Criteria of Formation of Fatty Liver Disease in Individuals of Different Age Groups in the Long-Term Period after Minimally Invasive Cholecystectomy

Abstract

INTRODUCTION: Despite the technical advance in medicine and the use of minimally invasive laparoscopic techniques, complications of cholecystectomy considerably reduce the quality of life of the operated patients. Development of the most common and severe complication — fatty liver disease (FLD) — is difficult to predict due to numerous factors that influence its formation.

AIM: To identify prognostic criteria of formation of FLD in the long-term period after cholecystectomy and to scientifically substantiate their significance.

MATERIALS AND METHODS: To identify prognostic criteria of formation of FLD in the long-term period after minimally invasive cholecystectomy, 330 patients (159 men and 171 women) who underwent surgical treatment, were examined. Anthropometric data, hemodynamic parameters were evaluated, autonomic index was calculated. US evaluation of choledoch and Elastography of the liver, magnetic resonance tomography of the liver and magnetic resonance cholangiopancreatography were performed. Using chromatography-mass-spectrometry, microbial markers of parietal microbiome of the intestine were determined.

RESULTS: Parameters of body mass index indicate the interrelation between the formation of FLD and increased body mass in patients of older age. In the first group with FLD, sympathetic status prevailed, and in the control group of the same age, parasympathicotonia was predominating. At the older age, in the second and third subgroup, the autonomic regulation did not influence the formation of FLD. The choledoch diameter in men and women with FLD of the first age subgroup was greater relative to patients of the control group and of the preoperative period and also relative to older patients of the same group. In the long-term period after cholecystectomy in the group with fatty liver disease, the opportunistic microflora prevailed over essential one, and aerobic microflora — over anaerobic one. Besides, increased amount of fungi and viruses was noted, as well as a change in the distribution of obligate microflora due to decrease in the content of eubacteria and predomination of lactobacteria over bifidobacteria in the parietal layer of the intestine. In the individuals of older age, reduction of the obligate and increase in the opportunistic microflora including aerobic one, was noted.

CONCLUSIONS: Age, autonomic regulation and body mass have a significant influence on the formation of FLD in the long-term period after cholecystectomy. In the group of older patients, the influence of the autonomic regulation is lower, and increase in body mass is higher than in younger individuals.

Keywords

fatty liver disease / cholelithiasis / cholecystectomy / postcholecystectomy syndrome / autonomic regulation / obesity

References

[1] Vakhrushev JM, Khokhlacheva NA. Gallstone disease: epidemiology, risk factors, clinical features, prevention. The Russian Archives of Internal Medicine. 2016;6(3):30–5. (In Russ). doi: 10.20514/2226-6704-2016-6-3-30-35

[2] Вахрушев Я.М., Хохлачева Н.А. Желчнокаменная болезнь: эпидемиология, факторы риска, особенности клинического течения, профилактика // Архивъ внутренней медицины. 2016. Т. 6, № 3. С. 30–35. doi: 10.20514/2226-6704-2016-6-3-30-35

[3] Mikhin IV, Kukhtenko YuV, Doronin MB. Cholecystectomy: evolution of laparoscopic approach. Endoscopic Surgery. 2015;21(1):42–60. (In Russ). doi: 10.17116/endoskop201521142-60

[4] Михин И.В., Кухтенко Ю.В., Доронин М.Б. Холецистэктомия: эволюция лапароскопического доступа // Эндоскопическая хирургия. 2015. Т. 21, № 1. С. 42–60. doi: 10.17116/endoskop201521142-60

[5] Bueverov AО. Sphincter of Oddi dysfunction in the post-cholecystectomy period. Meditsinskiy Sovet. 2020;(15):90–5. (In Russ). doi: 10.21518/2079-701X-2020-15-90-95

[6] Буеверов А.О. Дисфункция сфинктера Одди в постхолецистэктомическом периоде // Медицинский Совет. 2020. № 15. С. 90–95. doi: 10.21518/2079-701X-2020-15-90-95

[7] Gorbunova KA, Kondakova YuV, Styazhkina SN. Postkholet-sist·ektomicheskiy sindrom. Modern Science. 2020;(11–1):151–7. (In Russ).

