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INVENTION
Patent of the Russian Federation RU2255659
METHOD OF DIAGNOSTICS OF CHRONIC HEPATITIS
The name of the inventor: Lazebnik Leonid Borisovich (RU); Chekmazov Igor Alexandrovich (RU); Petrakov Alexander Vasilyevich (RU); Ilchenko Lyudmila Yurievna (RU); Sharafanova Tatyana Igorevna (RU); Vladimir N. Drozdov (RU); Silvestrova Svetlana Yurievna (RU); Khomeriki Sergey Germanovich (RU); Vinnitskaya Elena Vladimirovna (RU); Lychkova Alla Eduardovna (RU)
The name of the patent owner: Lazebnik Leonid Borisovich (RU); Chekmazov Igor Alexandrovich (RU); Petrakov Alexander Vasilyevich (RU); Ilchenko Lyudmila Yurievna (RU); Sharafanova Tatyana Igorevna (RU); Vladimir N. Drozdov (RU); Silvestrova Svetlana Yurievna (RU); Khomeriki Sergey Germanovich (RU); Vinnitskaya Elena Vladimirovna (RU); Lychkova Alla Eduardovna (RU)
Address for correspondence: 129343 , Moscow, ul. Amundsen, 11, building 1, ap. 53, A.E. Lychkova
Date of commencement of the patent: 2003.12.04
The invention relates to the field of medicine, in particular to virology. The method provides increased accuracy of diagnosis of chronic hepatitis due to TTV-virusemia. An ultrasound is performed, and liver liver biopsy is performed in the presence of hepatic cholestasis, and if there is an intra-lobular lymphoid cell infiltrate in place of liver cell necrosis, uneven wall thickening of the central vein, central, mild pericentral and focal perigepocellular fibrosis combined with deposition Lipofuscin and desquamation of epithelial cells in the bile ducts diagnose TTV-mediated chronic hepatitis.
DESCRIPTION OF THE INVENTION
The invention relates to the field of medicine and can be used in the diagnosis of chronic hepatitis caused by TTV virusemia.
A method for diagnosing viral hepatitis using the PCR method is known, taken for analog (1).
A method for the diagnosis of chronic hepatitis is known, including the study of the content of CD 95 + in peripheral blood using monoclonal antibodies (2), accepted as a prototype.
However, the accuracy of diagnosis of chronic hepatitis due to TTV-virusemia, according to the prototype method is relatively limited.
It is an object of the present invention to improve the accuracy of diagnosis of chronic hepatitis due to TTV virusemia that causes liver damage and to ensure early detection (3-6 months) of hepatitis.
The technical result is achieved by the fact that when the symptoms of intrahepatic cholestasis are detected, morphological examination of the liver biopsy specimen is carried out and in case of detection of focal portal, periportal and lobular hepatitis in combination with detection of diphofuscin deposits and desquamation of epitheliocytes in bile ducts in 76-78% of cases, TTV-mediated chronic hepatitis .
THE METHOD IS PROVIDED AS FOLLOWS:
At admission, patients complain of a feeling of heaviness or pain in the right upper quadrant, weakness, fatigue, some patients experienced dyspepsia, dry mouth and bitterness, heartburn, belching. Some patients showed signs of liver damage (small hepatic signs, hepato- and splenomegaly).
When a patient is admitted with suspicion of TTV infection, a complex of clinical, biochemical, immunological, virologic, morphological and ultrasound studies is performed. The functional state of the liver is assessed by the activity of alanine and aspartic aminotransferases, 
-glutamyltranspeptidase, the content of bilirubin, cholesterol, protein, protein fractions, creatinine, urea and prothrombin. The method of radial immunodiffusion in serum determines the content of immunoglobulins IgM, IgG, IgA. Using the enzyme immunoassay - HBsAg, HBsAb, HBeAg, HBeAb, HBcAb IgM, HBcAb IgG, HCVAb IgM and HCVAb IgG. HGV RNA, TTV DNA is determined by PCR. Ultrasonography is carried out on an Aloka 1100 apparatus.
To clarify the nature of gallbladder contractility with ultrasound, examine it on an empty stomach after a choleretic breakfast. The motor-evacuation function was assessed as normal if the volume of the gall bladder decreased to 30% of the initial 30-40 min.
In some cases, fractional duodenal sounding is performed. In portion "B", the total concentration of bile acids, cholesterol and phospholipids was determined by the enzymatic method, followed by the calculation of the cholate-cholesterol index (X / X) and the saturation index of bile with cholesterol. To clarify the diagnosis, a morphological study of liver biopsy specimens obtained by percutaneous puncture biopsy was performed.
According to the data of ultrasound examination of the abdominal organs, signs of diffuse liver damage were detected in 80% of patients with TTV-hepatitis. In addition, in TTV-monoinfected patients, changes in the gallbladder (concrements, suspensions, wall thickening, and gallbladder hypokinesia) occurred in 76% of cases.
Clinical and biochemical analysis of blood: Ac AT - 332.8-39.2 units / l, Al AT - 39.2-44.5 units / l and more; Alkaline phosphatase - 153-172 units / l, gamma-glutamyl transpeptidase - 45.2-51.3 units / l, bilirubin - 34.5-38.2 μM / l.
Morphological examinations of the liver biopsy are carried out, and in the 76-78% detection of focal portal, pereportal and lobular hepatitis, deposits of lipofuscin and desquamation of epithelial cells in the bile ducts are diagnosed with TTV-mediated chronic hepatitis.
