Эластография печени в детской практике

We anylised results of elastography of 77 patients with chronic liver diffus lesions including: viruses hepatitis B, C, D – 50, autoimmune – 16, metabolic disease – 6, neonatal hepatities – 5 persons. Fibrosis stage was assessed on METAVIR scail. For patients with viruses hepatitis B, C with an averege duration of disease 9,8±0,7 years, a minimum fibrosis stage (F0-1) and low cytolytic activity were indicated. Patients with viruses hepatitis D were characterised by F2 fibrosis stage at the level of hyperenzemia to 4-5 rate, and history of the disease – 10,3±1,8 years. Patients with metabolic liver damage showed signs of modarate fibrosis at 10,3±1,8 years. Heavy fibrosis was marked in autoimmune hepatitis with duration of disease 5 years and indicators of ALT to 3 rate. Neonatal hepatities were characterised by the highest level of cytolysis and by development of fibrosis in 80% of cases with 0,9+0,3 year history of the disease.Проанализированы результаты эластографии у 77 пациентов с хроническими диффузными поражениями печени, среди которых: вирусные гепатиты В, С, D – 50, аутоиммунные – 16, обменные заболевания – 6, неонатальные гепатиты – 5 человек. Степень фиброза оценивалась по шкале METAVIR. У больных вирусным гепатитом В и С со средней длительностью болезни 9,8±0,7 лет отмечалась минимальная степень фиброза (F0-1) и низкая цитолитическая активность; вирусным гепатитом D – F2, при уровне гиперферментемии до 4–5 норм, и анамнезе заболевания – 10,3±1,8 лет. Признаки умеренного фиброза (F2) у пациентов с метаболическими поражениями печени формировались к 11,6±0,8 годам. При аутоиммунных гепатитах отмечена выраженная степень фиброза (F3) с длительностью заболевания 5,6±0,5 лет и показателях АлАТ до 3 норм. Неонатальные гепатиты с анамнезом заболевания 0,9±0,3 года, характеризовались максимально высокими показателями цитолиза и развитием фиброза (F3-4) в 80% случаев

ОСОБЕННОСТИ ТЕЧЕНИЯ И ИСХОДЫ НЕОНАТАЛЬНЫХ ГЕПАТИТОВ РАЗЛИЧНОЙ ЭТИОЛОГИИ

We have performed primary examination of 50 children with neonatal hepatitis. Prevalence of herpes infection as the etiologic agent (40,0%) has been found, as well as parenteral hepatitis, both as an isolated (26,0%) and mixed infections. We conducted a comparative analysis of clinical and laboratory data at initial examination and determined the outcomes of neonatal hepatitis to 12 months of life depending on the etiology. Congenital CMV- etiology hepatitis characterized by more cytolysis, mainly due to aspartate aminotransferase and cholestasis, which is 33,3% of cases combined by acholia and urobiliya. In 50,0% of patients with CMV-hepatitis was detected fibrosis with a mean value of liver elastography 9,9 kPa, which is ІІІ degrees of fibrosis METAVIR scale, whereas in children with primary chronic hepatitis C and concomitant HCV + DNA-virus infection fibrosis was not registered. Despite on the large number of modern non-invasive techniques for determining the degree of hepatic fibrosis, the use of its in children during the first months of life is limited and does not allow to predict disease outcome.Проведен анализ клинико-лабораторных данных 50 пациентов с неонатальным гепатитом в динамике с целью определения особенностей течения болезни и ее исхода к 12 месяцам жизни в зависимости от этиологии и первичных клинико-анамнестических данных заболевания. Выявлено преобладание герпетической инфекции в качестве этиологического агента (40,0%), а также парентеральных гепатитов как в виде изолированной HCV-инфекции (26,0%), так и смешанной HCV+ДНК-инфекции. Установлено, что врожденные гепатиты CMV-этиологии протекают более тяжело с выраженным цитолизом (преимущественно за счет аспартатаминотрансферазы) и холестазом, который в 33,3% случаев сопровождается ахолией и уробилией. У 50,0% пациентов с CMV-гепатитом выявлен фиброз со средним значением эластографии печени 9,9 кПа по шкале METAVIR, тогда как у детей с первично-хроническим гепатитом С и сочетанной HCV+ДНК-вирусной инфекцией фиброз зарегистрирован не был. Несмотря на наличие большого количества современных неинвазивных методик по определению степени фиброза печени, использование их у детей первых месяцев жизни ограничено и не позволяет прогнозировать исход заболевания

Liver elastography in children practice

We anylised results of elastography of 77 patients with chronic liver diffus lesions including: viruses hepatitis B, C, D – 50, autoimmune – 16, metabolic disease – 6, neonatal hepatities – 5 persons. Fibrosis stage was assessed on METAVIR scail. For patients with viruses hepatitis B, C with an averege duration of disease 9,8±0,7 years, a minimum fibrosis stage (F0-1) and low cytolytic activity were indicated. Patients with viruses hepatitis D were characterised by F2 fibrosis stage at the level of hyperenzemia to 4-5 rate, and history of the disease – 10,3±1,8 years. Patients with metabolic liver damage showed signs of modarate fibrosis at 10,3±1,8 years. Heavy fibrosis was marked in autoimmune hepatitis with duration of disease 5 years and indicators of ALT to 3 rate. Neonatal hepatities were characterised by the highest level of cytolysis and by development of fibrosis in 80% of cases with 0,9+0,3 year history of the disease

Features of the course and outcomes of neonatal hepatitis of various etiologies

We have performed primary examination of 50 children with neonatal hepatitis. Prevalence of herpes infection as the etiologic agent (40,0%) has been found, as well as parenteral hepatitis, both as an isolated (26,0%) and mixed infections. We conducted a comparative analysis of clinical and laboratory data at initial examination and determined the outcomes of neonatal hepatitis to 12 months of life depending on the etiology. Congenital CMV- etiology hepatitis characterized by more cytolysis, mainly due to aspartate aminotransferase and cholestasis, which is 33,3% of cases combined by acholia and urobiliya. In 50,0% of patients with CMV-hepatitis was detected fibrosis with a mean value of liver elastography 9,9 kPa, which is ІІІ degrees of fibrosis METAVIR scale, whereas in children with primary chronic hepatitis C and concomitant HCV + DNA-virus infection fibrosis was not registered. Despite on the large number of modern non-invasive techniques for determining the degree of hepatic fibrosis, the use of its in children during the first months of life is limited and does not allow to predict disease outcome