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Introduction. Chicory (Cichorium intybus L.) is widely applied for liver disease treatment by traditional medicine of different countries; as well, it is the object for pharmacological research of hepatoprotective activity. In this regard, the method for obtaining dry extract of wild chicory herb (WCHE) is developed in the All-Russian Research Institute of Medicinal and Aromatic Plants.Aim. Aim of the research is determination of the qualitative composition of phenolic compounds, identification of the substances prevailing in WCHE and conducting pharmacological screening of the extract.Materials and methods. WCHE chemical composition has been explored with HPLC-MS/MS method; the main components were determined quantitatively with HPLC-UF method using single compounds that were isolated by us earlier and identified by NMR spectroscopy. WCHE pharmacological screening of hepatoprotective activity research was involving 50 male rats. Acute toxic hepatitis in animals was induced by a single subcutaneous injection of 50 % oily solution of tetrachloromethane (TCM) at a dosage of 0.4 ml per 100 g body weight. One hour before administration TCM, animals received WCHE at the doses of 100 or 500 mg/kg. 48 hours after TCM administration, the activity of serum enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), as well as the content of total bilirubin were determined for preliminary establishment of pharmacological activity. Pathomorphological studies of rat liver were carried out using histological methods. The liver histological structure was inspected using liver sections stained with hematoxylin and eosin.Results and discussion. The component composition of WCHE is represented by oxycoumarins, hydroxycinnamic acids and flavonoids. The dominant phenolic compounds are esculetin, chicoriin, chicoric, chlorogenic and caftaric acids. It was found under acute experimental toxic hepatitis, that preliminary WCHE administration reduces the toxic TCM effect on liver cells. In animals treated with WCHE at doses both 100 mg/kg and 500 mg/kg body weight, it was observed decreases in ALT activity by 35 % and 45 %, AST by 15 % and 28 %, alkaline phosphatase by 15 % and 21 %; the content of total bilirubin by 20 % and 29 %, respectively, in comparison with similar indicators in the group of animals that were not treated with the extract. The histological study showed that WCHE administration to animals at the doses of 100 and 500 mg/kg reduces dystrophic changes in hepatocytes, this effect is more pronounced at the extract dosage of 500 mg/kg.Conclusion. Main WCHE components are oxycoumarins (esculetin, chicoriin), hydroxycinnamic acids (chicoric, chlorogenic and caftaric). According to the results of screening studies, it was established that WCHE in doses of 100 mg/kg and 500 mg/kg is a promising object for further pharmacological research.

Autoimmune hepatitis is a chronic inflammatory liver disease of unknown etiology; the prevalence of juvenile autoimmune hepatitis is unknown. Autoimmune hepatitis occurs in 10–20% of patients with type 1 autoimmune polyendocrine syndrome, a rare (orphan) disease, which is characterized by a clinical triad in 70–100% of cases: chronic mucocutaneous candidiasis, hypopara thy roidismand adrenal insufficiency, as well as more 25 possible autoimmune endocrine and non-endocrine manifestations.Thisstudy describes a case of a 5-year-old girl with autoimmune hepatitis as the first clinical manifestation of the disease. The symptoms of chronic mucocutaneous candidiasis enabled us to suggest and genetically confirm the diagnosis of autoimmune poly endocrine syndrome type 1 before the lesions of endocrine organs. The girl had nonsense mutations R257 * and p.Q94* of the AIRE gene in a compound heterozygous state. Later, there appeared another autoimmune disorder – common vitiligo.Timelydiagnosisoftype1autoimmunepolyendocrinesyndromeinachildwiththefirstnon-endocrine autoimmune manifestation, initiation of therapy and further medical management made it possible to preventseve recomplications and improve the patient’s quality of life.

Back ground. Liver transplantation is an effective treatment for acute or chronic liver failure and metabolic liver disease, which is associated with good quality of life in over 80 percent of recipients. We aimed to evaluate outcome of duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses in pediatric liver transplant recipients below 15-kg.Methods. In this single-center retrospective study, all children less than 15 kg that have undergone liver transplantation at Nemazee Hospital Organ Transplant Center affiliated with Shiraz University of Medical Sciences from 2009 till 2019, were enrolled. Over a 10-yr period, 181 liver transplants were performed in patients with two techniques including duct-to-duct (Group 1) vs. Roux-en-Y hepaticojejunostomy biliary anastomoses (Group 2). All data was collected from patients’ medical records, operative notes, and post-transplant follow up notes. Data was analyzed by SPSS software V21.Results. Overall, 94 patients had duct to duct anastomosis (group 1) and 87 cases had Roux-en-Y hepaticojejunostomy (group 2). The mean age of the patients was 2.46 ± 1.5. The most common underlying diseases was biliary atresia (32%). The most prevalent complication after the surgery was infection in both groups. cardiopulmonary problems were significantly higher in group 2 (24.1% vs 4.3%) (p < 0.001). The rate of infection was significantly higher in group 2, as well.Conclusion. Our study showed a relatively high rate of post-operative infection which was the most among patients who had undergone Roux-en-Y hepaticojejunostomy. Except from biliary complications which were mostly observed in DD group, other complications were more common among Roux-en-Y group.

