Bile lithogenicity dependence on carbohydrate and lipid metabolism indices in patients with diabetes mellitus type 2 and chronic acalculous cholecystitis
Keywords:chronic acalculous cholecystitis, type 2 diabetes mellitus, lipid metabolism, cholesterol
Background. The purpose of the study is to identify the features of changes in bile homeostasis and major stone-forming substrates in chronic acalculous cholecystitis and type 2 diabetes mellitus (DM). Materials and methods. The clinical examination was performed in 60 patients with type 2 DM and chronic acalculous cholecystitis, 60 individuals with chronic acalculous cholecystitis alone and 20 apparently healthy persons. A thorough examination was carried out using generally accepted clinical, laboratory, biochemical, instrumental methods. The blood lipids and the gallbladder portion of bile have been determined. Results. In patients with chronic acalculous cholecystitis on the background of type 2 DM, there was an increase in the levels of total lipids (by 1.61 times in the blood), cholesterol (by 2.04 times in the blood and 1.62 — in bile), bile acids (by 4.4 times in the blood) and their decrease in bile (by 1.34 times), an increase in triacylglycerols (by 3.09 times in the blood), low-density lipoproteins (by 1.2 times in the blood) and a decrease in the content of high-density lipoproteins (by 1.98 times in the blood) and phospholipids (by 1.38 times in the blood and 1.48 — in bile), as well as a decrease in the two-component ratio of phospholipids/cholesterol (by 1.8 times) and bile acids/cholesterol (by 1.9 times), an increase in the three-component Isaxone index (by 1.85 times), indicating a significant imbalance of lipid metabolism as a predictor of the gallstone formation in this category of patients (p < 0.05). Conclusions. In persons with chronic acalculous cholecystitis combined with type 2 DM, there are significantly increased levels of total lipids, cholesterol, bile acids, triacylglycerols, and low-density lipoproteins against the background of lowering high-density lipoproteins and phospholipids in the blood serum and bile. The established correlations between blood lipids and bile give more complete and detailed information on disturbances of bile homeostasis in different groups of patients. The main stone-forming substrate in persons of the first group was cholesterol, and in the second — a deceased level of high-density lipoproteins.
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