a current and outcomes of chronic hepatitises at children and teenagers.

HG at children usually has a good-quality current. At a HBV-infection recover with eliminatsiej the originator, or long remission with residual Hbs-antigenemiej can be a disease outcome; in rare instances process comes to an end with formation of a portal hypertensia and a cirrhosis.

The important feature of a current of a HCV-infection at children is, high enough percent of a spontaneous clearance at S.On's acute hepatitis is especially high (to 35-45 %) in cases of an acute posttransfusion hepatitis [79, 228, 348, 393, 429, 444, 450].

There are different data about features of a current of a HBV-infection, depending on a virus genotype. A number of authors specify in more serious, prognostically adverse current of disease it is established at a genotype With HBV, in other researches of statistically significant differences in frequency of a cirrhosis at patients with genotypes With and In it is not taped [24, 311]. Latent current HGV at teenagers becomes perceptible in 77,6 % of cases [280]. Progressing current HGV leads to a cirrhosis at 12 %-15 % of sick children and to 30 % at adult patients with chronic infection HBV. In the presence of moderate activity of hepatic process, by results of a biopsy, cirrhosis development occurs within 13 years at 30 % of patients. The risk of formation of a cirrhosis at patients serious HG with active replikatsiej HBV is especially high. The adverse current HGV, caused by NVEAD-NEGATIVE mutant HBV is shown. Much more often, than at the disease caused by "wild" type of a virus,
Long subclinical disease is observed. As a result in the majority of patients by the moment of the first implications of illness find out the expressed morphological changes of a liver [16, 24, 183, 195, 298]

The picture of exacerbation HGV, up to fulminantnogo currents, can be observed at a superinfection by a virus of hepatitis D (HDV) to which occurrence in blood serum HDV RNA testifies, a-HDV, a-HDV IgM; in a liver tissue it is possible to find out HDV RNA and HDV Ag. Clinical implications of chronic hepatitis D (XrD), formed at 70-90 % of the patients who have transferred OrD, are substantially defined by character of a current of a previous HBV-infection: the range from an asymptomatic carriage of a virus In to HGV a high degree of activity is possible. [27, 59, 90, 183].

ХГВ+D - Mainly serious, steadily progressing disease of a liver. In group from: 95 patients XrD the cirrhosis is found out in 82 % of cases. Sochetannye infections differ from monoinfections higher clinico-laboratory and morphological indicators of activity of a hepatitis [27, 59, 90, 298]. It is established, that at presence sochetannoj infections three viruses of hepatitises (In, With and D) replikatsija HDV prevails over replikatsiej HBV and HCV [183] is more often.

The natural current of a chronic HCV-infection has a wide spectrum of variants of a current and outcomes. Rates of advance HGS can be various: along with seldom meeting fast advance probably very slow, within decades a current at which the cirrhosis has not time to develop. Rates of advance of a fibrosis much more low at patients HGS, proceeding with with firmness normal serumal aminotransferases, than at patients with the raised level of aminotransferases on the basis of what consider clinically important for a forecast sketch to allocate these two subgroups of patients [90, 179, 203, 256, 319, 348, 421]

A variety of rates of advance HGS bind to presence of set of factors influencing its current. To virus factors carry its genotype, degree of heterogeneity of population of a virus (kvazividy), volume
Infecting material. More serious current HGS, caused by a genotype lb, can be caused influence of additional factors - infitsiyorovaniem at hemotransfusions (larger volume of an infecting material) and in more advanced age, larger duration of an infection. Last years, more expressed direct cytopathic effects of a virus with development of more significant steatosis of a liver (and faster advance of a fibrosis) bind to 3 genotype. Among factors of the owner influence on current HGS of age at the moment of a becoming infected is convincingly proved. At identical duration of a current of an infection, slower advance of disease is shown at becoming infected HCV at children's age. [97, 179, 186, 214, 319].

It is considered, that in some ethnic groups (in Japan, Italy, Spain, India, Mexico) HG-WITH proceeds more hardly, with larger frequency of development GTSK, than in America and in the north of Europe [59, 183, 240, 328].

1.4.5.