Chronic hepatitis: causes, symptoms, diagnosis and treatment. Chronic hepatitis C: symptoms and treatment

Or a chronic infection, doctors usually diagnose hepatitis.

This diagnosis implies an inflammatory process in the liver tissues that ensure its functionality and lasts more than six months.

Chronic appearance hepatitis inevitably causes complications such as:

tissue necrosis;
infiltration of infected cells.

This disease may have:

different etymologies of origin;
varieties;
stages of development;
consequences.

The earlier and more accurately it is possible to diagnose the type of hepatitis and determine the nature of its origin, the more successful the therapy will be.

Causes of chronic hepatitis

The problem in the timely diagnosis of chronic hepatitis and treatment lies precisely in the causes of this disease. The main source of the disease is infection, but this is far from the only possible reason incidence of hepatitis.

Main causes of the disease:

intrauterine infection, in which the mother infects the fetus, or infection during childbirth;
unprotected sex, although many doctors do not believe that chronic hepatitis is directly transmitted. Rather, they are the result of other diseases or infections, such as HIV;
medical manipulations and surgical interventions - people can become infected when inserting a catheter or simply taking blood tests, not to mention more serious procedures;
using a “shared” syringe absolutely guarantees that the virus will pass from a sick person to a healthy one. And not only drug addicts are at risk; regular vaccination with a non-sterile instrument will transfer the viral agent to a healthy liver.

People can become infected through tools in hairdressing salons or nail salons, on which the causative agent of the disease remains. Chronic hepatitis can be transmitted in acupuncture and exotic massage salons; many people bring the disease back from vacations spent in Asia.

Epidemiology of the disease

The epidemiology of the disease is very extensive; in addition to infection, the culprits may be:

alcoholism;
addiction;
taking any medications;
lifestyle;
abuse of strict diets;

Photo: Classification The fact is that any form chronic hepatitis progresses due to an autoimmune failure, in which a person begins to produce antibodies to his own liver. These "anti-liver" agents, produced by the body itself, appear not only due to infection, but also due to purely internal factors. At the same time, the patient cannot even imagine that an infectious process is occurring in his body, since it was unrealistic to become infected.

Parenteral infections with this disease often accompany dental procedures.

These different causes of chronic hepatitis make infection and transmission of the virus quite a serious problem.

Forms and classification of chronic hepatitis

The forms and classification of the disease imply a difference in the disease:

by type of pathogen;
according to the course of the disease.

Clinical division according to the form of chronic hepatitis implies:

active form - in which the manifestation of the disease is very vivid, with many symptoms, the liver tissue is destroyed extremely quickly, the disease often degenerates into cirrhosis or an oncological tumor;
persistent form - there are no periods of exacerbation, the virus develops with virtually no symptoms, and can “dormant” for years;
cholestatic form - the processes of bile outflow are disrupted, which is why pain symptom clearly expressed, there is also such a sign as strong yellowing of the skin.

The definition of “chronic hepatitis” also includes the division of the disease by virus:

The “G” virus, identified not so long ago, while the study is underway, does it become chronic or limited to acute, at at the moment doctors don't know.
Photo: Types

Classification table in medical reference books

Separately, the classification table in medical reference books of recent years highlights the following types:

drug;
alcoholic.

Each of these types also has its own ICD 10 code in the latest, tenth version international classifications.

Why is chronic hepatitis dangerous?

Symptoms and signs of chronic hepatitis cause a lot of problems for sick people, and also have quite dangerous consequences, regardless of the nature of the disease established by the examination and identified laboratory tests- viral or not.

If the virus is not treated, it will lead to:

hepatocellular oncological carcinoma, that is, liver cancer;

In addition to these main consequences of hepatitis, it leads to various syndromes, malfunctions and disorders in the body: from tumors in the whites of the eyes and spontaneous urination to kidney failure.
Photo: Symptoms

Symptoms and signs of chronic hepatitis

Chronic hepatitis can cause various symptoms, depending on:

what is the history of its origin;
what type of virus is in the blood;
what form does the disease take?

But all types and varieties of this disease have common symptoms:

unhealthy changes in stool - consistency, smell, color, etc., not related to nutrition in any way;
periodically occurring depressed state, physical weakness;
pain, both concentrated under the ribs in the liver area and girdling;
yellowing of the skin, often itching all over the body;
“stars”, that is, cracked capillaries on the face, neck, upper chest;
redness of the skin of the hands with purple blood vessels, as with anemia;
bitter taste in the mouth, nausea, specific belching with pungent odor, general heaviness in the abdomen.

If you find such signs, you should immediately go to the doctor and take everything possible tests for chronic hepatitis and:

or confirm the diagnosis and begin treatment;
or make sure of your own health.

Diagnostic methods

Suspicion of a diagnosis of chronic hepatitis must be confirmed before starting treatment.

The main method of determining the virus is blood tests:

general, including platelet test;
complete, expanded, biochemical;
on rheumatoid factors, including LE cell testing;
for the presence and percentage of antibodies - antinuclear, antimitochondrial, active against microsomes and smooth muscle cells.

Markers of chronic hepatitis

In addition, markers of chronic hepatitis will be carried out:

HBsAg markers;
antiHDV (hepatitis);

Depending on the results, the doctor may refer for additional, highly specific laboratory blood tests or PCR, that is, a polymerase test chain reaction in biological material. As a rule, blood is tested, but sometimes PCR is performed on other materials.
Photo: Chronic hepatitis with outcome in cirrhosis

Tests for chronic hepatitis

In addition to tests, the following are often performed:

Ultrasound of both the liver and the entire abdominal cavity;
EGDS;
determination of the state of blood vessels in the liver using the Doppler method;
elastometric examination;
both magnetic resonance imaging (MRI) and computed tomography (CT).

