Features of changes in the levels of neuroactive substances and amino acids in blood serum at different stages of treatment of gallstone disease in patients with metabolically associated fatty liver disease and changes in the body mass index

Abstract

Introduction. In patients with asymptomatic gallstones detected incidentally, the probability of developing symptoms or complications is 1% to 2% per year. Therefore, further study of the characteristics of neurohumoral regulation in gallstone disease (GSD), especially in patients with chronic liver damage, is needed. The purpose of the study: To determine the changes in neurohumoral regulation and amino acid imbalance in blood serum in patients with GSD and metabolic-associated fatty liver disease (MAFLD). Object and research methods. 134 patients with MAFLD and GSD (at various stages of cholecystectomy (ChE)) were examined. Patients were divided according to the method of treatment of GSD, as well as the possible consequences of ChE. Group I included 62 patients with MAFLD and GSD who did not require surgical treatment. Group II included 44 patients with MAFLD and GSD who underwent laparoscopic ChE (patients were examined during inpatient treatment, 1-2 days after ChE). Group III consisted of 28 patients with MAFLD and postcholecystectomy syndrome (PCHES). All examined patients underwent determination of free amino acid levels in blood serum, as well as assessment of serotonin (ST) and cholecystokinin (CCK) levels. Research results and their discussion. Among patients in group I, overweight individuals were more common (29.0% of those examined), while among patients in group II who underwent ChE – patients with MAFLD and GSD with grade I obesity were more common (31.8% of patients). In patients with MAFLD and GSD (at various stages of treatment), a significant decrease in the levels of ornithine (Orn), arginine (Arg), alanine (Ala), serine (Ser), tryptophan (Trp), tyrosine (Tyr), threonine (Thr), methionine (Met), and leucine (Leu) in the blood serum. These changes in the patients we examined were accompanied by a significant increase in the levels of cysteine (Cys), glutamine (Gln), proline (Pro), valine (Val), asparagine (Asp), and phenylalanine (Phe). In patients with MAFLD, a significant decrease in serum serotonin levels was diagnosed, which was most pronounced in patients after ChE (decrease to 234.5±2.6 μg/L – p<0.01). The level of CCK in all examined groups exceeded that of the control group, with the maximum value in group II. High CCK levels were also diagnosed in patients in group III (an increase in its level to 1.38±0.06 ng/ml, compared to the norm of 0.94±0.07 ng/ml in the control group – p<0.05). Conclusions. 1. In patients with GSD and MAFLD, a decrease in serotonin levels was found, which correlates with the level of tryptophan in the blood serum, regardless of the method of treatment of the biliary system. 2. In patients with MAFLD, an increase in serum CCK levels was observed, with the maximum value after ChE (increase to 1.74±0.09 ng/ml – p<0.01), as well as in patients with PCHES (increase to 1.38±0.06 ng/ml – p<0.01).