<<
>>

1.5.3. Definition of activity HG.

The judgement about activity HG is based on degree of rising of level of serumal aminotransferases and-or data of morphological research of a tissue of a liver (biopsy). Activity HG is estimated as low (soft) at less than 3-fold rising of aminotransferases, as moderated at rising from 3 to 10-fold and as high at more than 10-fold.

[6, 30, 183]

At children activity rising hepatically-kletochngh enzymes is characteristic for a stage of exacerbation HG. In the remission period depression of activity of enzymes, up to their full normalisation becomes perceptible. [30, 123, 124, 137, 173, 204]

At histological research bioptata a liver the degree of activity is defined on the basis of an estimation of an index of histological activity. As a rule, exponents of activity of biochemical and histological researches coincide. However at discrepancy of these data degree
Activity it is defined on the most expressed this or that indicator.

A number of other laboratory indicators testifies to activity HG also: rising of level of bilirubin, the general fiber and blood serum Y-GLOBULINS; the augmentation of an ESR reflecting a disproteinemia. Character of a disproteinemia moderated also reaches appreciable expression only at some patients when albumin level falls below 45 %, and level at - globulin exceeds 25 %. Disturbances in coagulating system of blood (hypocoagulation) of various degree develop at patients with HG high activity mainly at the expense of depression of synthetic function of a liver [123, 124, 173, 204]. In some cases it does not become perceptible coordinations of the above-stated indicators: about activity of a hepatitis can speak only raised levels of aminotransferases or, on the contrary, only albuminous shifts. [173, 204]

Stages of a chronic virus hepatitis. Judgement about degree of a fibrosis, initial signs of formation of the cirrhosis, a formed cirrhosis and about cirrhosis presence probably on the basis of data of histological research bioptata a liver. In favour of outcome HG in a cirrhosis can sviyodetelstvovat also clinical given ("small" hepatic signs, liver density, augmentation and lien density), biochemical tests (depression of serumal levels of an albumin, a prothrombin, a cholinesterase), the given ultrasonics (signs of a portal hypertensia) and an endoscopy (a varicose phlebectasia of an esophagus, a stomach, hemorrhoidal veins).

Immunologic methods.

With HG disturbances in the immune status are inherent to patients. At each concrete patient it is necessary to establish character of deviations of immunologic indicators. For this purpose the maintenance T - lymphocytes and their subpopulations, a parity of helpers and supressorov is defined, and serumal immunoglobulins, the condition makrofagalnoj, interferonovoj system and cytokines [9, 58, 62, 133, 156, 212] is important to estimate level V-limfotsitov also.

Liver puncture biopsy.

The purpose of a puncture biopsy of a liver to establish character of a lesion of a liver to define activity of process and to estimate efficiency of therapy. [54, 201, 230, 317, 301]

Because rising of levels ACT and ALT frequently does not reflect expression of inflammatory changes in a liver, the estimation of morphological changes by means of semiquantitative scales is the important expression for definition of inflammatory and necrotic changes, fibrosis degree, and also dynamics of these changes in a disease and-or treatment course.

[40, 134, 201, 367]

By one of the first it has been developed and till now system R.G.Knodell and co-workers (1981) for an estimation of a lesion of a liver is widely used at chronic virus hepatitises. Studying of rate of development of a fibrosis at HVG is the main question for clinicians. Conditionally there are three variants of a progression of a fibrosis of a liver: fast - 10 and less years, average - about 30 years and slow - more than 50 years. [230, 367].

Huge value of an intravital biopsy of a liver consists and that the received material probably to investigate molekuljarno-biological methods, in particular, with the help polimeraznoj chain reaction about detection RNK or DNA of viruses of parenteral hepatitises. At a so-called carriage of a virus of a hepatitis In morphological signs of a hepatitis are found out in 87-90 % of cases, and in "carriers" of a virus of a hepatitis With - in 82-98 % [63, 65, 153].

Without application of molekuljarno-biological methods, the morphological conclusion does not carry information on an aetiology of a lesion of a liver as the same changes are possible not only at chronic virus hepatitises, but also at such diseases as Wilson's illness — Konovalova, deficiency of a-antitrypsin, at autoimmune process, etc. [230]. At sufficient size of a punctate of a liver the received morphological information has crucial importance at an estimation of activity, degree of fibrosing of a chronic hepatitis and in a choice of therapeutic tactics [201, 301].

Now activly there is a search of new non-invasive techniques of definition of a stage of a fibrosis [455]. Use experience elastografii a liver and serumal tests of diagnostics of activity of a hepatitis and degree of a fibrosis at children has given positive takes [291, 314, 361, 378].

Elasticity of a hepatic tissue define on rate of diffusion of elastic waves in a liver parenchyma. Results elastografii a liver correlate with stages of a fibrosis of a liver on METAVIR, estimated at histological research the Maximum diagnostic accuracy elastometrii is noticed at patients HVG with a stage of fibrosis F3 - 92,5 % and F4 - 96 % that is comparable to results of a semiquantitative morphological estimation on system METAV1R. Sensitivity elastometrii for stage F1 of a fibrosis has made 66 %, specificity - 83 %. Elastometrija it has appeared not informative at 16 % of patients. [146, 147]

Magnitno-resonant elastografija - other method allowing quantitatively to estimate mechanical property of soft tissues. Research can be spent standard Mr-tomographs with use of the additional acoustic gauge generating fluctuations.