The combination of examinations makes it possible to determine as accurately as possible both the type of disease, its stage, and the rate of development, which makes the accepted curative measures as efficient as possible.

Therapy depends primarily on:

what type of hepatitis is being treated;
what stage of development and form is it in?

The general principles of therapy for chronic hepatitis are:

combination of medications;
following a strict diet;
conduct as much as possible healthy image life.

Among the prescribed medications for the treatment of both adults and children, a combination of hepatoprotectors, antiviral agents, and dietary supplements are used that stimulate cell regeneration in liver tissue.

In case of a complex condition and pathology of chronic hepatitis, hospitalization of the sick person is possible.

Drugs to treat the virus

Most commonly prescribed drugs:

Ademetionine;
Ursodeoxycholic acid;
Silymarin;
Katergen;
Hepanorm;
Cyanidanol;
Welferon;
Intron-A;
Lamivudine;
Adefovir;
Entecavir.

The duration of treatment, the regimen of medications and their combinations are completely individual and are under the control of the attending physician.
Treatment

None of the drugs can cure the disease without effort on the part of the patient; the path to health with chronic hepatitis lies through:

strict adherence to the required diet;
giving up alcohol and smoking;
maintaining the desired daily routine, including walks, sufficient time for sleep and other nuances.

Diet for illness

A diet for any disease should be developed individually during an appointment with a nutritionist who has before his eyes the results of all tests and imagines full picture human health.

The general principles of nutrition during the treatment of chronic hepatitis are as follows:

the amount of animal protein in the daily diet should correspond to the formula - no more than 2 g per kilogram of weight;
the amount of vegetable protein is not limited, but it should be no less than animal protein in the diet;

beets;
cabbage;
liver;
offal;
oats and so on.

Prevention of chronic hepatitis

Preventive actions, directed against hepatitis, can be divided into public and personal.

Personal prevention of chronic hepatitis should include everything that concerns the person himself:

caution when drinking alcohol;
compliance with sanitary and hygienic standards;
compliance with precautions when in contact with poisons, chemicals, toxins, building materials, fertilizers and others;
balance and completeness in nutrition;
lack of physical and mental overload;
clear and correct routine day;
sound sleep;
liver health support;
regular medical examinations and tests;
strengthening the immune system.

Chronic hepatitis: treatment, signs of infection, how it is transmitted, why it is dangerous, causes

– inflammatory disease, characterized by fibrous and necrotic changes in liver tissue and cells without disruption of the structure of the lobules and signs of portal hypertension. In most cases, patients complain of discomfort in the right hypochondrium, nausea, vomiting, loss of appetite and stool, weakness, decreased performance, weight loss, jaundice, and itchy skin. Diagnostic measures include conducting a biochemical blood test, ultrasound of the abdominal organs, and liver biopsy. Therapy is aimed at neutralizing the cause of the pathology, improving the patient's condition and achieving stable remission.

General information

Diagnostics

Diagnosis of chronic hepatitis should be timely. All procedures are carried out in the gastroenterology department. Final diagnosis placed on the basis of the clinical picture, instrumental and laboratory examination: blood test for markers, ultrasound of the abdominal organs, rheohepatography (study of blood supply to the liver), liver biopsy.

A blood test allows you to determine the form of pathology due to the detection of specific markers - these are virus particles (antigens) and antibodies that are formed as a result of the fight against the microorganism. Viral hepatitis A is characterized by only one type of marker - anti-HAV IgM or anti-HEV IgM.

With viral hepatitis B, several groups of markers can be detected, their number and ratio indicate the stage of the pathology and prognosis: surface B antigen (HBsAg), antibodies to the nuclear antigen Anti-HBc, Anti-HBclgM, HBeAg, Anti-HBe (it appears only after completion of the process), Anti-HBs (formed when immunity adapts to the microorganism). Hepatitis D virus is identified based on Anti-HDIgM, total Anti-HD and RNA of this virus. The main marker of hepatitis C is Anti-HCV, the second is the RNA of the hepatitis C virus.

Liver functions are assessed based on biochemical analysis, or more precisely, determining the concentration of ALT and AST (aminotransferase), bilirubin (bile pigment), alkaline phosphatase. Against the background of chronic hepatitis, their number increases sharply. Damage to liver cells leads to sharp decline albumin concentrations in the blood and a significant increase in globulins.

Ultrasound of the abdominal organs is painless and safe way diagnostics It allows you to determine the dimensions internal organs and identify changes that have occurred. Most exact method research - liver biopsy, it allows you to determine the form and stage of the pathology, as well as select the most effective method therapy. Based on the results, one can judge the extent of the process and its severity, as well as the likely outcome.

Treatment of chronic hepatitis

Treatment aims to eliminate the cause of the pathology, relieve symptoms and improve general condition. Therapy must be comprehensive. Most patients are prescribed a basic course aimed at reducing the load on the liver. All patients with chronic hepatitis need to reduce physical activity, they are shown a sedentary lifestyle, semi-bed rest, minimum quantity medications, as well as a complete diet enriched with proteins, vitamins, and minerals (diet No. 5). Vitamins are often used in injections: B1, B6, B12. It is necessary to exclude fatty, fried, smoked, canned food, spices, strong drinks (tea and coffee), as well as alcohol.

If constipation occurs, mild laxatives are indicated; to improve digestion - enzyme preparations without bile content. To protect liver cells and speed up recovery processes, hepatoprotectors are prescribed. They should be taken for up to 2-3 months, it is advisable to repeat the course of taking such medications several times a year. For severe asthenovegetative syndrome, multivitamins and natural adaptogens are used.

Viral chronic hepatitis is difficult to treat; immunomodulators play an important role, which indirectly affect microorganisms, activating the patient’s immunity. It is prohibited to use these medications on your own, as they have contraindications and characteristics.

