Особенности клинического течения, биохимического и иммунного ответа у больных хроническим гепатитом смешанной этилогии

Abstract

У статті представлені дослідження клінічних, біохімічних і імунологічних показників у 31 хворого мікст-гепатит В + С, що проживають в Одеському регіоні. Виявлено кореляційні зв'язки між ступенем фіброзу печінки і деякими імунологічними показниками, що може бути додатковим критерієм тяжкості захворювання і дозволить скласти індивідуальний план ведення пацієнта.

The number of patients increases annually, not only with chronic hepatitis C and B, but also patients in whom hepatitis has a mixed etiology. At the same time, the potentiating effect of the association of HBV and HCV with a high risk of developing progressive forms of chronic viral hepatitis and hepatocellular carcinoma is noted. Viral hepatites mixed etiologies are the result of superinfection, less often co-infection with the sequential or simultaneous activity of several hepatotropic viruses. It has been shown that viral mixed hepatitis is more often caused by a combination of HBV + HCV, as well as HCV + HBV + HDV. At the same time, HCV replication is noted in 64% of cases, and HBV replication - in 58% of cases. The objective: to study the immune status and biochemical parameters in patients with chronic hepatitis of mixed etiology (B + C) for a more accurate assessment of the severity of the pathological process. Materials and methods. There were examined 31 patients with chronic hepatitis В+С; their age was 18-62 years. All patients were evaluated traditional biochemical indices. In order to confirm the diagnosis in all patients by the PCR method, qualitative and quantitative determination of viral RNA and DNA was carried out. Results and its discussion. Clinical signs of the patients with HBV + C did not indicate a cyclic course of the disease, the severity of individual syndromes was uneven. All patients with chronic hepatitis B + C showed a significant increase in transaminase activity: the average value of AST was 2.27, ± 0.7 mmol / l per hour, and ALT - 3.29 ± 0.9 mmol / l per hour. The prothrombin index did not change significantly, its average value was 94.04 ± 0.39%. The study of lymphocyte subpopulations in the peripheral blood of patients with chronic hepatitis B + C established a low expression of CD3 + and CD4 +, as well as an increase in the number of cells expressing the CD8 + and CD19 + antigens compared with healthy individuals. The relationship of fibrotic changes in the liver tissue, biochemical indicators and indicators of cellular immunity was assessed using the Spearman's rank correlation coefficient. There are the next interrelation of such indicators: • a negative (inverse) interrelation between the degree of fibrosis and the content of CD3 +, p <0.01 (patients with VHB+C with a lower degree of fibrosis have a greater number of CD3 + lymphocytes); • a strong negative (inverse) interrelation between the degree of fibrosis and the CD4 + content, p <0.01 (in patients with VHB+C with a lower degree of fibrosis have a greater number of CD4 + lymphocytes is noted); • a negative (inverse) interrelation between the degree of fibrosis and the content of CD16 +, p <0.01 (in patients with HVB+C with a lower degree of fibrosis have a higher number of CD16 + lymphocytes is noted); • a positive (direct) interrelation between the degree of fibrosis and the content of CD19 +, p <0.01 (patients with HVB+C with a lower degree of fibrosis have a smaller number of CD19 + lymphocytes is observed). The presence of a relationship between the degree of fibrosis and immunological parameters in patients with HVB + C allows using the obtained information as one of the additional criteria for the severity of the pathological process. The severity of changes in cellular immunity parameters may serve as an additional criterion for the degree of morphological disorders in the liver tissue.

В статье представлены исследования клинических, биохимических и иммунологических показателей у 31 больного микст-гепатитом В+С, проживающих в Одесском регионе. Выявлены корреляционные связи между степенью фиброза печени и некоторыми иммунологическими показателями, что может быть дополнительным критерием тяжести заболевания и позволит составить индивидуальный план ведения пациента.