Decision support system for predicting metabolic risks in patients with comorbid non-alcoholic fatty liver disease and gallstone disease after cholecystectomy
Аннотация:183 patients with non-alcoholic fatty liver disease (NAFLD) were included into the case control study. Objective. Development a medical decision support system to improve the prediction of metabolic risks in persons with comorbid NAFLD and gallstone disease (GD) after cholecystectomy. Materials and methods. The main group was represented by patients with NAFLD and GD (n = 88), of which 53 patients underwent cholecystectomy. The comparison group was represented by patients with NAFLD without GD (n = 95). A standard laboratory and instrumental examinations were performed, including elastometry to assess of the stage of liver fibrosis and assessment of the level of hormones leptin, its soluble receptor, adiponectin and insulin. Results. Patients suffering from GD and NAFLD had a symptom of dyspepsia and general weakness. High prevalence of type 2 diabetes (rs = 0.164; р ≤ 0.01) and сoronary heart disease (25.00 % versus 9.47 % in the comparison group; р ≤ 0.01), high level of LDL and GGT (rs = 0.228, р ≤ 0.01 and rs = 0.298, р ≤ 0.01) were found in patients with GD after cholecystectomy. The phenomenon of insulin and leptin resistance, high levels of adiponectin were detected in patients suffering from NAFLD and GD. Hyperleptinemia was observed in NAFLD patients with GD after cholecystectomy (H = 5.812, p ≤ 0.05, rs = 0.313, p ≤ 0.05). Cholecystectomy in patients suffering from GD and NAFLD was associated with the formation of progressive stages of liver fibrosis (rs = 0.366; р ≤ 0.01). Conclusion. We have developed a decision support system to assess of the possibility of cholecystectomy in patients with NAFLD and GD according to the level metabolic risk of cardiovascular diseases and NAFLD progression.