Interferons occupy a special place among such drugs. They are prescribed as intramuscular or subcutaneous injections up to 3 times a week; In this case, an increase in body temperature is possible, so it is necessary to take antipyretic drugs before the injection. Positive result after treatment with interferon is observed in 25% of cases of chronic hepatitis. IN childhood this group of drugs is used in the form of rectal suppositories. If the patient’s condition allows, intensive therapy is carried out: interferon drugs and antiviral drugs are used in large dosages, for example, they combine interferon with ribavirin and rimantadine (especially for hepatitis C).

The constant search for new drugs has led to the development of pegylated interferons, in which the interferon molecule is combined with polyethylene glycol. Thanks to this, the medicine can stay in the body longer and fight viruses for a long time. Such medications are highly effective; they can reduce the frequency of their use and prolong the period of remission of chronic hepatitis.

If chronic hepatitis is caused by intoxication, then detoxification therapy should be carried out, and the penetration of toxins into the blood should be prevented (discontinue medications, alcohol, leave chemical production, etc.).

Autoimmune chronic hepatitis is treated with glucocorticoids in combination with azathioprine. Hormonal drugs are taken orally; after the onset of effect, their dose is reduced to the minimum allowable. If there are no results, a liver transplant is prescribed.

Prevention and prognosis

Patients and carriers of hepatitis viruses do not pose a great danger to others, since infection through airborne droplets and household contact is excluded. You can become infected only after contact with blood or other biological fluids. To reduce the risk of developing pathology, you need to use barrier contraception During sexual intercourse, do not take other people's hygiene items.

For emergency prevention For hepatitis B, human immunoglobulin is used in the first day after possible infection. Vaccination against hepatitis B is also indicated. Specific prevention other forms of this pathology have not been developed.

The prognosis of chronic hepatitis depends on the type of disease. Dosage forms are almost completely curable, autoimmune forms also respond well to therapy, viral forms are rarely resolved, most often they transform into cirrhosis of the liver. The combination of several pathogens, for example, hepatitis B and D viruses, causes the development of the most severe form of the disease, which progresses rapidly. The lack of adequate therapy in 70% of cases leads to liver cirrhosis.

Many people have heard about the chronic form of viral hepatitis C and what it is, but not everyone has complete information.

If we talk about the chronic form of hepatitis C, then this pathology is a serious disease of inflammatory-dystrophic nature that affects liver tissue. The progression of this disease leads to disruption of the structural and functional state hepatobiliary system. Hepatitis type C and chronic hepatitis, caused by other pathogens, are not characterized by changes in the lobular structure of the liver, but poor diagnosis and lack of treatment leads to the formation of liver cirrhosis. That is why much attention is paid to the diagnosis of type C in chronic form.

An interesting fact is that for chronic form hepatitis C is characterized by widespread distribution, and the incidence of the disease does not depend on a person’s age, social status and gender. These circumstances make chronic hepatitis C a generally recognized problem. Below we will describe the chronic form of hepatitis C and the treatment of this pathology using modern methods. In addition, the causes of chronic hepatitis and the pathogenesis of the disease will be mentioned.

Characteristics of the pathogen

The infectious agent of the chronic form of hepatitis C is an RNA chain that is coated with specific proteins. Many scientists are inclined to believe that this virus is viable for hundreds of years. Compared to the causative agents of other forms of hepatitis, the type C virus was discovered later than all others.

Pay attention! The discovery of this virus occurred in the 80s of the twentieth century, when cases of human hepatitis infection were identified. Possibility of reliable laboratory diagnostics of this disease became available in the 90s of the twentieth century. Taking into account observations, it was found that the acute form of hepatitis C becomes chronic in 80% of infected people.

Symptoms

The chronic form of hepatitis C is characterized by a long asymptomatic course, which is accompanied by active progression of the disease. Characteristic symptoms and treatment largely depends on the neglect of the process. After the formation of individual symptoms, the clinical picture of the disease remains blurred. The so-called chronic viral hepatitis with a minimal degree of activity is manifested by the following symptoms:

Increased irritability;
Weakness and general malaise;
Decreased mood for no apparent reason;
Deterioration or complete absence appetite;
Increase in body temperature within 37.4 degrees;
Mild nausea.

Some patients experience symptoms of chronic hepatitis C such as weight loss and muscle pain. The progression of the disease is accompanied by the following clinical signs:

Discomfort and heaviness in the right hypochondrium. To begin with, a person begins to experience discomfort after eating food, especially when it comes to fatty foods and fried foods. When hepatitis C begins to rapidly progress, discomfort and severity occur regardless of food intake.

The meager clinical picture of the pathology makes it difficult to make a timely diagnosis, since most patients associate the listed symptoms with ordinary fatigue, stress and overwork. If one of the listed symptoms appears, it is recommended to immediately consult a physician or gastroenterologist to undergo a comprehensive examination.

If the disease is latent, then when acute liver failure develops, the person begins to feel the most striking symptoms indicating the progression of liver disease. When the chronic form of hepatitis C is advanced, the following manifestations of chronic hepatitis form:

Human urine takes on the color of dark beer;
The skin becomes yellow;
Body weight decreases sharply;
There is an increase in the size of the spleen and liver, hepatosplenomegaly.

The late stage of the disease is characterized by a feeling of general malaise, muscle weakness, increased sleepiness, causeless fatigue, decreased vitality and loss of interest in life. In addition, the chronic form of hepatitis C affects the condition reproductive function person. In men, this is manifested by a decrease in erectile function, and in women, libido disappears.

Pay attention! Over time, it becomes difficult for a sick person to perform even minimal work that previously did not cause him difficulties. Such symptoms develop as a result of serious damage to the liver tissue, which leads to depletion of the body’s internal energy reserves.

