ВЗАЄМОЗВ’ЯЗОК БІОХІМІЧНИХ ПОКАЗНИКІВ ЦИТОЛІЗУ Й ХОЛЕСТАЗУ З МОРФОЛОГІЧНИМИ ЗМІНАМИ ПЕЧІНКИ У ПАЦІЄНТІВ ІЗ COVID-19, ЦУКРОВИМ ДІАБЕТОМ 2-ГО ТИПУ ТА ПІД ЧАС ЇХ ПОЄДНАННЯ

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has become one of the most significant challenges in modern medicine. It has not only caused a substantial number of illnesses and deaths but also highlighted the complex mechanisms of damage to organs and systems, including the liver. The frequency of liver dysfunction among patients with COVID-19 ranges from 14 to 53 %, depending on disease severity and the presence of comorbidities. Determining the relationship between liver morphology and biochemical indicators is critically important for predicting the course of the disease and adjusting therapeutic tactics. The study aims to establish the relationship between morphological changes in the liver—particularly steatosis, necrosis, and fibrosis identified postmortem and biochemical indicators that reflect the degree of hepatocyte cytolysis and the severity of cholestasis. Liver tissue and biochemical indicators of 120 deceased remains were studied and divided into the following groups: Group I – COVID-19 with type 2 diabetes mellitus (T2DM), Group II – COVID-19 without T2DM, and Group III – T2DM without COVID-19. Serum levels of ALT, AST, total and direct bilirubin were assessed, and their correlation with hepatic steatosis, fibrosis, and necrosis was evaluated based on histological analysis performed using standard methods (hematoxylin-eosin, Masson-Goldner, ORB according to Zerbino D.D., Lukasevich L.L.). The study results demonstrated a trend toward increased ALT and AST levels with steatosis and fibrosis progression. However, these differences were not statistically significant in most groups. In the second group, a marked increase in ALT levels was observed in cases of severe steatosis and early fibrosis, suggestive of acute liver injury. Enzyme activity remained stable among patients with T2DM without COVID-19 despite significant steatosis. Total and direct bilirubin levels varied, with particularly elevated values observed in cases of F1 fibrosis in the group without COVID-19. These findings suggest the involvement of distinct pathophysiological mechanisms of liver damage depending on the presence of COVID-19 and/or type 2 diabetes mellitus. In patients with COVID-19 and/or T2DM, the levels of biochemical indicators of liver dysfunction and cholestasis did not show statistically significant differences depending on the presence of hepatocyte necrosis (p>0.05). The study made it possible to establish separate relationships between biochemical indicators of cytolysis and cholestasis with morphological changes of the liver (steatosis, necrosis, and fibrosis) in patients with COVID-19, type 2 diabetes mellitus, and their combination. Comparison of histological data of morphological changes of the liver with the results of biochemical indicators of cytolysis and cholestasis contributes not only to the confirmation of clinical diagnoses but also to the refinement of diagnostic and monitoring algorithms in patients with COVID-19, T2DM, and their combination. These findings contribute to a deeper understanding of the pathogenetic mechanisms underlying liver injury, their clinical relevance, and potential avenues for therapeutic intervention.