The aim of the study: to evaluate the efficacy of extracorporeal liver support systems in patients with acute liver failure of various etiologies.Material and methods. The study included 117 patients with acute liver failure of various etiologies. The main group consisted of 71 patients who received complex intensive therapy, including MARS-therapy and hemodiafiltration. The comparison group included 46 patients who received albumin dialysis (24 patients) and hemodiafiltration (22 patients) alone. The mean age of the patients was 34±5.6 years, the majority (56.4%) were men. Dynamic assessment of patients' severity was performed using Sequential Organ Failure Assessment (SOFA) and Model for End-Stage Liver Disease (MELD) scales.Results. A more significant reduction of SOFA and MELD scores was noted as early as by day 10 of intensive therapy in the main group with sequential use of extracorporeal liver detoxification methods — to 2.7±0.2 vs. 8.3±0.5 points (P=0.021) on SOFA and to 16.7±0.4 vs. 23.4±1.4 points (P=0.023) MELD scales. The use of a comprehensive approach to extracorporeal detoxification in acute decompensated liver failure increased the regression rate of multiple organ failure from 51.2 to 74.6% and reduced mortality from 47.8 to 25.4% (χ2=6.266; df=1; P=0.013). At the same time, the cumulative proportion of survivors depending on the type of complication within 30 days was 88.4% in the main group and 69.0% in the comparison group (χ2=4.164; df=1; P=0.042).Conclusion. A comprehensive approach to extracorporeal detoxification is highly effective, providing a more significant reduction of SOFA and MELD scores, increasing the proportion of regression of multiple organ dysfunction and reducing mortality.

Invasive fungal infections (IFIs) have become the leading cause of morbidity and mortality in oncohematological patients and hematopoietic stem-cell transplant recipients (HSCT). But at the same time, fungal infections are less than 2 % of the causes of liver abscesses in patients without onco-hematological diseases. Doctors from hospitals with onco-hematology departments encounter this more often and know the typical picture of fungal liver abscesses, but for others doctors, who do not have sufficient experience, this finding may not seem like something familiar. This is why knowing the typical patterns of fungal liver disease is so important. We have studied the typical patterns of abscesses in patients with hematological oncology and present a clinical case of patient D, 48 years old. Differential diagnosis of the etiological agent of the abscess is difficult, but in some cases the picture is specific: in the described case, the multiplicity and small size of the foci made it possible at an early stage to effectively identify the fungal nature of the disease and begin the right treatment.

Introduction. Alcoholic liver disease (ALD) is the most common liver disease, the terminal stage of which is alcoholic liver cirrhosis (ALC), which ranks first in terms of prevalence and frequency of lethal outcomes in hospital patients. The pathogenesis of alcoholic liver disease is based on direct damage to the hepatocyte membrane, oxidative stress, hepatic parenchyma inflammation with hyperproduction of inflammatory mediators, immune mechanisms, hepatic parenchyma fibrosis. S-adenosyl-L-methionine (ademetionine) is able to affect the different parts of the pathogenesis of ALD. One of the new ademetionine drugs is Samelix (manufacturer – Canonfarma Production JSC, Russia).Aim of the study. Evaluation of Samelix efficacy and safety in patients with chronic alcoholic liver disease with cholestasis syndrome at the inpatient stage of treatment.Materials and methods. 23 patients (men – 11, women – 12) were admitted to the study. The average age was 51.8 ± 3.4 years. Duration of the disease in the remaining patients averaged 3.5 ± 1.9 years (from 0.5 to 8 years). All patients received detoxification therapy, vitamin therapy, and Verospiron was used in patients with liver cirrhosis. Within 10-12 days the therapy with Samelix was carried out: 800 mg/day intravenous drip. The dynamics of biochemical indices (ALT, AST, GGT, bilirubin, ALP); clinical manifestations; life quality according to the SF-36 questionnaire; side effects were assessed.Conclusions. There was a significant reduction in the number of patients with skin itching, increased fatigue and depressed mood, positive dynamics of biochemical indicators in the form of a decrease in AST, ALT, alkaline phosphatase, GGT, total and direct bilirubin. Thus, the therapy allows to effectively reduce symptoms in patients with alcoholic liver disease, resulting in an improvement on all scales and summary indicators – psychological and physical component of health.

