Morphofunctional Сhanges of Gallbladder and Biochemical Parametеrs of Lipid Metabolism in Children with Liver Steatosis
Background. The aim of study was to investigate peculiarities of structural and functional disorders of gallbladder in children with non-alcoholic fatty liver disease. Materials and methods. The study was conducted in 51 children aged 10–17 years. Patients were divided into four groups: the 1st group consisted of 11 children with biliary normokinesia without steatosis; the 2nd group — 20 children with biliary hypokinesia without steatosis; 3rd group — 11 children with biliary normokinesia and steatosis, and the 4th group — 9 children with biliary hypokinesia and steatosis. Anthropometric parameters were measured: height, weight, abdominal circumference, body mass index. Functional state of gallbladder was investigated with the help of ultrasound. Such biochemical parameters, as total cholesterol, triacylglycerols, levels of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and very-low-density lipoprotein cholesterol were defined, atherogenic index was calculated according to Friedewald formula. Results. Present study shows overweight (in 15 % of patients), obesity (in 85 % of patients), increase in the gallbladder volume by 30–50 % (p < 0.05), in the density of gallbladder wall by 12–16 % (p < 0.05) and its echogenicity by 24 % (p < 0.05) in children with steatosis versus group without steatosis and gallbladder normokinesia. Positive correlation between wall thickness and steatosis has been established. Thus, weight increase may potentially play a role in lipid disorders and biliary dysfunction. The 70 % of children with obesity had pathological changes of lipid levels, such as 74 % — increased blood atherogenicity. Conclusions. Physicians must necessarily correct a functional state of gallbladder during the treatment of obesity in children and adolescents. Only comprehensive approach to the treatment allows prevention of non-alcoholic fatty liver disease and its complications.
Stepanov Yu.M., Zavhorodnia N. Yu., Lukianenko O. Yu., Yagmur V.B., Skyrda I. Yu., Petishko O.P. Risk Factors for Hepatic Steatosis in Children. Gastroenterology. 2016, Issue 2, pp. 5–9.
Auen D., Norat T., Vatten L. J. Body mass index, abdominal fatness and the risk of gallbladder disease. Europian Journal of Epidemiology, 2015, issue 30, pp. 1009–1019.
Koller T., Kollerova J., Hlavaty T., Huorka M., Payer J. Cholelithiasis and markers of nonalcoholic fatty liver disease in patients with metabolic risk factors. Scandinavian Journal of Gastroenterology, 2012, issue 47, pp. 197–203.
Tsai C. J. Steatocholecystitis and fatty gallbladder disease. Digestive Diseases and Sciences, 2009, issue 54, pp. 1857–1863.
Chalasani N., Younossi Z., Lavine J.E., Diehl A.M., Brunt E.M., Cusi K., Charlton M., Sanyal A.J. The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology, 2012, issue 55, pp. 2005–2023.
Zavgorodnya N.Yu., Lukianenko O.Yu. Gallbladder Function and Hepatic Structural Changes in Children with Nonalcoholic Fatty Liver Disease. Gastroenterology, 2016, issue 2, pp. 81–94.
Schwimmer J.B., Deutsch R., Kahen T., Lavine J.E., Stanley C., Behling C. Prevalence of fatty liver in children and adolescence. Pediatric. 2006, issue 118, pp. 1388–1393.
Zavhorodnia N.Yu., Babii S.O., Klenina I.A., Skyrda I.Yu., Petishko O.P Biochemical markers of lipid metabolism disorders in children with hepatic steatosis. Zdorovie rebenka, 2015, issue 8, pp. 38–42.
Colak Y., Bozbey G., Erim T., Caklili O.T., Ulasoglu C., Senates E., Mutlu H.H., Mesci B., Doğan M.S., Tasan G., Enc F.Y., Tuncer I.. Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease [Electronic resource]. Journal of Neurogastroenterology and Motility. 2016, Mode of access.: http://www.jnmjournal.org/journal/view.html?uid=1094&vmd=Full&
Palmera P.E.S. Manuals to the ultrasound diagnostic / ed. P.S.E. Palmera – Geneve, WHO, 2000, 334p.
