DYSLIPIDEMIA IN ALCOHOLIC LIVER DISEASE

Dr. Krishna Malik 1 , *Dr Anisha Sharma 2 , Dr Deepak Gulia 3 ,Dr Kiran Chugh 4 and Kiran Dahiya 5 . 1. Junior Resident,Department of Biochemistry, Pt. B.D. Sharma, P.G.M.I.S. Rohtak, Haryana, India. 2. Senior Resident,Department of Biochemistry, Lady Hardinge Medical College, Delhi, India. 3. Medical Officer, Delhi Health Services, India. 4. Professor,Department of Biochemistry, Pt. B.D. Sharma, P.G.M.I.S. Rohtak, Haryana, India. 5. Professor,Department of Biochemistry, Pt. B.D. Sharma, P.G.M.I.S. Rohtak, Haryana, India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


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categorising the grades of liver injury. But most of the tests show extent of hepatocellular damage without commenting on synthetic function of liver.
In 1862, Austin Flint had suggested that the blood cholesterol level was affected by the liver diseases. 2

Later on, Neil
McIntyre also studied the levels of various plasma lipoproteins in liver diseases. 3 In present study we had studied and compared the levels of different lipoproteins, serum calcium, serum phosphorous and complete blood count (Hb, TLC and DLC) in alcoholic liver disease cases and healthy controls.

Material and methods:-
The present study was conducted in the department of Biochemistry in collaboration with Department of Medicine, Pt. B.D. SHARMA, P.G.I.M.S, Rohtak.
Inclusion Criteria:-Group-I:-This group included 50 clinically diagnosed cases of Alcoholic Liver diseases (ALD) supported with serological tests, ultrasonogram in the age group of 25-60 years. Group-II:-This group included 50 age and sex matched healthy individuals.
Exclusions Criteria:-Patients with following disease were excluded from the study  Any patient with history of drug intake that are known to be hepatotoxic  Diabetes, hypertension and any other long term systemic illness  Tuberculosis  Acute lymphoid leukemia  Chronic viral hepatitis  Wilson's disease  Hemochromatosis  Any malignant disease  Infectious mononucleosis Sample collection Under all aseptic precautions fasting 10ml of venous blood sample was collected in Red topped and purple topped vacutainer. Samples in purple topped vacutainer were analysed immediately for complete hemogram. Samples in red topped vacutainer were allowed to stand at room temperature until clotted. Clotted Samples were centrifuged at 3000rpm and serum separated Tests were analysed immediately.

Observations:-
The present study was conducted in the Department of Biochemistry in collaboration with department of Medicine, Pt. B.D. sharma, P.G.I.M.S, Rohtak. A total of 100 subjects were included in the present study. Subjects were divided into two groups. Group I was study group and Group II was control group. Study group included clinically diagnosed cases of alcoholic liver diseases supported with serological tests, ultrasonogram in the age group of 25-60 years. Control group included 50 age and sex matched healthy individuals.

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The following were the observations of the present study. Age distribution:-   Table II shows sex distribution of patients in our study. All the patients as well as control subjects (100%) were male. In our study, no female was found to be alcoholic.  In the present study S. calcium was found to be low in alcoholic liver disease patients i.e. mean calcium was 7.70±0.77 mg/dL in group I as compared to 9.15±0.46 mg/dL in group II,the difference between two groups was stastically significant(P<0.001) and mean phosphorous level was 3.3±0.11 mg/dL in group I as compared to 3.4±0.10 mg/dL in group II. S.Phosphorous level was found to be comparable in both the groups (p>0.05).

Discussion:-
In the present study mean haemoglobin and absolute platelet count (APC) of alcoholic liver disease patients were found to be low as compared to healthy individuals. Hemoglobin (Hb) was 8.43±2.64gm% in group 1 and 14.28±1.10gm% in group 2. Absolute platelet count (APC) in alcoholic liver disease patients was 153300±68186/cu.mm and in control group was 173260±19119/cu.mm. But TLC was found to be raised in group I patients as compared to healthy controls. On comparison with control group the results were found to be significant i.e. p< 0.001, p< 0.001 and p< 0.05 for Hb, APC and TLC respectively (table III). The low level of hemoglobin and platelets indicated that alcohol has a variety of pathological effects on hematopoiesis. It suppresses the blood cell production because of its toxic effects which result in fewer-than-normal or non-functional mature blood cells. As a result alcoholics may suffer from moderate anemia characterized by enlarged, structurally abnormal RBC's; mildly reduced number of WBC's, especially of neutrophils; and moderately to severely reduced numbers of platelets 6 .
Many bone marrow abnormalities occurring in severe alcoholics affect the RBC precursor cells. These abnormalities most predominantly include vacuolated precursors or characteristic iron deposits 6 . In our study calcium was found low in alcoholic liver disease patients, mean calcium was 7.70±0.77mg/dL in cases as compared to controls 9.15±0.46mg/dL. Mean phosphorous level was 3.3±0.11mg/dL in cases as compared to controls 3.4±0.10mg/dL and the statistical difference was found in calcium but no significant difference was observed in phosphorous (table VI).
An adequate concentration of calcium in the blood stream is required for proper functioning of nerves and muscle. The body monitors calcium concentration and responds through the action of hormones, vitamins, and local growth factors to regulate the distribution of calcium between blood and bone. Alcohol may disrupt this balance by affecting the hormones that regulate calcium metabolism as well as the hormones that influence calcium metabolism indirectly (e.g. steroid reproductive hormones and growth hormone) 7 .
Further alcoholics normally have low levels of activated vitamin D, along with low levels of the proteins that bind with vitamin D during transport within the blood 8 .The alcohol-induced decrease in activated vitamin D results in decreased absorption of calcium 9 . Another reason may be short-term alcohol consumption increases PTH secretion possibly by causing calcium to leave body fluids (e.g. blood) and flow into cells 10 .
In the present study lipid profile of patients was investigated. Mean triglycerides and VLDL showed no significant difference between patients and healthy controls but cholesterol; HDL and LDL levels were found to be significantly low when compared with controls. Selimogluand colleagues in their study showed that with the exception of serum triglyceride level, other variables like serum HDL, LDL level were decreased in alcoholic cirrhotics 14. Study done by Phukan et al found marked alteration of serum lipid profile values in patients with alcoholic cirrhosis compared with normal non alcoholic-cirrhotic individual 15 . Another study done by Ghadir et al demonstrated that more severe the liver damage the more decline in lipids levels is detected, especially in LDL and total cholesterol levels 16 . However, no correlation was observed between the serum triglyceride level and the extent of liver damage.
Hypolipidemia is also seen in various other medical conditions like malnutrition, malabsorption, hyperthyroidism, renal failure, malignancy and immunoglobin disorders. So we excluded patients suffering from these disorders in our study 17 .
In conclusion estimation of serum Lipid Profile allows better assessment of hepat ic synthetic function and evaluation of prognosis of patients with alcoholic liver disease..