IMPACT OF CORTICOSTEROID AND IMMUNOSUPPRESSIVE THERAPY ON THE COURSE OF CHRONIC HEPATITIS: RISKS AND PROSPECTS

Аннотация

Chronic viral hepatitis is an inflammatory dystrophic-proliferative process in the liver, genetically determined by a deficiency of cellular and macrophage immunity, prolonged (more than 6 months), clinically manifested by asthenovegetative and dyspeptic syndromes, persistent hepatosplenomegaly, liver dysfunction, hyperfermentemia and dysproteinaemia. Keywords: Liver encephalopathy, chronic liver disease, hypoglycaemia, Complications, cirrhosis, mucosa, coma, atrophy, pain, disorders, clinical forms, symptom, drug overdose, the portal vein system. ВЛИЯНИЕ КОРТИКОСТЕРОИДНОЙ И ИММУНОСУПРЕССИВНОЙ ТЕРАПИИ НА ТЕЧЕНИЕ ХРОНИЧЕСКОГО ГЕПАТИТА: РИСКИ И ПЕРСПЕКТИВЫ Аннотация. Хронический вирусный гепатит — воспалительный дистрофически- пролиферативный процесс в печени, генетически обусловленный дефицитом клеточного и макрофагального иммунитета, длительный (более 6 месяцев), клинически проявляющийся астеновегетативным и диспептическим синдромами, стойкой гепатоспленомегалией, нарушением функции печени, гиперферментемией и диспротеинемией. Ключевые слова: Печеночная энцефалопатия, хронические заболевания печени, гипогликемия, осложнения, цирроз, слизистая, кома, атрофия, боль, расстройства, клинические формы, симптом, передозировка лекарственных средств, система воротной вены. Introduction: Criteria for the evaluation of chronic hepatitis are based on 4 main points - aetiology, pathogenesis, degree of activity of the process and stage of chronicisation (degree of fibrosis). According to the decision of the World Congress of Gastroenterologists (Los Angeles, 1994), the following variants of chronic hepatitis are distinguished: By etiology: -viral hepatitis (chronic viral hepatitis B, C, D, chronic viral hepatitis of unknown type); -autoimmune hepatitis; -chronic drug-induced hepatitis; 1123 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 2 -alcoholic hepatitis; -toxic hepatitis; -cryptogenic (idiopathic) chronic hepatitis. According to the clinical picture: I. HBsAg carrier (ALT 2 norms; DNA > 104 copies/ml, or 2,000 IU/ml; HBeAg+). III. Immunotolerant hepatitis B. The main cause of all chronic liver diseases is hepatotropic viruses. HCV causes 40-60 per cent of all cases and HBV 10-15 per cent of chronic hepatitis. The current epidemic situation is particularly dangerous due to the growth of drug addiction among young people. In this group, the risk of hepatitis infection ranges from 50 to 90 per cent, whereas in the general population the incidence does not exceed 5 per cent. The global incidence of viral hepatitis far exceeds the incidence of many other viral infections in terms of growth rate and prevalence. In comparison, the annual global incidence of human immunodeficiency virus infections due to intravenous drug use: - human immunodeficiency virus from 80 to 160 thousand people, - hepatitis B virus from 8 to 12 million people, - hepatitis C virus about 35 million people. As a result of these three infections alone (HIV infection, hepatitis B and C), about 13 million people die each year. Long-term analyses of the incidence of viral hepatitis show a decreasing trend in the proportion of acute forms of the disease in the overall structure of viral hepatitis and an increase in chronic forms. Among hepatotropic viruses, A, HC viruses are predominantly prevalent, while B and C viruses are capable of causing a chronic process in the liver. The clinical picture of chronic hepatitis is characterised by several symptoms and syndromes. Hepatomegaly is a frequent and constant sign in diffuse chronic liver diseases. In CH, it is due to lymphomacrophagal infiltration, to a lesser extent hepatocyte dystrophy. Examination allows to determine the ‘tumour’ shifting during breathing in the right subcostal or subgluteal region. At percussion the left border of hepatic dullness is determined (in norm it does not go beyond the left pericardial line), increase in the size of the liver according to Kurlov (9 % 8 % 7 cm in norm). 1124 ResearchBib IF - 11.01, ISSN: 3030-3753, Volume 2 Issue 2 Palpation - the liver is moderately dense, painful, its edge is pointed. However, it should be noted that the painfulness of the liver, determined palpatorily, is caused by stretching of the glisson capsule (against the background of circulatory insufficiency) or increased pressure in the biliary passages - in case of cholangitis. Hepatalgia - in periods of activity of process at CH almost all patients have painfulness in liver area or unpleasant feeling of heaviness in liver area, which appear or intensify. liver, which appear or intensify after physical activity. Mesenchymal-inflammatory syndrome - its clinical signs are fever (due to impaired inactivation of pyrogens in the liver and intoxication), arthralgias and myalgias, lymphoadenopathy, hepatomegaly and splenomegaly, vasculitis (skin, lungs, kidneys). Fever is not pronounced, not accompanied by chills, b