THE INFLUENCE OF AGE ON THE DEVELOPMENT OF CARDIOMETABOLIC CHANGES IN PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE IN COMBINATION WITH SUBCLINICAL HYPOTHYROSIS

Kolesnikova E. V., Potapenko A. V., Vovk K. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

In recent years there has been an increase in the incidence of non-alcoholic fatty liver disease (NAFLD), which proceeds against the background of metabolic disorders. One of the components of metabolic disorders is subclinical hypothyroidism (SH), which can change the course of NAFLD and cause the development of cardiovascular pathology. The search for early markers that determine the risk of cardiovascular changes in patients with NAFLD in combination with SH, depending on age, remains the subject of scientific debate.Aim: to determine the features of the formation of cardiometabolic changes in patients with NADH in combination with SH depending on age. Object and methods. The study involved 74 patients with verified diagnosis of NAFLD and SH. All patients were divided into two groups depending on age> 50 years and <50 years, as well as on the level of TSH: subgroup A – from 5 to 10 mU/ml; subgroup B-TSH> mU/ml. The control group consisted of healthy males and females of the same age category. Clinical, biochemical, anthropometric, enzyme immunoassay and instrumental examination was performed for patients. Results. Analyzed the hormonal and metabolic parameters of patients with NAFLD in combination with SН younger and older than 50 years. Depending on the level of TSH (4-10 mU/ml; up to 4 mU/ml), there were significant differences in people younger than 50 years old, according to such indicators as: glucose level 5.67 ± 0.27 mmol/l vs 4.14 ± 0.23 P = 0.010; HbA1c 6.54 ± 0.25% vs 5.02 ± -0.10%, p <0.001; LDL cholesterol – 4.32 ± 0.24 mmol/l vs 3.25 ± 0.19 mmol/l p = 0.030; Hs HDL -1.0 ± 0.02 mmol/l versus 1.09 ± 0.04 mmol/l, p = 0.038. Also important was the presence of statistical differences in GGTP – 78.0 ± 3.85 U/l vs 53.33 ± 9.35 U/l, p = 0.016. In patients over the age of 50 years, significant differences in groups depending on the level of TSH had a different character with a predominance of changes in the carbohydrate profile (HbA1c=7.07±0.14% vs 4.74±0.24%, p <0.001 insulin – 18.7±1.28 mU/ml versus 15.10 ± 0.49 mU/ml, p <0.001). Changes in the indices of endothelial dysfunction and inflammation markers (circulating desquamated cells (CDEC), vascular endothelial growth factor (VEGF), C-reactive protein (CRP), tumor necrotic factor-a (TNF-a)) depended on age and the level of TSH. Significant differences were obtained in all indicators in patients with NAFLD in combination with SH over the age of 50 years: CDEC -9.88 ± 0.52 cells/100 μl vs 6.67 ± 0.33 cells/100 μl, p = 0.006; VEGF – 398.94 ± 25.74 pg /ml vs 97.08 ± 19.39 pg / ml, p = 0.001; CRP – 10.64 ± 1.02 mg/l vs 7.58 ± 1.14 mg/l, p = 0.001; TNF-a – 11.93 ± 0.92 pg/ml vs 8.6 ± 0.54 pg/ml, p = 0.001, and also in the IMT – 0.99 ± 0.02 mm vs 0.75 ± 0 , 01 mm, p <0.001, which may indicate the effect of age on the development of “vascular aging” in patients with NAFLD in combination with SH. Conclusions. In patients with NAFLD in combination with SH, disorders in carbohydrate metabolism with insulin resistance and lipid metabolism, which is proatherogenic, increase significantly with age. Comparison of cardiometabolic indices in NAFLD in combination with SH suggests that already at the age of 50 years, depending on the level of TSH, early signs are formed, providing for the development of ED and atherosclerotic vascular damage. The significant prevalence of CDEC, VEGF, inflammation markers and TKIM in the group of patients with NAFLD in combination with SH age> 50 years compared with patients <50 years, which is a manifestation of vascular aging, has been proven.

age, non-alcoholic fatty liver disease, subclinical hypothyroidism, cardiometabolic changes

1. Kolesnikova OV. Osoblyvosti farmakologichnoyi korekciyi nealkogolnoyi zhyrovoyi khvoroby pechinky u paciyentiv z vysokym kardiovaskulyarnym ryzykom. Medycyna transportu Ukrayiny. 2012;3:10-5. [in Ukrainian].
2. Kravchenko VI, Postol SV. Dynamika zakhvoryuvanosti na patologiyu shhytopodibnoyi zalozy v Ukrayini. Mezhdunarodnyiy endokrinologicheskiy zhurnal. 2011;35:26-31. [in Ukrainian].
3. Ludwig U, Holzner D, Denzer C, Greinert A, Haenle MM, Oeztuerk S, et al. Subclinical and clinical hypothyroidism and non-alcoholic fatty liver disease: a cross-sectional study of a random population sample aged 18 to 65 years. BMC Endocrine Disorders. 2015;15(1):41.
4. Koryakina LB, Pivovarov YuI, Kurilskaya TE, Sergeeva AS, Babushkina IV. Disfunktsiya sosudistogo endoteliya pri arterialnoy gipertonii i ishemicheskoy bolezni serdtsa. Byulleten VSNTs SO RAMN. 2013;2:165-70. [in Russiаn].
5.  Bhatia LS, Curzen NP, Calder PC, Byrne CD. Non-alcoholic fatty liver disease: a new and important cardiovascular risk factor? European Heart Journal. 2012;33(10):1190-200.
6.  Kolesnikova OV, Nemtsova VD. Effect of preventive measures for major metabolic parameters in patients with non-alcoholic fatty liver disease and cardiovascular risk [abstract]. In: The ESC Textbook of Preventive Cardiology. Comprehensive, practical, and the official textbook of the European Association for Cardiovascular Prevention and Rehabilitation. Oxford University press. 2015. p. 112.
7. Berg EHVD, Tienhoven-Wind LJV, Amini M, Schreuder TC, Faber KN, Blokzijl H, et al. Higher free triiodothyronine is associated with nonalcoholic fatty liver disease in euthyroid subjects: the Lifelines Cohort Study. Metabolism. 2017;67:62-71.
8. Garin MC, Arnold AM, Lee JS, Tracy RP, Cappola AR. Subclinical Hypothyroidism, Weight Change, and Body Composition in the Elderly: The Cardiovascular Health Study. The Journal of Clinical Endocrinology & Metabolism. 2014;99(4):1220-6.

«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 124-127 pages, index UDK 616-053:616.36-003.826-092:616.441-008.64

10.29254/2077-4214-2019-2-2-151-124-127