European Journal of Biomedical and Pharmaceutical Sciences

STUDY OF HEPATIC CHANGES IN PATIENTS OF METABOLIC SYNDROME AND CHRONIC ALCOHOLISM

Dr. Balvir Singh*, Dr. Rahul Gupta2 and Dr. Nidhi Sharma

ABSTRACT

Aims and Objectives- Study of hepatic changes in patients of metabolic syndrome and chronic alcoholism. Materials and Methods - 30 metabolic syndrome patients and 30 chronic alcoholic patients were selected from the Postgraduate Department of Medicine, SN Medical College Agra. Results- Most of metabolic syndrome patients (60%) as well as chronic alcoholics (50%) were asymptomatic. Anorexia and fatigue was present in 13.3% and 40% respectively in metabolic syndrome patients as compared to anorexia (30%) and malaise (50%) in chronic alcoholics. Nausea / vomiting and right upper abdominal quadrant pain was present in 10% metabolic syndrome patients as compared to nausea, vomiting (40%) and right upper abdominal quadrant pain (26.6%) in chronic alcoholics. Hepatomegaly and icterus was present in 23.3% and 10% respectively in metabolic syndrome patients as compared to hepatomegaly (80%) and icterus (60%) in chronic alcoholics. Ascites and upper GI bleeding was present in 13.3% and 6.7% metabolic syndrome patients respectively as compared to ascites (50%) and upper GI bleeding (9%) in chronic alcoholics. Mean AST and ALT levels were 65.56+_ 67 .22 and 84.9 +_ 91.9 U/L respectively in metabolic syndrome patients. AST /ALT ranged from 0.91 to 1.85 with mean of 0.98+_0.26 while in chronic alcoholics mean AST and ALT levels were 98.4 and 48.2. AST and ALT levels were statistically significant(p value < 0.05) in chronic alcoholics and the AST/ ALT was 2.04. Gamma glutamyl transferase enzyme level was elevated in most (80%) chronic alcoholics while was near normal in metabolic syndrome patients. On ultrasonography, most of chronic alcoholics (93.3%) had abnormal findings like fatty liver (80%), cirrhosis (13.3%) as compared to metabolic syndrome patients having NAFLD (33.3%) and cirrhosis (6 .67%). On histological examination, metabolic syndrome patients had NAFLD in 33. 3%, NASH in 41.6% and cirrhosis in 8.3% as compared to chronic alcoholic patients having fatty liver in 35.7% alcoholic hepatitis in 49.9% and cirrhosis in 14.3%. Conclusions: 1. Symptoms like anorexia, fatigue/malaise, nausea/vomiting, right upper abdominal pain and signs like hepatomegaly, icterus, splenomegaly, ascitis, UGI bleeding were compared and statistically significant (p value < 0.05%). Symptomatology and signs were found in chronic alcoholics as compared to metabolic syndrome patients. 2. Statistically significant (p value < 0.05%) deranged liver function tests were found in chronic alcoholics as compared to metabolic syndrome patients. 3. On hepatic Ultrasonography, statistically significant (p value <0.05%) hepatic changes in the form of fatty liver, cirrhosis were observed in 93.4 % patients of chronic alcoholics as compared to metabolic syndrome patients (60%). 4. Patients with hepatomegaly abnormal liver function tests and abnormal ultrasonographic findings were observed as high risk cases. Histopathological assessment of high risk patients revealed significant changes in the form of NAFLD ( 33.3%), NASH (41.6%) and cirrhosis (8.3%) in metabolic syndrome patients as compared to chronic alcoholics in the form of alcoholic fatty liver (35.7%), alcoholic hepatitis (40%) and cirrhosis (14 3%). 5. Statistically positive correlation of high risk group patients has shown abnormal ultrasonographic finding. abnormal liver function tests and the histopathological changes in the patients of both groups. Though statistically (p value <0.05) significant changes were seen in chronic alcoholics as compared to metabolic syndrome patients.

Keywords: Metabolic syndrome, chronic alcoholism, hepatomegaly.