CHRONIC HEPATITIS WITH DOUBLE B/C INFECTION: VIROLOGICAL, CLINICAL, MORPHOLOGICAL CHARACTERISTICS.

AIM: To estimate the r, virological and clinical characteristics of chronic viral hepatitis (CVH) with double B/C infection. MATERIALS AND METHODS: We examined 282 patients with CVH. Genomes of hepatitis B virus (HBV) and hepatitis C virus (HCV) were studied by PCR in blood and liver (AmpliSens HBV and Amplisens HCV Russia), nuclear proteins (HBcorAg HBV and NS3 HCV) were determined by immunohistochemical method (Novocastra, UK), HBVgenome was sequenced by the Sanger method using ABI prism BigDye Terminator v3.1 kits and ABIPRISM 3100 analyzer (AppliedBiosystems, USA). Indices of histological activity (HAI), fibrosis, and portal vein (PV) congestion index (CI) were calculated by formula CI=SBB/LB V where S is P V cross section area in cm2 and LB V - linear blood flow velocity in cm/s (Vivid Pro- 7 apparatus, USA). RESULTS: CVH with double B/C infection was diagnosed in 85 (30.1%) patients including 44.7% with viral genomes and proteins in the live; 42.4% with HCVviremia, and 12.9% with HBJV/HCVviremia. Maximum CVH activity was documented in patients with latent HBV/HCVviremia (ALT 157.2±59.2 U/, HAI 11.6±1.3,fibrosis 2.8±0.7, C1 0.059±0.005); it was minimal inpatients.without viremia (Alt 76.25±63.0 U/I, HAI 6.7+-0.6,fibrosis 1.7±0.5, CI 0.042±0.001;p <0.05). Patients with latent HBV infection had precore/ore and pres/s mutations in HBVgenome and cytoplasmic localization ofHBcorAg. CONCLUSION: Double B/C infection was diagnosed in 30.1% of the patients with CVH dominated by HCV Patients with latent HBVhadprecore/ore and pres/s mutations. The highest intensity of hepatic cellular inflamation,fibrosis, and PV congestion was associated with HBV/HCV viremia and the lowest with intrahepatic localization of both viruses.

[Hepatic parenchimatous damage and perfusion disturbance in the progression of nonalcoholic fatty liver disease].

AIM: To detect early diagnostic criterions of hepatocellular inflammation and portal hypertension for revealing the progressive course of nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS: We have studied 58 patients with NAFLD: 6 with steatosis, 47 with steatohepatitis (SH), 5 with class A liver cirrhosis (LG). Liver biopsy was performed in 24 (41.4%) patients with estimation of histological activity index (HAI) and fibrosis by Brunt method. Abdominal sonography and dopplerography of portal and spleen venous bloodflow with estimation of portal vein congestive index (CI) were performed in all patients. RESULTS: Among conventional laboratory markers of parenchimatous damage gammaglutamiltransferase (GGTF) was increased more frequently--in 77.6% of patients, then alaninaminotransferase (ALAT)--in 62.0% and aspartataminotransferase (ASAT)--in 51.7% of patients. GGTF correlated more closely with HAI: with fatty cellular degeneratic r = 0.82 (p < 0.01), bottled cellular degeneration--r = 0.65 (p < 0.05), lobular inflammation--0.58 (p < 0.05), fibrosis r = 0.67 (p < 0.05), than ALAT--0.51 (p < 0.05), 0.48 (p < 0.05), 0.42 (p < 0.05), 0.51 (p < 0.05) accordingly. Liver venous perfusion worsening was revealed already in moderate SH, when clinical symptoms of portal hypertension were absent. CI in portal vein correlated closely with HAI r = 0.78 (p < 0.05) and fibrosis r = 0.69 (p < 0.05) in NAFLD, that confirmed its diagnostic role in detection of parenchimatous and vascular liver architectonics deterioration and portal hypertension development. CONCLUSION: GGTF is more sensitive parenchimatous damage marker in NAFLD than ALAT and ASAT. Liver venous perfusion study with estimation portal vein congestive index permits to reveal the portal hypertension long before clinical symptoms of this syndrome appearance. Liver parenchimatous damage and its perfusion disturbance confirm the NAFLD progressive course.

[Splenoportal blood flow with nonalcoholic fatty liver disease].

UNLABELLED: The aim of this study was to characterise by duplex Doppler sonography the splenoportal venous and arterial blood flow in patients with nonalcoholic fatty liver disease (NAFLD) depending on the grade of biopsy proven steatosis. MATERIALS AND METHODS: 37 patients with NAFLD were examined: 22 female and 15 male average age 46,8 +/- 10,2 (29-62), with IBM 33,5 +/- 4,8 (28-42). The grade of steatosis was estimated by morphological investigation according to Brunt classification (1999). Colour Doppler sonography was performed by the same researcher using Doppler system Vivid-pro-7, USA with a 3,5 MHz convex probe. RESULTS: Alterations were detected in the following parameters: increase of portal and splenic vein diameters, slow-down of blood flow velocity in the portal and splenic veins, increase of the congestion index, decrease of systolic and diastolic blood flow velocity in the common hepatic and splenic artery, increase of pulsatility and resistance indexes of these arteries, increase of portal hypertensive index and decrease of liver vascular index according to the progression of steatosis with maximal negative dynamics of all characteristics in patients with III grade of steatosis. The closest correlative connections were revealed between the grade of steatosis and congestion index (r = 0.81), portal hypertensive index (r = 0.79), and negative connection--with liver vascular index (r = -0.69). CONCLUSION: Using Doppler sonography we have detected a deterioration of venous and arterial splenoportal hemodynamics in patients with nonalcoholic fatty liver disease in connection with the progression of steatosis, therefore this method may be used as a noninvasive way to estimation the grade of steatosis, establish the diagnosis of portal hypertension and detect the formation of liver cirrhosis.

[Splenorectal blood flow in chronic viral hepatitis B and C].

The aim of the study was to compare results of dopplerography characterizing hepatic and splenic blood flow at different stages of chronic viral hepatitis B and C and correlate them with histological findings and sclerosis. The study included 79 patients of whom 45 had chronic hepatitis B (CHB) and 34 hepatitis C (CHC). The most sensitive dopplerographic characteristics proved to be congestion index, liver vascular index, and hepatic hypertension index that started to change significantly at minimal activity of hepatitis and greatly deteriorated after development of liver cirrhosis. In both cases venous blood flow was affected more seriously than arterial one. Hepatic hyperperfusion progressed faster in CHC than in CHB. Dopplerographic characteristics correlated with histologic activity index, its components, and sclerosis index. Hence, the possibility of using dopplerographic studies for the evaluation of hepatic and splenic vasculature and indirect assessment of morphological changes in the liver.