC - ALAT - 75.5±24.6 U/l (p>0.05), ACAT - 151.5±39.1 U/l (p>0.05). The level of CK-18 in ALD negatively correlated with indicators of synthetic liver function: with albumin (r=-0.42, p<0.05), with prothrombin (r=-0.48, p<0.05), cholesterol (r=-0.41, p<0.05) and positively with the level of bilirubin (r=0.54, p<0.05). The level of CK-18 increased according to the degree of severity of the LC: in A class of LC - 885.2±71.6 U/l, in class B - 1401.1±50.3 U/l (p<0.05), in class C - 1443.9±73.2 U/l. The content of CK-18 depended on the level of the MELD scale: in MELD<20, it was 690.7±19.8 U/l, in MELD>20-1318.8±82.3 (p<0.05). Conclusion. In all forms of alcoholic liver disease, apoptosis of hepatocytes prevailed over necrosis, reaching a maximum level in case of liver cirrhosis, correlating with the main functional liver tests and the severity of ABP.