[8] Горбунова К.А., Кондакова Ю.В., Стяжкина С.Н. Постхолецистэктомический синдром // Modern Science. 2020. № 11-1. С. 151–157.

[9] Zhirkov II, Gordienko AV, Pavlovich IM, et al. Diagnosis of liver fibrosis: an emphasis on elastography. Experimental and Clinical Gastroenterology. 2021;(10):72–81. (In Russ). doi: 10.31146/1682-8658-ecg-194-10-72-81

[10] Жирков И.И., Гордиенко А.В., Павлович И.М., и др. Диагностика фиброза печени: акцент на эластографию // Экспериментальная и клиническая гастроэнтерология. 2021. № 10. С. 72–81. doi: 10.31146/1682-8658-ecg-194-10-72-81

[11] Mekhtiev SN, Mekhtieva OA. Cholelithiasis and non-alcohol fat hepatic disease: combination and forecast. Lechashchiy Vrach. 2017;(3):77. (In Russ).

[12] Мехтиев С.Н., Мехтиева О.А. Желчнокаменная болезнь и неалкогольная жировая болезнь печени: сочетание и прогноз // Лечащий врач. 2017. № 3. С. 77.

[13] Silina EV, Stupin VA, Orlova AS, et al. Sphincter of Oddi dysfunction after cholecystectomy (review). Spravochnik Vracha Obshchej Praktiki. 2015;(10):17–22. (In Russ).

[14] Силина Е.В., Ступин В.А., Орлова А.С., и др. Дисфункция сфинктера Одди после холецистэктомии (обзор) // Справочник врача общей практики. 2015. № 10. С. 17–22.

[15] Batskov SS. Ul’trazvukovoy metod issledovaniya v gastroenterologii. Saint-Petersburg; 1995. (In Russ).

[16] Бацков С.С. Ультразвуковой метод исследования в гастроэнтерологии. СПб.; 1995.

[17] Man’yakov AV, Radchenko VG, Seliverstov PV. Vozmozhnosti profilaktiki nealkogol’noy zhirovoy bolezni pecheni posle kholetsist·ektomii. Gastroenterologiya Sankt-Peterburga. 2017;(1):92–92b. (In Russ).

[18] Маньяков А.В., Радченко В.Г., Селиверстов П.В. Возможности профилактики неалкогольной жировой болезни печени после холецистэктомии // Гастроэнтерология Санкт-Петербурга. 2017. № 1. С. 92–92b.

[19] Mekhtiev SN, Mekhtieva OA, Ukhova MV, et al. Modern view of the importance of cholecystectomy in the prognosis of a patient with non-alcoholic fatty liver disease: follow-up algorithm and therapeutic approaches. Russian Medical Inquiry. 2021;5(6):438–45. (In Russ). doi: 10.32364/2587-6821-2021-5-6-438-445

[20] Мехтиев С.Н., Мехтиева О.А., Ухова М.В., и др. Современный взгляд на значение холецистэктомии в прогнозе пациента с неалкогольной жировой болезнью печени: алгоритм наблюдения и терапевтические подходы // РМЖ. Медицинское обозрение. 2021. Т. 5, № 6. С. 438–445. doi: 10.32364/2587-6821-2021-5-6-438-445

[21] Vinnik YuS, Serova EV, Miller SV, et al. Diagnostic aids of sphincter of Oddi dysfunction after cholecystectomy. Annaly Hirurgii. 2012;(6):5–9. (In Russ).

[22] Винник Ю.С., Серова Е.В., Миллер С.В., и др. Диагностические критерии дисфункции сфинктера Одди после холецистэктомии // Анналы хирургии. 2012. № 6. С. 5–9.

[23] Pantsyrev YuM, Shapoval'yants SG, Chernyakevich SA, et al. Postcholecystectomy functional disorders of the sphincter of Oddi after. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2011;21(3):28–34. (In Russ).

[24] Панцырев Ю.М., Шаповальянц С.Г., Чернякевич С.А., и др. Функциональные расстройства сфинктера Одди после холецистэктомии // Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2011. Т. 21, № 3. С. 28–34.