When the liver pigment bilirubin accumulates in the tissues of the body, a person develops the following symptoms:

Skin itching. Patients suffering from a chronic form of viral hepatitis C, as a rule, are faced with a clinical picture of jaundice, which is manifested by yellowing of the skin and severe itching. At visual inspection such people can observe a profuse amount of skin scratching;
Hepatic encephalopathy. Since the pigment bilirubin is a toxic component, its penetration into the brain structures leads to the formation of so-called hepatic encephalopathy. This serious condition manifests itself in the form of nervous and mental activity. The main symptoms of encephalopathy are disorders of consciousness, memory impairment, increased irritability, nervousness, attacks of aggression, a tendency to depression, and sleep disturbances.

TO late symptoms chronic form infectious hepatitis C can be attributed to:

Palmar erythema. This symptom manifests itself in the form of redness of the palmar surface of the hand. This condition appears in the background hormonal changes caused by cirrhotic changes in liver tissue;
Telangiectasia or spider veins. Similar changes affect small capillaries of the skin. An infected person may observe invisible red spider veins on the surface of the skin. In most cases, these formations form in the upper part of the body.

In severe cases of CHC with signs of cirrhosis, the following symptoms develop.

This condition is characterized by the accumulation of fluid between the parietal and visceral layers of the peritoneum. This symptom occurs against the background of a decompensated form of liver cirrhosis, when irreversible inhibition of its function occurs. Against the background of ascites, a person’s risk of inflammatory damage to the layers of the peritoneum (peritonitis) increases significantly. Any therapy for hepatic ascites will be symptomatic, since cirrhotic changes in hepatocytes cannot be cured.

Bleeding from dilated veins of the esophagus. Liver cirrhosis, which occurs against the background of progressive hepatitis C, is characterized by a condition such as portal hypertension. In this case, there is an increase blood pressure in the esophageal veins. Increased load on the venous walls leads to their varicose veins. Over time, a person develops this serious complication like esophageal bleeding. This condition requires immediate medical care, up to surgical intervention to stop bleeding.

Violation of blood coagulation function. Another characteristic sign of cirrhotic liver tissue damage due to hepatitis C is a decrease in coagulation rates. In this case, an infected person may notice that even minimal trauma causes extensive hematoma and bleeding. This circumstance is a serious obstacle to operating on infected people, since they are at risk of severe intraoperative bleeding.

Spontaneous bone fractures and osteoporosis. One of the functions of the liver is the absorption of vitamin D, which is necessary to normalize calcium metabolism in the body. If a person has liver failure, then this is reflected in calcium metabolism. Over time, calcium reserves are washed out of bones, which leads to increased fragility and susceptibility to spontaneous fractures.

Extrahepatic lesions

The mechanism of such a serious disease as chronic viral hepatitis C causes the formation of symptoms of extrahepatic damage. It's about about the development of diseases of internal organs located outside the hepatobiliary system. In the background infectious lesion liver, the following diseases can develop:

Polymyositis;
Segren's syndrome;
Raynaud's syndrome;
Cutaneous vasculitis;
Glomerulonephritis;
Fibrosing alveolitis;
B-cell malignant lymphoproliferation;
Arthritis.

The mechanism of formation of extrahepatic lesions is due to the ability of the hepatitis C virus to replicate in various tissues and organs, causing cytotoxic reactions.

Reasons

The mechanism of development of this disease is based on the entry of the hepatitis C virus into the human body. After foreign microorganisms enter the systemic bloodstream, a person develops an acute form of the disease. Over time, this pathology becomes chronic. Infection of a person with the causative agent of viral hepatitis C can be provoked by the following factors:

During the implementation of subcutaneous, intravenous, intramuscular and intradermal injections. People undergoing infusion therapy are at risk;
When performing piercing and tattooing in unsanitary conditions;
Subject to unprotected sexual contact with a carrier of the virus;
When using personal hygiene products of an infected person. Such means include a toothbrush, a towel, manicure accessories and a razor;
During a blood or red blood cell transfusion;
When executing dental procedures, using unprocessed tools;
In the process of implementing hemodialysis;
For injection use narcotic drugs using a non-sterile syringe;
The vertical route of transmission of the pathogen from an infected mother to the fetus.

Taking into account the statistics on the frequency of occurrence of hepatitis C infection factors, the most common cause entry of the virus into the body is the use of untreated medical instruments. Until recently, the leading factor in the transmission of the chronic hepatitis virus was the blood transfusion procedure. Modern technologies testing of whole blood and red blood cells minimizes the risk of using biological materials containing the hepatitis C virus.

Pathogenesis of the disease

Chronic form of hepatitis C for lately has become a leader in pathologies occurring most frequently among the population. In European countries, the incidence rate of viral hepatitis C is at least 70% among all pathologies of an infectious nature. Criteria such as severity pathological process, the rate of its progression and the intensity of clinical manifestations are determined by such parameters as the area of damage to the liver tissue, the mutagenic ability of the virus, the amount of the pathogen that has entered the body, as well as the individual characteristics of the human body. The following factors can aggravate the course of the disease:

The age of the sick person is over 45 years;
Alcohol consumption;
Taking tablets or injected drugs;
Abuse of certain groups of drugs;
Tobacco smoking;
Non-compliance with dietary recommendations;
Decline protective forces body;
Availability concomitant diseases organs and systems;
The harmful effects of environmental factors;
Sedentary lifestyle.

Pay attention! The chronic form of hepatitis C can occur in both icteric and anicteric forms. About 12% of people infected with acute hepatitis C recover without outside intervention. The remaining 88% are faced with the transition of the acute form of the disease to chronic.

A few days after the pathogen enters the systemic bloodstream, a specific immune reaction, aimed at destroying free viral particles. During the immune response, the production of specific antibodies is observed, the action of which is aimed at destroying non-structural antigens of the virus. If a person previously infected with the hepatitis C virus has had a disease that has resulted in recovery, his body does not produce antibodies that form long-term immunity to pathogens.