In 2002 the panel of serumal non-invasive tests "FibroTest", representing a combination actually FibroTesta and AktiTesta has been offered. FibroTest it is intended for diagnostics of stage FP at sick of chronic virus hepatitises and includes 5 biochemical indicators (a2-macroglobulin, gaptogloblin, apolipoprotein А1, g -

glutamiltranspeptidazu, the general bilirubin) bound in discriminant function. AktiTest estimates degree of nekro-inflammatory reaction in a liver and includes listed above 5 components and in addition alaninovuju the aminotransferase, bound in discriminant function

There are data about the diagnostic importance of serumal markers of a fibrosis. Methods of revealing of the molecular bonds which are participating in patofiziologii of process of formation of an extracellular matrix or being are included in a basis of trouble-shooting tests of definition of degree of expression of a fibrosis
Fibrogenesis activators. The most studied are rosttrasformirujushchy the factor in, collagen of IV type (IV-C), aminoterminalnyj a propeptide III procollagen (R III P), hyaluronic acid (GK), matrix metalloproteinaz (MMR) and fabric inhibitors metalloproteinaz (TIMP) [140, 230, 231, 352, 361].

Ultrasonic research

The ultrasonic method (Ouse) of research which practically do not have contraindications, allows to estimate the sizes of a liver and a lien, their contour, arhitektoniku parenchyma, a condition portal and biliarnoj systems. Resolving power modern reaches Ouse-diagnostic of apparatus of a millimetre share that approaches Ouse a method to morphological and does by its method of a choice at diagnostics of diseases of a liver [31, 54, 89, 151, 152].

Ultrasonic picture HGV is characterised sredneochagovoj diffusive heterogeneity of a parenchyma of a liver (characteristic Ouse sign HGV). Dopplerografichesky changes: at is minimum expressed fibrosis are absent; at the expressed fibrosis the augmentation of linear and volume rates of a blood flow on a portal vein on 30 % becomes perceptible; augmentation of linear and volume rates of a blood flow on a splenic vein on 20 %; the blood flow curve on an average hepatic vein has the diphasic form [54, 89, 151, 152].

The comparative analysis of ultrasonic and morphological changes shows, that ehograficheskuju the picture of heterogeneity of a parenchyma of a liver is caused by inflammatory infiltrates in portal zones without change of structure of lobes and a dystrophia of hepatocytes. [54, 89, 151].

The clinical picture at XГD at children is always distinctly expressed gepatosplenomegalija. Ouse the picture at XГD (and also at a combination of chronic hepatitis D and a cirrhosis) is similar described above (at HGV) [54, 89, 151, 152].

Ultrasonic signs of a chronic hepatitis With along with the general for chronic hepatitises include also specific changes: melkoochagovuju
Diffusive heterogeneity of a parenchyma of the liver, bound to a fatty dystrophia of hepatocytes (at 75 % of patients), sredneochagovuju diffusive neyoodnorodnost, assotsiirovannuju with prevalence gidropicheskoj dystrophias of hepatocytes (at 25 % of patients), presence of lymph nodes in portal fissures and-or in the abdominal cavity, defined on echograms as hypoechoic structures of the oval form of the small sizes (no more than 6 mm) [54, 89, 151, 152].

Dopplerografichesky changes at is minimum expressed fibrosis are characterised: augmentation of volume rate of a blood flow on portal (not 15 %) and splenic (on 12 %) to veins; augmentation IR in the general hepatic artery to 0,77; the blood flow on a hepatic vein has three-or the diphasic form. At the expressed fibrosis the augmentation of volume rate of a blood flow on portal (not 40 %) and splenic (on 22 %) to veins becomes perceptible; augmentation IR in general hepatic (to 0,8) and splenic (ds 0,78) to arteries; the diphasic form of a blood flow on a hepatic vein. The question about dopplerograficheskih changes is discussed at a chronic hepatitis at children as about substitute markers of a fibrosis of a liver [249].

<< | >>
Scientific source Dmitriev Tatyana Gennadevna. CHRONIC VIRUS HEPATITISES At CHILDREN And TEENAGERS In REGION GIPERENDEMICHNOM. The PROGRAM of PERFECTION of RENDERING of the MEDIKO-SOCIAL HELP. The dissertation on competition of a scientific degree of the doctor of medical sciences. Yakutsk - 2014. 2014

Other medical related information 1.5.3. Definition of activity HG.:

  1. THE LIST OF THE USED REFERENCES
  2. Definition korotkotsepochechnyh fat acids (С2-С6) in excrements a method gazozhidkostnogo a stratographic analysis
  3. 1.5.3. Definition of activity HG.
  4. 2.2. Research methods
  5. the analysis of the module of physical activity.
  6. the analysis of the module of physical activity.
  7. CHAPTER 4. RESULTS OF STUDYING OF THE MICROFLORA OF THE STOMATOPHARYNX AND THE INTESTINE BY MEANS OF THE BACTERIOLOGICAL METHOD OF RESEARCH WITH DEFINITION OF FACTORS OF PATHOGENICITY OF STAPHILOCOCCUSES AND DEGREES OF THE ENDOGENOUS INTOXICATION
  8. diagnostics of functional disorders of a gastroenteric tract at children of early age
  9. definition kalprotektina in a feces
  10. definition of the stomatologic status
  11. CHAPTER 4. ACTIVE PRIMARY GERPESVIRUSNAJA THE INFECTION AT CHILDREN WITH THE LONG SUBFEBRILE CONDITION
  12. Tverdofaznyj an enzyme immunoassay (enzyme-linked immunosorbent assay (ELISA) for definition of level IL-10, IL-6, IL - 8, IL-1B, IFN-y, TNF-a in blood serum
  13. Visual immunohromatografichesky the express test for occult blood definition in samples of a chair Colon View Hb and Hb/Hp
  14. THE MAINTENANCE
  15. Reception of mitochondrions and toxicity definition