[25] Cherkashchenko NA, Livzan MA, Krolevets TS, et al. Decision support system for predicting metabolic risks in patients with comorbid non-alcoholic fatty liver disease and gallstone disease after cholecystectomy. Medical Alphabet. 2020;(30):11–7. (In Russ). doi: 10.33667/2078-5631-2020-30-11-17

[26] Черкащенко Н.А., Ливзан М.А., Кролевец Т.С., и др. Система поддержки врачебных решений по прогнозу метаболических рисков у больных с коморбидным течением неалкогольной жировой болезни печени и желчнокаменной болезни после холецистэктомии // Медицинский алфавит. 2020. № 30. С. 11–17. doi: 10.33667/2078-5631-2020-30-11-17

[27] Kleiner DE, Brunt EM, van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21. doi: 10.1002/hep.20701

[28] Kleiner D.E., Brunt E.M., van Natta M., et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease // Hepatology. 2005. Vol. 41, No. 6. P. 1313–1321. doi: 10.1002/hep.20701

[29] Permutt Z, Le T–A, Peterson MR, et al. Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease — MRI accurately quantifies hepatic steatosis in NAFLD. Aliment Pharmacol Ther. 2012;36(1):22–9. doi: 10.1111/j.1365-2036.2012.05121.x

[30] Permutt Z., Le T.–A., Peterson M.R., et al. Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease — MRI accurately quantifies hepatic steatosis in NAFLD // Alimentary Pharmacology & Therapeutics. 2012. Vol. 36, No. 1. P. 22–29. doi: 10.1111/j.1365-2036.2012.05121.x

[31] Allahverdieva YaS, Vorob’ev SV, Mineev NI. Modern opportunities of magnetic-resonance technologies in diagnostics of the fatty live. Medical News of the North Caucasus. 2018;13(4):695–701. (In Russ). doi: 10.14300/mnnc.2018.13140

[32] Аллахвердиева Я.С., Воробьев С.В., Минеев Н.И. Современные возможности магнитно-резонансных технологий в диагностике ожирения печени // Медицинский вестник Северного Кавказа. 2018. Т. 13, № 4. С. 695–700. doi: 10.14300/mnnc.2018.13140

[33] Leushina EA. Magnitno-rezonansnaya kholangiopankreatografiya pri abdominal’noy boli u patsiyentov s disfunktsiyey sfinktera Oddi. Russian Journal of Pain. 2021;19(Suppl):54. (In Russ).

[34] Леушина Е.А. Магнитно-резонансная холангиопанкреатография при абдоминальной боли у пациентов с дисфункцией сфинктера Одди // Российский журнал боли. 2021. Т. 19, Suppl. С. 54.

[35] Buyeverov AO, Roshchina KM, Bogomolov PO. Non-Alcoholic Fatty Liver Disease: a New Look at Aspects of Comorbidity. Effective Pharmacotherapy. 2022;18(6):32–8. (In Russ). doi: 10.33978/2307-3586-2022-18-6-32-38

[36] Буеверов А.О., Рощина К.М., Богомолов П.О. Неалкогольная жировая болезнь печени: новый взгляд на аспекты коморбидности // Эффективная фармакотерапия. 2022. Т. 18, № 6. P. 32–38. doi: 10.33978/2307-3586-2022-18-6-32-38

[37] Vinnitskaya YeV, Sandler YuG, Bordin DS. The New Paradigm of Non-Alcoholic Fatty Liver Disease: Phenotypic Diversity of Metabolically Associated Fatty Liver Disease. Effective Pharmacotherapy. 2020;16(24):54–63. (In Russ). doi: 10.33978/2307-3586-2020-16-24-54-63

[38] Винницкая Е.В., Сандлер Ю.Г., Бордин Д.С. Новая парадигма неалкогольной жировой болезни печени: фенотипическое многообразие метаболически ассоциированной жировой болезни печени // Эффективная фармакотерапия. 2020. Т. 16, № 24. С. 54–63. doi: 10.33978/2307-3586-2020-16-24-54-63

[39] Nikonov EL, Aksenov VA. Current approaches to diagnosing and treating nonalcoholic fatty liver disease. The Russian Journal of Preventive Medicine. 2018;21(3):62–9. (In Russ). doi: 10.17116/profmed201831262

[40] Никонов Е.Л., Аксенов В.А. Современные подходы к диагностике и лечению неалкогольной жировой болезни печени // Профилактическая медицина. 2018. Т. 21, № 3. С. 62–69. doi: 10.17116/profmed201831262

[41] Savel’yev VS, Petukhov VA. Zhelchnokamennaya bolezn’ i sindrom narushennogo pishchevareniya. Moscow: Borges; 2011. (In Russ).