Diagnostics

In most cases, the diagnosis of chronic hepatitis C occurs during a standard procedure medical examination. The vast majority of people who encountered this problem were unaware of the presence of the virus in their bodies. It is not always possible to recognize the presence of the disease by the characteristic color of the skin, since the icteric form of the disease is very rare. To certain moment formation of irreversible processes in the liver, the infected person does not present any complaints and does not notice a deterioration in general health.

Many people do not pay attention to potential risk factors for pathogen transmission. It is the picture of external well-being that makes it difficult timely diagnosis chronic hepatitis C. Making a reliable diagnosis of viral liver damage is a labor-intensive process that includes a number of sequential laboratory and instrumental studies. Despite the fact that this disease is characterized by the appearance of specific antibodies in the blood, a negative antibody test does not always confirm the absence of the disease.

Laboratory diagnostics

Laboratory research methods for suspected chronic hepatitis C include the following test options:

General clinical blood test. In the acute course of the disease, in clinical analysis blood there are no significant changes. If the disease is in the stage of cirrhotic lesions of liver tissue, then this study will show a decrease in the quantitative and qualitative composition of the blood. A decrease in the number of red blood cells indicates an acceleration of the process of their destruction in the spleen tissue;
Blood coagulation factors. One of the functions of the liver is the synthesis of blood clotting factors. One of these factors is prothrombin. A decrease in the concentration of this substance leads to an increase in blood clotting time and the formation of a tendency to bleeding. A decrease in the prothrombin index is typical for the acute phase of the disease, as well as for irreversible processes in the liver with cirrhosis;
Blood test for alpha-fetoprotein levels. This substance has a protein structure. An increase in alpha-fetoprotein levels is observed with active inflammation of the liver tissue, as well as in the presence tumor process in the liver;
Biochemical blood test.

In addition, laboratory diagnosis of this disease includes a number of virological studies aimed at detecting the causative agent of viral hepatitis C. To identify these smallest particles, the following virological techniques are used:

Anti-HCV Ig test This is standard virological method is used for all patients who are suspected of developing viral hepatitis C. The antibodies presented are synthesized by the human body, as in chronic course diseases, as well as acute ones. In addition, their presence in the blood is observed in those people who previously suffered from this pathology and recovered on their own. This type of research cannot provide reliable information about the presence or absence of the virus in the body, so it is used in combination with other methods;
Analysis for anti-HCV Ig M. The presence of this type of antibody indicates an acute course infectious process. Another reason for the appearance of specific class M immunoglobulins is an increase in the intensity of the chronic infectious-inflammatory process. In medical practice, situations often arise when class M immunoglobulins are not detected in the presence of viral liver damage. That is why the diagnostic significance of this analysis is small;
Blood tests for hepatitis C virus RNA. This type of laboratory diagnostics is aimed at identifying particles of genetic material of the hepatitis C pathogen in the blood. This research method is recommended for every person in whose blood class M immunoglobulins were detected. The blood test method for virus RNA can be quantitative and quality character. If the study shows a positive high-quality composition, then this indicates the presence of viral agents in the human body. Purpose quantitative research blood test for hepatitis C virus RNA is to determine its concentration in the systemic circulation.

Biochemical blood test

The method of assessing the biochemical composition of blood must be given special attention, since this method is capable of identifying multiple markers of inflammatory and destructive changes in the hepatobiliary system. Through this analysis, it is possible to assess the degree of damage to the liver tissue, the level of activity of the infectious and inflammatory process, as well as assess the functional state of this body. The biochemical research technique includes the analysis of indicators such as bilirubin, liver enzymes, and albumin.

Liver enzymes. Each liver cell, called a hepatocyte, contains within itself specific enzymes necessary for the normalization of many biochemical processes in the body. The main liver enzymes include:

Alkaline phosphatase;
Alanine aminotransferase;
Gamma glutamyl transferase;
Aspartate aminotransferase.

An increase or decrease in the levels of each of the listed enzymes indicates the level of activity of the infectious-inflammatory reaction in the liver tissue. When the infectious pathogen hepatitis C virus enters the body, the process of systematic death of hepatocyte cells begins. This process is called cytolysis. Its flow is accompanied by release and release into bloodstream a large number of the listed enzymes. In the chronic course of viral hepatitis C, the concentration of gamma-glutamyltransferase, alanine aminotransferase, and aspartate aminotransferase increases. In this case, the concentration of alkaline phosphatase can remain within the limits physiological norm. The acute course of the disease is indicated by a significant increase in the concentration of the mentioned enzymes.

Albumen. This protein structure is formed from a set of amino acids that enter the human body with food intake. Based on the level of albumin in the blood, it is possible to assess the functional state of the liver. About the reduction functional indicators hepatocytes, indicates a decrease in the concentration of albumin in the blood.

Bilirubin. During normal operation human body, the appearance of this substance in the systemic circulation indicates the physiological death of red blood cells in the spleen. One of the functions of the liver is to process and excrete this pigment along with bile. With the development of an infectious inflammatory process in hepatocytes, bilirubin accumulates in the systemic circulation. When the pigment concentration reaches critical levels, excess substance penetrates the skin and mucous membranes, coloring them with a characteristic yellow. In this case, there is a decrease in the color of stool and darkening of the urine. Similar symptoms are characteristic of the icteric form of chronic hepatitis C.

Instrumental diagnostic methods

In addition to those listed laboratory methods research in the diagnosis of chronic and acute forms of hepatitis C important role instrumental methods are played. These diagnostic measures allow us to evaluate cellular composition liver, its size and functional state. The following methods are used to diagnose viral hepatitis C:

Ultrasound examination of the abdominal organs;
Magnetic resonance imaging;
Computed tomography;
Liver fibroelastometry;
Liver tissue biopsy followed by histological examination;
Acti-test.