Goncharenko N.I., Tarasyuk B.A., Gridina T.A., Gordienko K.P., Lukyanova I.S. The gallbladder motility on children with cronic hepatitis and portal hypertension. Prenatology and pediatry, 2011, issue 1, pp. 76–79.
Unifikovany klinichnyi protocol medychnoii dopomogy ditiam iz funkcionalnymy rozladamy zhovchnogo mihura ta sfinktera Oddi [Unified clinical protocols of medical care for children with functional disorders of the gallbladder and sphincter of Oddi ]// Nakaz Ministerstva ohorony zdorov’ia Ukraiiny [The Order of the Ministry of Health of Ukraine] №59 by 29.01.2013.
Petri A., Sebin K. Naglyadnaya statistika v meditsine [Visual statistic in medicine]. Moscow, Geotar-Med, 2003. 144 p.
Day С. Р. James O. F. Steatohepatitis: a tale of two «hits»? Gastroenterology, 1998, issue 114, pp. 842–845.
Goldblatt M.I., Swartz-Basile D.A., Al-Azzawi H.H., Tran K.Q., Nakeeb A., Pitt H.A. Nonalcoholic Fatty gallbladder disease: the influence of diet in lean and obese mice. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2006, issue 10, pp. 193–201.
Chen Q., Amaral J., Biancani P., Behar J. Excess membrane cholesterol alters human gallbladder muscle contractility and membrane fluidity. Gastroenterology, 1999, issue 116, pp. 678–685.
Tuncer I., Harman M., Colak Y., Arslan I., Turkdogan M. K. Effect of ursodeoxycholic Acid alone and ursodeoxycholic Acid plus domperidone on radiolucent gallstones and gallbladder contractility in humans. [Electronic resource]. Gastroenterology Research and Practice, 2012. – Mode of access: https://www.hindawi.com/journals/grp/2012/159438/.
Mathur A., Walker J.J., Al-Azzawi H.H., Lu D., Swartz-Basile D.A., Nakeeb A., Pitt H.A. Ezetimibe ameliorates cholecystosteatosis. Surgery, 2007, issue 142, pp. 228–233.
Alexopoulos N, Katritsis D., Raggi P. Visceral adipose tissue as a source of inflammation and promoter of atherosclerosis. Atherosclerosis, 2014, issue 233, pp. 104–112.
Jung U. J., Choi M.S. Obesity and its metabolic complications: the role of adipokines and the relationship between obesity, inflammation, insulin resistance, dyslipidemia and nonalcoholic fatty liver disease. International Journal of Molecular Sciences, 2014, issue 15, pp. 6184–6223.
Makki K., Froguel P., Wolowczuk I. Adipose tissue in obesity-related inflammation and insulin resistance: cells, cytokines, and chemokines. [Electronic resource], ISRN Inflammation, 2013 – Mode of access: https://www.hindawi.com/journals/isrn/2013/139239/.
Al-Azzawi H.H., Mathur A., Lu D., Swartz-Basile D.A., Nakeeb A., Pitt H.A. Resistin-like molecule alpha reduces gallbladder optimal tension. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2007, issue 11, pp. 95–100.
Pellegrinelli V., Rouault C., Rodriguez-Cuenca S., Albert V., Edom-Vovard F., Vidal-Puig A., Clément K., Butler-Browne G.S., Lacasa D.. Human Adipocytes Induce Inflammation and Atrophy in Muscle Cells During Obesity. Diabetes, 2015, issue 64, pp. 3121–3134.
Prosolenko K.O. Modern Approaches to Treatment of Nonalcoholic Fatty Liver Disease with Metabolic Syndrome. Liky Ukrainy, 2012, issue 3, pp. 30–34.
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