[42] Савельев В.С., Петухов В.А. Желчнокаменная болезнь и синдром нарушенного пищеварения. М.: Боргес; 2011.

[43] Hohlacheva NA, Sergeeva NN, Vahrushev YM. Age and gender peculiarities of development of gallstone disease. The Russian Archives of Internal Medicine. 2016;6(1):34–9. (In Russ). doi: 10.20514/2226-6704-2016-6-1-34-39

[44] Хохлачева Н.А., Сергеева Н.Н., Вахрушев Я.М. Возрастные и гендерные особенности развития желчнокаменной болезни // Архивъ внутренней медицины. 2016. Т. 6, № 1. С. 34–39. doi: 10.20514/2226-6704-2016-6-1-34-39

[45] Zefirov TD. Novyy vzglyad na mekhanizmy vozrastnykh izmeneniy serdechnogo ritma. Bulletin of Experimental Biology and Medicine. 2001;131(6) 612–6. (In Russ).

[46] Зефиров Т.Д. Новый взгляд на механизмы возрастных изменений сердечного ритма // Бюллетень экспериментальной биологии и медицины. 2001. Т. 131, № 6. С. 612–616.

[47] Seliverstov PV, Skvortsova TE, Sitkin SI, et al. Non-alcoholic fatty liver disease and cholelithiasis: a new view on old relationships. Farmateka. 2018;(S3):68–75. (In Russ). doi: 10.18565/pharmateca.2018.s3.68-74

[48] Селиверстов П.В., Скворцова Т.Э., Ситкин С.И., и др. Неалкогольная жировая болезнь печени и желчнокаменная болезнь: новый взгляд на старые взаимоотношения // Фарматека. 2018. № S3. С. 68–75. doi: 10.18565/pharmateca.2018.s3.68-74

[49] Lyalyukova EA, Livzan MA. Dysfunction of Oddi sphincter and the syndrome of excess increase in the intestine. Lechashchiy Vrach. 2013;(1):61–6. (In Russ).

[50] Лялюкова Е.А., Ливзан М.А. Дисфункция сфинктера Одди и синдром избыточного бактериального роста в кишечнике // Лечащий врач. 2013. № 1. С. 61–66.

[51] Lyapina MV, Vakhrushev YaM. The value of mucosal small intestine microbiotа in digestion and absorption disorders in metabolic syndrome. Therapeutic Archive. 2019;91(11):37–42. (In Russ). doi: 10.26442/00403660.2019.11.000300

[52] Ляпина М.В., Вахрушев Я.М. Значение пристеночной микробиоты тонкой кишки в нарушении энтерального переваривания и всасывания при метаболическом синдроме // Терапевтический архив. 2019. Т. 91, № 11. С. 37–42. doi: 10.26442/00403660.2019.11.000300

[53] Bueverov AO. Cholecystectomy as a risk factor of non-alcoholic fatty liver diseaseprogression. Consilium Medicum. 2019;21(8):93–7. (In Russ). doi: 10.26442/20751753.2019.8.190503

[54] Буеверов А.О. Холецистэктомия как фактор риска прогрессирования неалкогольной жировой болезни печени // Consilium Medicum. 2019. Т. 21, № 8. С. 93–97. doi: 10.26442/20751753.2019.8.190503

[55] Tang A, Tan J, Sun M, et al. Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis. Radiology. 2013;267(2):422–31. doi: 10.1148/radiol.12120896

[56] Tang A., Tan J., Sun M., et al. Nonalcoholic fatty liver disease: MR imaging of liver proton density fat fraction to assess hepatic steatosis // Radiology. 2013. Vol. 267, No. 2. P. 422–431. doi: 10.1148/radiol.12120896

[57] Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.

[58] Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation // World Health Organization Technical Report Series. 2000. Vol. 894. P. i–xii, 1–253.

RIGHTS & PERMISSIONS

Ambartsumyan A.R., Chumak B.A., Deryagina L.E., Batskov S.S., Pyatibrat E.D.