Ultrasound examination. This budget and simple diagnostic option allows you to assess the homogeneity of the liver structure, its size, the condition of the bile ducts, the degree of blood supply to the abdominal cavity and the presence of tumor formations of the hepatobiliary system.

Moreover, thanks to the technique ultrasound examination, no matter what phase of hepatitis, it is possible to assess the condition of the pancreas, spleen and gall bladder. An abdominal ultrasound is prescribed for every person with suspected viral hepatitis C. This study is recommended to be carried out on an empty stomach. A few days before the procedure, the patient is prescribed medications that reduce gas formation in the intestines.

Magnetic resonance imaging. This diagnostic technique The most effective approach is to diagnose liver tumors. The method is based on the use electromagnetic radiation in a constant magnetic field of high intensity.

Computed tomography. This diagnostic method is based on the use of x-rays. After execution computed tomography You can get a more informative picture compared to ultrasound.

Fibroelastometry of the liver. The purpose of this study is to assess the degree of fibrotic damage to liver tissue. The duration of a fibroelastometry session does not exceed 20 minutes. To implement the technique, a so-called fibroscan is used, which absorbs ultrasonic waves reflected from liver tissue.

Liver biopsy. One of the most informative methods for diagnosing liver diseases is a biopsy. The essence of the technique is the collection of a small area of liver tissue under the control of an ultrasound sensor. Because the biopsy procedure occurs quickly, the patient may only feel a slight shock. This manipulation is carried out on an outpatient basis. After collecting biological material, it is sent to histological laboratory for further morphological study. Based on the results histological examination it is possible to assess the level of activity of the infectious-inflammatory process, the degree of fibrosis and the cellular composition of the liver. A biopsy also helps determine whether hepatitis is in the acute or latent phase.

Acti-test. To carry out this analysis, the patient is not taken large number venous blood. The acti test is not performed if the disease is exacerbating, in the presence of a bacterial infection, or if high rates bilirubin. The purpose of this test is to assess the severity of the inflammatory process and the degree of fibrosis of the liver tissue.

Treatment

The treatment of this disease requires a comprehensive and thoughtful approach. The basis of treatment for viral hepatitis C is the use of the following groups of medications:

Specific antiviral agents;
Interferons;
Hepatoprotectors;
Immunostimulants and multivitamin complexes.

In addition, each patient is prescribed a specialized diet aimed at reducing the load on the liver and maintaining its functional state.

Drug therapy

Patients suffering from viral hepatitis C are prescribed the drug Ribavirin. This is specific antiviral agent belongs to the class of nucleoside analogues. It is advisable to treat chronic hepatitis with the drug Ribavirin only in combination with interferon alpha. The drug is produced in the form of an injection solution. Usage this drug This is especially true for patients with chronic hepatitis C. It is recommended to consult with your doctor about what chronic hepatitis is and how to treat the disease with this drug. The dosage of the medication is selected individually, depending on the patient’s weight category and the genotype of the virus.

When using Ribavirin to treat this disease, you must be aware of the possible adverse reactions. One common side effect is iron deficiency anemia.

It is impossible to effectively treat chronic hepatitis without the use of alpha interferon. This substance is synthesized by body cells to fight various infections. The alpha interferon category is divided into long-acting substances and short-acting interferons. Short-acting drugs are used less and less in medical practice. For the treatment of viral hepatitis C, it is recommended to use long-acting interferons, which are used no more than once a week. These drugs include Pegasis and Pegintron. Except active substance, these medications contain inert molecules of polyethylene glycol, which allows the active components to be slowly released. Medicines based on alpha interferon are used to treat both acute and chronic forms of this disease. Before starting treatment, it is recommended to read the list of contraindications. Such contraindications include:

Disorders of neuropsychic activity;
The period of bearing a child;
Drug and alcohol abuse;
Subject to availability serious illnesses lungs, kidneys and circulatory system.

Pay attention! In addition to the listed medications, each patient is prescribed hepatoprotectors, the purpose of which is to maintain the functional state of hepatocytes. These drugs include Essentiale and Karsil. A person suffering from this disease is advised to injection B vitamins, consumption of vitamins A and E.

Diet

An integral part effective treatment chronic form of hepatitis C is diet. For patients with this disease, general dietary recommendations are provided:

Complete exclusion of alcohol and tobacco smoking. There are no so-called safe dosages of alcohol, so people suffering from similar disease It is recommended to completely abandon the addiction;
Consuming water-soluble and fat-soluble vitamins. These vitamins include D, E, A, K C, B. Special attention it is necessary to pay attention to B vitamins, which have hepatoprotective properties;
Unlimited consumption of table salt. The diet of people suffering from viral hepatitis C does not include restriction of sodium chloride intake;
Unlimited consumption of animal and plant proteins. This condition is especially relevant for patients suffering from a decompensated form of liver cirrhosis that developed against the background of chronic hepatitis C;
Moderate fat intake. Excessive use foods containing large amounts of fat create an excessive burden on the diseased liver.

Patients with a fairly stable course of chronic hepatitis B may develop clinical signs exacerbations. This is reflected in worsening weakness and usually in increased activity of serum transaminases.

An exacerbation may be associated with seroconversion from an HBeAg-positive to an HBeAg-negative state. Liver biopsy reveals acute lobular hepatitis, which eventually subsides and serum transaminases fall. Seroconversion can be spontaneous and occurs annually in 10-15% of patients or is a consequence of antiviral therapy. The HBV DNA test may remain positive even when anti-HBe appears. In some HBeAg-positive patients, “flares” of viral replication and increased serum transaminase activity occur without disappearance of HBeAg.

