Markers of Immune Inflammation in Patients with Nonalcoholic Fatty Liver Disease in Combination with Chronic Obstructive Pulmonary Disease

Abstract

The purpose of the study was to determine markers of immune inflammation in patients with nonalcoholic fatty liver disease combined with chronic obstructive pulmonary disease. Materials and methods. The observation revealed 82 patients who were treated in the pulmonology and gastroenterology department of the Andriy Novak Transcarpathian Regional Clinical Hospital during 2018-2020 with a diagnosis of nonalcoholic fatty liver disease and chronic obstructive pulmonary disease II group B and C. Among the examined there were 61.0% (50) men and 40.0% (32) women. The average age was 57.8±1.5 years old. Results and discussion. As a result of the conducted research it is established that increased levels of chronic immune inflammation markers were observed in all examined with significant increase in patients with a comorbid condition. The highest concentrations of C-reactive protein were found in patients with nonalcoholic fatty liver disease combined with chronic obstructive pulmonary disease with frequent exacerbations and hospitalization, and exceeded the normal values by 8.3 times. The levels of tumor necrosis factor-α and neopterin in patients with frequent exacerbations of chronic obstructive pulmonary disease and hospitalization were by 2.7 times and 1.9 times higher than in patients with a small number of exacerbations and by 3.2 and 3.9 times higher than in patients with nonalcoholic fatty liver disease without chronic obstructive pulmonary disease. The indexes of interleukin-6, transforming growth factor-β, the number of IgG antibodies to neutrophil elastase and the level of tissue inhibitor of matrix proteinases-1 remain consistently high in all patients with combined pathology of nonalcoholic fatty liver disease and chronic obstructive pulmonary disease regardless of the frequency of exacerbations, thus supporting inflammation even in remission. Elastase antibody levels correlate directly with the levels of the tissue metalloproteinase-1 inhibitor and increase with the degree of severety of fibrosis, which may indicate a high level of serum neutrophil elastase activity in patients with nonalcoholic fatty liver disease in combination with chronic obstructive pulmonary disease and its participation in fibrosis. Conclusion. Patients with nonalcoholic fatty liver disease in combination with chronic obstructive pulmonary disease showed an increased level of chronic systemic inflammation of low intensity based on the analysis of C-reactive protein, tumor necrosis factor-α, neopterin and interleukin-6 compared with nonalcoholic fatty liver disease without chronic obstructive pulmonary disease even in remission, which indicates an aggravating course of the disease in combination of two pathologies. Stably high concentration of IgG antibodies to neutrophil elastase may indirectly indicate the maintenance of the activity of this enzyme in the serum of patients with nonalcoholic fatty liver disease in chronic obstructive pulmonary disease and confirms its participation in liver fibrogenesis