EXAMPLES OF IMPLEMENTATION
Example 1
The patient I-in, 32 years old, was diagnosed with chronic hepatitis, exacerbation. Complaints about the feeling of heaviness in the right hypochondrium, weakness and fatigue. On examination, hepatic palms, a small enlargement of the liver and spleen are noted. Clinical and biochemical blood tests are carried out: АТ АТ - 39,2 units / l, АТ АТ - 44,5 units / l; Alkaline phosphatase - 172 units / l, gamma-glutamyl transpeptidase - 51.3 units / l, bilirubin - 36.4 μM / l. Virological research revealed the presence of TTV +.
Using ultrasound, the volume of the gallbladder was examined on an empty stomach after a choleretic breakfast. The motor-evacuation function in this patient was reduced, amounting to 1/4 of the original. Stone deposits of 0.8, 1.0 and 0.9 mm in diameter were found. At ultrasound examination of the liver, signs of its diffuse lesion were found.
Conduct a morphological study of liver biopsy. An intra-lobular lymphoid cell infiltrate was found in the place of hepatic cell necrosis. Its edges are even, some of the adjacent hepatocytes have a wrinkled acidophilic cytoplasm, hyperchromic and pycnotic nucleus. In addition, signs of focal portal hepatitis were found. Simultaneously, deposits of lipofuscin and desquamation of epithelial cells in bile ducts are noted. Based on the studies conducted, a diagnosis was made: TTV-mediated chronic hepatitis.
Etiological treatment was carried out. The patient was discharged in the state of clinical and laboratory remission. Further observation confirmed the correctness of the diagnosis.
Example 2
Patient Ts-va, 49 years old, complained of pain in the right hypochondrium, bitterness in the mouth, heartburn and belching. The patient had small hepatic signs and a moderate increase in the liver.
To clarify the nature of gallbladder contractility with ultrasound, examine its volume on an empty stomach after a choleretic breakfast. The motor-evacuation function of the bladder was reduced, the walls of the bladder thickened. The phenomena of biliary sludge were noted. According to ultrasound, the liver shows signs of its diffuse lesion.
Immunological examination revealed TTV + hepatitis. The content of immunoglobulins in the blood serum was: IgM - 134 mg% (norm 105), IgG - 1605 mg% (norm 1080), IgA - 295 mg% (norm 155).
Fractional duodenal sounding is carried out. In the portion "B" the total concentration of bile acids was 16.9 μM / l and cholesterol - 4.8 mM / l.
Cholato-cholesterol index - 9,3 (norm 10-13) and bile saturation index of cholesterol (CSI) - 1,3 (norm less than 1,0). To clarify the diagnosis, a morphological study of liver biopsy specimens obtained by percutaneous puncture biopsy was performed.
Perform a morphological study of liver biopsy: there is pereportal hepatitis in combination with the deposition of lipofuscin and desquamation of epithelial cells in the bile ducts. Based on the study conducted DS: TTV-mediated chronic hepatitis.
Interferon treatment was performed.
After the treatment, he does not complain.
Then the control examination is carried out: Hb 110 g / l, E - 3,3 · 10 12 / l, ESR - 9,5 mm / h, L - 8 · 10 3 / l, platelets - 290 · 10 3 / l, Ac AT - 23 units / l, Al AT - 28 units / l; Alkaline phosphatase - 99 units / l, gamma-glutamyl transpeptidase - 21.8 U / l, bilirubin - 15.3 μM / l.
The patient is discharged in a satisfactory condition.
Example 3
The patient M., 24 years old, complains of pain in the right hypochondrium, dryness and bitterness in the mouth.
A complex of clinical-biochemical, immunological, virological, morphological and ultrasound studies is conducted.
According to ultrasound data, signs of diffuse lesion were detected, changes were noted on the part of the gall bladder (thickening of the wall, suspension). The contractility of the gallbladder after a choleretic breakfast is lowered.
Clinical and biochemical blood test: ATS - 35.8 units / l, Al AT - 42.3 U / l; Alkaline phosphatase - 168 units / l, gamma-glutamyl transpeptidase - 49.0 units / l, bilirubin - 36.4 μM / l.
In the morphological study of liver biopsy, uneven thickening of the wall of the central vein was noted. Central, moderate pericentral and focal perigepocellular fibrosis. Lipofuscin deposits and desquamation of epithelial cells in the bile ducts were found. A conclusion is drawn about TTV-mediated chronic hepatitis.
The patient is prescribed treatment with interferon.
The patient was put into a state of clinical remission. When discharging, recommendations are given for compliance with diet and phytotherapy.
According to the claimed method, 25 patients were diagnosed with hepatitis. TTV-associated viral hepatitis was detected in 23 patients. At the same time early detection of viral hepatitis is provided.
All patients were discharged in a state of remission and transferred to outpatient supervision. Follow-up observation confirmed the correctness of the diagnosis in 92% of cases.
INFORMATION SOURCES
1. Kokueva O.V. And others Ross. F. Gastroenterol. Hepatol. Coloproctal. 2003, 13, p. 75.
2. Avezov S.A. And others Ross. F. Gastroenterol. Hepatol. Coloproctal. 2003, 13, p. 81.
CLAIM
A method for diagnosing chronic hepatitis due to TTV virusemia by ultrasound, characterized by performing an ultrasound and detecting hepatic cholestasis while performing a morphological study of liver biopsy and in the presence of an intra-lobular lymphoid cell infiltrate in place of liver cell necrosis, uneven wall thickening of the central Veins, central, moderately expressed pericentral and focal perigepocellular fibrosis in combination with the deposition of lipofuscin and desquamation of epithelial cells in the bile ducts, diagnose TTV-mediated chronic hepatitis.
print version
Date of publication 09.01.2007гг
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