Aim. To study the significance of clinical and laboratory non-invasive indexes along with the insulin resistance index when carrying out diagnostic assessment of non-alcoholic fatty liver disease (NAFLD) during screening examinations. Materials and methods. The study involved 348 employees working at oil-production enterprises. An ultrasound scanning of the liver was carried out to assess the criteria of NAFLD. The following indexes were calculated: fatty liver index (FLI), hepatic steatosis index (HSI), lipid accumulation products (LAP), and homeostasis model assessment of insulin resistance (HOMA1-IR). The prognostic significance of these indexes in relation to the probability of NAFLD diagnosis based on ultrasound data was studied using single-factor and multi-factor logistic regression models followed by ROC-analysis. Results. The FLI, HSI, and HOMA1-IR indexes in single-factor logistic regression models showed a high statistical significance when carrying out diagnostic assessment the NAFLD with good model calibration capability. The percentage of correct binary classification regards the presence/absence of NAFLD amounted to 82.4% for FLI, 79.7% for HSI, and 72.7% for HOMA1-IR (p0.001). According to the ROC-analysis, the area under the curve (AUC) by the NAFLD diagnostic assessment was 0.917 (95% CI 0.8890.945); 0.880 (95% CI 0.8460.915) and 0.849 (95% CI 0.7640.934), respectively. The multi-factor logistic regression model with the inclusion of FLI and HOMA1-IR 72.7% enabled us to achieve the correct binary classification in terms of NAFLD in 84.2% of cases. When it comes to the ROC-analysis, considering the probabilities predicted in the multi-factor logistic model as the test variable and NAFLD in ultrasound examination as the state variable, it was possible to set the value of AUC 0.933 (95% CI 0.8820.985). Conclusion. The studied clinical and laboratory indexes (FLI, HSI, HOMA1-IR) have a high diagnostic significance regarding NAFLD diagnosed using ultrasonographic criteria. The application of the proposed two-factor logistics model makes it possible to predict the presence of NAFLD when examining a large number of patients, without involving additional ultrasound diagnostics specialists in order to use medical resources rationally.
The results of a study of the health status of employees of metallurgical enterprises under the conditions of exposure to rare earth elements (on the example of employees of titanium and magnesium production) are presented. 107 workers (men) of the observation group exposed to harmful production factors and 72 employees of the administrative apparatus without exposure to harmful production factors were examined. An analysis of the working conditions of workers, research on the content of rare earth elements in the air of the working area and in bioassays, and a sociological survey were carried out. The general clinical, biochemical, immunological parameters of the blood of workers in the titaniummagnesium production were studied. A functional study of the cardiovascular, respiratory, digestive, and nervous systems was performed. According to the results obtained, the final class of working conditions at the workplace corresponded to classes 3.1–3.3. Exceeding the MPC of rare earth elements and estimated safe exposure levels have not been identified. An increase in the content of europium, which can replace calcium and magnesium in the body, was found in the workers of the observation group. The revealed dysfunction of the autonomic nervous system and impaired adaptation of the body are formed as a result of exposure of workers in the titanium-magnesium production to a harmful production environment. Exposure of chemicals in workers causes a change in humoral immunity in the form of hyperproduction of IgA, and with an experience of more than 5 years, activation of cellular immunity (increased absolute phagocytosis, CD16+56+ and CD3+25+). Recorded changes in the parameters of rhinomanometry and spirography in the observation group may indicate the presence of the process of aseptic inflammation in the airways under the combined effect of irritating chemicals and rare earth elements. Low-symptomatic or asymptomatic liver damage, characterized by non-specific structural changes (hepatomegaly, increased echogenicity) and a laboratory symptom complex of a simultaneous increase in AlAt and AsAt, LDH. The emerging dysfunction of the cardiovascular and respiratory systems is transformed into cardiorespiratory and hepatopulmonary pathology, increasing the risk of sudden death. The combined impact of production factors «rejuvenates» the age of formation of production-related and occupational diseases, contributes to the loss of professional working capacity by employees even before retirement age.
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