PECULIARITIES OF THE VITAMIN D DEFICIENCY AND ITS INFLUENCE ON LIPID EXCHANGE INDICATORS IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE IN COMBINATION WITH OSTEOARTHROSIS

The analysis of lipid metabolism indi-cators (total cholesterol (TC), triglycerides (TG), high and low density lipoproteins (HDL, LDL), alanine aminotrans-ferase (ALT) activity, aspartate aminotransferase (AST) and vitamin D level (25 (OH) D) by enzyme immunoassay was carried out ) in 75 patients with non-alcoholic fatty liver disease (NAFLD) in combination with osteoarthritis (OA), depending on the stage of NAFLD. The patients were divided as follows: Group IA -24 (57.1%) patients with non-alcoholic fatty hepatosis (NAFH), IIB -18 (42.9%) patients with non-alcoholic steatohepatitis (NASH); Group II (comparison group) -33 (44.0%) pa-tients with OA without NAFLD. All patients showed a de-crease in the level of 25 (OH) D, which is more pro-nounced, with a combination of NAFLC and OA, espe-cially at the stage of steatohepatitis: insufficiency and deficiency of vitamin 25 (OH) D were found in 46 (61.33%) and 29 (38.66%) cases in both groups of patients, respectively (p <0.05).In patients ofgroup II, the 25 (OH) D level was (26.41 ± 1.04) ng/ml, which was lower than in healthy subjects on 27.18% (p <0.05); deficiency of vitamin D was found in 21 (63.63%) cases, deficiency -in 12 (36.36%) cases.A reduced level of vitamin 25 (OH) D is combined with lipid metabolism disorders, as indicated by inverse correlations between the level of total choles-terol, triglycerides and the level of 25 (OH) D. When as-sessing the indicators of the lipid spectrum of the blood, a significant increase in the level of TC by 44.08% (group IA), 61.62% (group IB) and 24.88% (group II), respec-tively, compared with healthy persons (p <0,05). The level of TG in patients with NASH was 2.37 times higher than in healthy people (p<0.05); 2.12 times compared with pa-tients with OA (p1<0.05) and 1.3 times compared with pa-tients with IA group (p2<0.05). The content of low density lipoproteins (LDL) in patients of group IA was 1.8 times higher than in healthy patients; in the IB group -2.02 times; in the second group -1.07 times (p<0.05). In pa-tients with IB group with NASH, the level of LDL choles-terol was 89.12% higher than in patients with OA (p1<0.05). In contrast, high density lipoproteins (HDL) were lowest in patients with NASH. Comparing this indi-cator with the level in healthy people, it was reduced by 35.34% (IA group) (p<0.05); by 42.24% (IB group) (p<0.05) and by 17.24% (group II) (p<0.05). In patients with NAFH and NASH, the level of HDL was reduced by 21.87% and 30.20%, respectively, compared with the level of patients with OA (p1<0.05). In NASH, this indicator tended to decrease compared with patients with NAFL (p2<0.05).We found a significant increase ofAST level at1.7; at 3.8; at 1.3 times in IA; IB and II groups, respectively, compared with healthy persons (p<0.05). In the presence of NASH, the AST level was higher than in patients with OA at 2.8 times (p1<0.05), in the presence of NAFH–at 2.2 times (p1<0.05). A similar direction of changes was found in the analysis of ALT activity, which was more pronounced in patients with NASH (p<0.05).In particular, in patients with NASH, an inverse correlation was found between the level of TC and 25 (OH) D (r = -0.7885, p = 0.0008) and an inverse correlation between the level of TG and 25 (OH) D (r = -0.6814, p = 0.0004). An inverse correlation was established between the serum level of vitamin 25 (OH) D and indicators of the functional state of the liver (AST and ALT) in patients with NAFLD in combination with OA (r = -0.7687, p = 0.0007) і (r = -0, 7882, p = 0.0006), respectively.