The work is devoted to the optimization of diagnostics, course prognosis and treatment of patients with type 2 diabetes mellitus combined with chronic noncalculous cholecystitis based on the determination of the levels of fibroblast growth factor-19 and bile acids in the blood serum and metabolic disorders correction.
The study shows that a combined course of type 2 diabetes and chronic noncalculous cholecystitis is accompanied by a decrease in fibroblast growth factor-19 activity compared to isolated type 2 diabetes or isolated chronic noncalculous cholecystitis by 1.2 and 1.7 times, respectively, and is dependent on the duration of metabolic disorders and the age of patients. In patients with a combination of type 2 diabetes and chronic noncalculous cholecystitis, there is an increase in atherogenic lipid profile fractions – total cholesterol, triglycerides and low density lipoproteins, along with hyperinsulinemia and insulin resistance, the severity of which increases in the 1st quartile of fibroblast growth factor-19 levels (within 51.64-62.58 pg/ml). In patients with combined type 2 diabetes and chronic noncalculous cholecystitis, there is an increase in serum bile acid levels and in the values of the immunosuppressive parameter – C-reactive protein. At the same time, violations of the motor-evacuation function of the gallbladder occur due to an increase in the latency period, the volume of the gallbladder cavity, stool dynamics and a decrease in the gallbladder contraction index. A decrease in the serum fibroblast growth factor-19 level in patients with a concomitant course of type 2 diabetes and chronic noncalculous cholecystitis is accompanied by an increase in serum bile acid levels (R = -0.78, p<0.05), which indicates the dysregulation of bile acids metabolism along with a decrease in the coefficients of gallbladder emptying, its reduction index (R = 0.78, p<0.05) and an increase in the manifestations of insulin resistance (R = -0.74, p<0.05) and low density lipoproteins levels (R = -0.38, p<0,05). The use of drugs ursodeoxycholic acid and alpha-lipoic acid in the complex therapy of type 2 diabetes and chronic noncalculous cholecystitis was accompanied by positive effects in the form of a decrease in bile acids levels, an increase in the content of fibroblast growth factor-19, a decrease in low density lipoproteins and an improvement in the contractility of the gallbladder, which improved the motor, cholesecretory functions of the gallbladder and clinical condition of patients. Fibroblast growth factor-19 can be considered as a prognosis marker for the development of bile acids metabolism disorders (at the level of <98.33 pg/ml), disorders in the motor-evacuation function of the gallbladder (at the level of <96.23 pg/ml), disorders of carbohydrate and lipid metabolism (at the level <113.5 pg/ml and <95.25 pg/ml, respectively). A model for predicting disorders of bile acids metabolism was developed using the levels of fibroblast growth factor-19, low density lipoproteins, total serum protein and gallbladder contraction index, and its high reliability (96.4%) was proved, which makes it possible to use it in clinical practice