Spontaneous reactivation of the virus with a transition from an HBeAg-negative state to an HBeAg- and HBV-DNA-positive state has also been described. Clinical picture varies from minimal manifestations to fulminant liver failure.

Viral reactivation is especially difficult in HIV-infected patients.

Reactivation can be determined serologically by the appearance of anti-HBc IgM in the blood.

Reactivation may be a consequence of cancer chemotherapy, the use of low doses of methotrexate for treatment rheumatoid arthritis, organ transplantation or administration of corticosteroids to HBeAg-positive patients.

Severe disorders are associated with mutations in the pro-core region of the virus, when, in the presence of HBV DNA, there is no e- antigen.

HDV superinfection is possible. This leads to a significant acceleration of the progression of chronic hepatitis.

Superinfection with HAV and HCV is also possible.

As a result, any deviations in the course of the disease in HBV carriers increase the possibility of developing hepatocellular carcinoma.

Chronic hepatitis B associated with the replicative phase (HBeAg-positive replicative chronic hepatitis B)

Clinical and laboratory data in this variant of chronic hepatitis B correspond to active hepatitis.

Patients complain of general weakness, fatigue, elevated temperature body (up to 37.5°C), weight loss, irritability, poor appetite, a feeling of heaviness and pain in the right hypochondrium after eating, a feeling of bitterness in the mouth, bloating, unstable chair. The higher the activity of the pathological process, the more pronounced the subjective manifestations of the disease.

When examining patients, attention is drawn to transient yellowness of the skin and sclera (not often), weight loss, high activity Chronic hepatitis may cause hemorrhagic phenomena (nosebleeds, hemorrhagic skin rashes). Appearance on the skin " spider veins", skin itching, "liver palms", transit ascites usually indicate transformation into cirrhosis of the liver, however, the same symptoms can also be observed with severe activity of chronic hepatitis.

Objective studies reveal hepatomegaly in all patients varying degrees expressiveness. The liver is painful, of a densely elastic consistency, its edge is rounded. An enlarged spleen may be palpable, but the degree of enlargement is often insignificant. Severe hepatosplenomegaly with symptoms of hypersplenism is more characteristic of liver cirrhosis.

In some cases, a cholestatic variant of chronic hepatitis B may be observed. It is characterized by jaundice, itching, hyperbilirubinemia, hypercholesterolemia, high blood levels of γ-glutamyl transpeptidase, and alkaline phosphatase.

In a small number of patients with chronic hepatitis B, extrahepatic systemic lesions with involvement in the inflammatory process of the digestive organs (pancreatitis), exocrine glands (Sjögren's syndrome), thyroid gland ( autoimmune thyroiditis Hashimoto's), joints (polyarthralgia, synovitis), lungs (fibrosing alveolitis), muscles (polymyositis, polymyalgia), blood vessels ( periarteritis nodosa and other vasculitis), peripheral nervous system (polyneuropathy), kidney (glomerulonephritis).

However, it should be emphasized that pronounced extra-systemic lesions are much more characteristic of autoimmune hepatitis and the transformation of chronic hepatitis into cirrhosis of the liver.

Chronic hepatitis B associated with the integrative phase (HBeAg-negative integrative chronic hepatitis B)

HBeAg-negative integrative chronic hepatitis B has a favorable course. As a rule, this is the inactive phase of the disease. This variant of chronic hepatitis usually occurs without pronounced subjective manifestations. Only some patients complain of mild weakness, loss of appetite, mild pain in the liver area. An objective examination of patients does not reveal any significant changes in their condition (no jaundice, weight loss, lymphadenopathy and systemic extrahepatic manifestations). However, there is almost always hepatomegaly and very rarely minor splenomegaly. As a rule, the spleen is not enlarged. Laboratory values are usually normal or upper limit normal, the level of alanine aminotransferase is not increased or increased slightly, there are no significant changes in immunological parameters.

Liver biopsies reveal lymphocytic-macrophage infiltration of the portal fields, intralobular and portal fibrosis, and there is no necrosis of hepatocytes.

Markers of the integration phase of the hepatitis virus are detected in the blood serum: HBsAg, anti-HBe, anti-HBdgG.

Radioisotope and ultrasound scans of the liver reveal hepatomegaly of varying severity.

Chronic HBeAg-negative (integrative) hepatitis with a high level of alanine aminotransferase in the blood - integrative mixed hepatitis

In this variant of HBeAg-negative (integrative) chronic hepatitis, despite the absence of hepatitis B virus replication markers, high levels of alanine aminotransferase in the blood remain, which indicates ongoing pronounced cytolysis of hepatocytes. It is generally accepted that conservation high level alanine aminotransferase in the absence of signs of viral replication requires the exclusion of the addition of other hepatotropic viruses (integrative mixed hepatitis B+C, B+D, B+A, etc.) or may indicate a combination of viral hepatitis B in the integration phase with other liver diseases (alcohol , drug-induced damage liver, liver cancer, etc.).

HBeAg-negative hepatitis with preserved viral replication (mutant HBeAg-negative variant of chronic hepatitis B)

In recent years, the ability of the hepatitis B virus to produce mutant strains has been described. They differ from typical “wild” strains in that they lack the ability to produce specific antigens. Mutations of the hepatitis B virus are caused by an inadequate weakened response of the body to infection, as well as the introduction of vaccinations against hepatitis B. The cessation of antigen synthesis is considered as an adaptation of the virus to the defense mechanisms of the macroorganism, as an attempt to escape from immunological surveillance.

The mutant HBeAg-negative variant of chronic hepatitis B is characterized by a loss of the virus’s ability to synthesize HBeAg and occurs mainly in patients who have a weakened immune response.

