The processes of progression of liver disease, including neoangiogenesis and fibrosis in the liver are closely related to the functional state of the endothelium. The defeat of the endothelium and insulin resistance can be a factor in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). The aim was to assess the dynamics of the functional state of the endothelium, insulin resistance and carbohydrate metabolism in patients with NAFLD.

The study involved 78 NAFLD patients with normal, overweight and obese, and 54 patients without NAFLD. Conducted anthropometric survey measured levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), the degree of liver fibrosis using elastography (FibroScan). The stratification of cardiovascular risk was carried by traditional SCORE scale version for countries with high risk. We determined the level of inflammatory mediators (TNF-α, IL-1, IL-6), markers (CRP, fibrinogen), endothelin (ET-1), the activity of the Willebrand factor (vWF), the thickness of the intima-media complex, presence atherosclerotic plaque and stenosis of the carotid arteries, insulin resistance index HOMA-IR for all examined patients.

Violation of lipoprotein metabolism were found in 51 patients. More often was recorded hypertriglyceridemia, slightly less (37 surveyed) was observed increased serum concentrations of total cholesterol>5.2mmol/L. In 22 patients, the concentration of LDL-cholesterol in serum was higher than 3.5mmol/L. Reduction of serum concentrations of HDL-cholesterol were registered in 16 patients with NAFLD. Violation of carbohydrate metabolism detected in more than half of patients with NAFLD, including more than 20% of them with type 2 diabetes. At the comparing the functional activity of endothelium in patients with steatosis, NASH and cirrhosis was found a significant level of difference. Specifically, blood levels of nitrate and nitrite in blood serum in patients with steatosis was lower than the rate in the control group, respectively, in 1.82, in patients with NASH – in 1.95 times in patients with cirrhosis of the liver – in 2.04 times (P<0.05). At the same time, blood levels of ET-1 in patients with steatosis was higher than the rate in the control group, 2.15 times (P<0.05) in patients with NASH – in 2.41 times in patients with cirrhosis – 2 64 times (P<0.05). The presence of a strong inverse correlation between index HOMA and the level of nitrates and nitrites in blood serum; correlation between insulin and content of nitrates and nitrites; c-peptide content and nitrates and nitrites; strong direct correlation between blood levels of ET-1 and index HOMA in patients.

The studies indicate that the presence of endothelial dysfunction, disorders of carbohydrate metabolism and relative insulin deficiency promote the development of cardiovascular disorders in patients NAFLD.