The mutant HBeAg-negative variant of chronic hepatitis B is characterized by the following features:

absence of HBeAg in the blood serum (due to low production it remains in hepatitis) in the presence of HBV replication markers;
detection of HBV DNA in the blood serum of patients;
presence of HBeAb in blood serum;
presence of HBS antigenemia in high concentration;
detection of HBeAg in hepatocytes;
more severe clinical course diseases and a much less pronounced response to interferon treatment compared to HBeAg-positive chronic hepatitis B.

F. Bonito, M. Brunetto (1993), Nonaka et al. (1992) reported a severe, clinically manifesting course of mugant HBeAg-negative chronic hepatitis B. The morphological picture of liver biopsies corresponds to HBeAg-positive chronic hepatitis B; the development of destructive liver damage similar to chronic active hepatitis is possible.

It is assumed that in mutant HBeAg-negative chronic hepatitis there is a high risk of malignancy with the development of hepatocarcinoma.

If the inflammatory process in the liver does not stop for a long time (from six months), then the disease passes into another form. In this case, chronic liver hepatitis is diagnosed - a protracted disease, constantly accompanied by regular exacerbations. People with such a diagnosis cannot afford to eat too much; they must categorically refuse alcohol and systematically undergo medical examinations.

Causes of development and clinical manifestations of chronic hepatitis

Most often develop into chronic acute viral hepatitis B and C. In addition, alcohol intoxication, with continued alcohol consumption and in the presence of signs, can also become chronic.

Toxic and drug-induced hepatitis also very often become chronic.

Thus, all the causes of the development of chronic hepatitis that can cause the patient to transition the process into a protracted form are divided into the following groups:

viral hepatitis;
alcohol;
toxic substances;
medications.

Also, one of the main causes of chronic hepatitis are diseases such as Wilson-Konovalov disease and hemochromatosis.

Clinical manifestations of chronic hepatitis are usually divided into three types:

persistent chronic hepatitis- characterized by the fact that liver cells are not affected, and the inflammatory process is localized and affects the hepatic vessels. It occurs relatively easily, often asymptomatically;
lobular chronic hepatitis. With this type of chronic hepatitis, single lobules of the liver are affected;
active chronic hepatitis- is the heaviest. Often this manifestation of chronic hepatitis develops into cirrhosis of the liver. In this case, a large number of liver lobules are affected, and entire sections of the liver die.

Symptoms of chronic hepatitis during periods of exacerbation

Symptoms of chronic hepatitis manifest themselves during periods of exacerbation.

symptoms of damage to the nervous system - weakness, fatigue, irritability, general depression, sleep disturbances;
toxic liver damage and, accordingly, gastrointestinal tract manifest themselves by weight loss; permanent dull pain in the right hypochondrium, which intensify after physical activity; sometimes there is no pain, but there is a heaviness in the abdomen that does not depend on food intake, bloating, belching, a feeling of bitterness in the mouth, nausea, vomiting;
Jaundice is a common, although not obligatory, symptom. Sometimes a sign of chronic hepatitis due to stagnation of bile is unbearable itching of the skin;
symptoms of peripheral vascular damage appear in the form of “spider veins”, “liver” palms (palms become reddish).

Chronic hepatitis, which develops after a viral infection, often occurs with rare exacerbations. Less commonly, the general unsatisfactory condition persists for a long time.

Exacerbation of chronic hepatitis develops, first of all, with violations of the diet, heavy physical activity, alcoholic excesses, and stress.

Remission (improvement in general condition) occurs after active treatment and exclusion of provoking factors. The patient does not experience any particular discomfort. Depending on his compliance with safety rules, the period of remission can be long (up to several years).

Basic principles of treatment of chronic hepatitis

First of all, for the treatment of chronic liver hepatitis, it is necessary to follow the rules of behavior prescribed by the doctor. The main thing is to ensure peace; bed rest is recommended. Due to the fact that with strict adherence bed rest metabolic processes in the liver improve, liver cells recover faster.

One of the basic principles of treating chronic hepatitis is diet. Food should be rich in proteins, carbohydrates and vitamins, fats should be limited, and some should be excluded altogether. Meals should be frequent, fractional, small portions. Of course, alcohol is strictly prohibited!

Drug therapy must be agreed with the attending physician, even if at first glance it is completely harmless herbal infusions or biologically active food additives.

For patients with chronic persistent and chronic lobular hepatitis, it is enough to take hepatoprotectors (Essentiale, potassium orotate, etc.).

Detection of hepatitis B and C virus markers in the blood is an indication for the use of antiviral treatment.

In severe cases of chronic hepatitis, the patient is usually hospitalized in a specialized department of the hospital, where he is prescribed a combination of treatment.

Prevention of exacerbations in chronic hepatitis

Quite a lot has already been said about the reasons for the development of exacerbations of chronic hepatitis. Therefore, it is not at all difficult to conclude: If you do not violate the doctor’s instructions and try to avoid contact with provoking factors, then exacerbations of hepatitis will be extremely rare.

In a weakened body suffering from chronic hepatitis, any infectious diseases, they may increase liver damage. The most serious infections in terms of their consequences are mononucleosis. A person suffering from chronic hepatitis should avoid contact with sick people and carefully observe personal hygiene rules.

Extremely negative influence The course of chronic hepatitis is influenced by diseases of the gastrointestinal tract -,. Dangerous lung diseases and cardiovascular system(oxygen supply to liver cells decreases).

Timely consultation with a doctor regarding diseases of various organs and systems and their full treatment for the prevention of chronic hepatitis is a very important condition.

Physical and emotional stress, alcohol, poor diet, hypothermia, prolonged exposure to the sun cause the condition to worsen, so avoid all this.

To prevent chronic hepatitis, the working day must be organized, moderate physical activity must be alternated with periods of rest, and it is strictly forbidden to work with pesticides (herbicides, pesticides, aggressive technical fluids). Twice a year, patients with chronic hepatitis should undergo preventive examinations, take blood and urine tests.

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