The growth hormone/insulin-like growth factor-1 (IGF-1) system is an important humoral mediator of liver function with an inherent potential for assessing liver condition and survival prognosis following liver transplantation (LT). Aim . Analysis of associations between growth hormone and IGF-1 levels in blood and markers of liver function and post-LT survival in children. Materials and methods . We examined 143 children with end-stage liver disease (ESLD) aged 3 to 73 (median 8) months after related LT. The growth hormone and IGF-1 concentrations in plasma were evaluated in ELISA assays. Results . In children with ESLD, concentrations of growth hormone and IGF-1 were significantly higher and lower, respectively, compared to healthy children of the same age ( p

The OBJECTIVE was to make the comparative assessment of surgical methods for the treatment and prevention of the recurrence of echinococcal liver disease, as well as to study negative and positive aspects of closed echinococcectomy in relation to recurrent efficacy.METHODS AND MATERIAL. 1072 cases (1358 cysts) of echinococcal liver disease were subjected to a retrospective analysis. The clinic performed radical (closed) echinococcectomy using high-tech resection devices on 258 patients, including ultrasound dissectors and destructors-aspirators for 105 patients (main group), other resection devices (LigaSure, an argon plasma scalpel) for patients (control group).RESULTS. Inpatient treatment of patients in the main group amounted to (9.4±2.1) days, in the control group – (11.6±1.7). Postoperative complications in the main group were observed at 4.6 % of patients, in the control group – 11.0 %. Relapse of the liver echinococcosis in the control group occurred in 2.3 % of cases, there were no relapses in the main group. The quality of life of patients in the main group was (73.5±1.8) points, in the control group – (72, 8±1.7) points. There were no lethal outcomes in both groups of patients.CONCLUSION. The most effective in the treatment and prevention of recurrence of echinococcal liver disease are closed methods of echinococcectomy: a cyst pericystectomy, liver resection. When we use ultrasound resection techniques for closed (radical) surgical interventions, intra- and postoperative complications are reduced and the immediate and long-term results of patients with liver echinococcosis are improved.

Aim. To identify trends in the structure of patients with liver diseases, in particular hepatocellular cancer (HCC), by analysing the experience of two specialised medical centres.Materials and methods. A retrospective analysis of the medical records of hepatological patients who sought medical treatment at to the V.Kh. Vasilenko Clinic of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology of the Sechenov University in 2013, 2014 and 2017 (total 2459 patients) was carried out. The number of patients with chronic viral hepatitis (CVH) was 651, with non-alcoholic fatty liver disease (NAFLD) — 590, with alcoholic liver disease (ALD) — 66, with autoimmune liver diseases — 416, with liver cirrhosis (LC) of any etiology 407, other liver diseases — 329. A retrospective analysis of the medical records of patients with HCC who were examined and treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2008 to 2017 (n = 86) was carried out.Results. The ratio of patients with chronic hepatitis C and B in 2013–2017 significantly changed. An almost twofold decrease in the number of patients with chronic hepatitis C (210 patients in 2013 and 141 patients in 2017) and an increase in the number of patients with chronic hepatitis B (20 patients in 2013 and 45 patients in 2017) was observed. An almost twofold increase in the total number of NAFLD patients was detected (163 patients in 2013 and 276 patients in 2017). The number of ALD patients increased from 12 patients in 2013 to 31 patients in 2017. The proportion of patients with autoimmune liver diseases in the overall structure of patients who applied to the department was 20 % in 2013, 13.6 % in 2014 and 10.8 % in 2017. An almost twofold decrease in the number of patients with alcoholic LC and LC associated with HBV was observed (73 patients and 17 patients in 2013 and 38 patients and 6 patients in 2017, respectively) as well as a noticeable increase in the number of patients with alcoholic LC and LC associated with HCV (6 patients and 51 patients in 2013 and 26 patients and 75 patients in 2017, respectively). In the analysis of HCC patients, the ratio of men to women was 3:1 (64 men and 22 women), the median age was 54.5 years (IQR 48–59). The median time from the establishment of chronic liver disease to the detection of HCC was 7.5 years (IQR 3–14.5). In 86 % of cases, the HCC development was preceded by cirrhosis (Child-Pugh A: n = 24; Child-Pugh B: n = 30; Child-Pugh C: n = 20), in 14 % — by chronic hepatitis. Viral liver lesions were the leading cause of HCC in 79 % (n = 68), ALD in 4 % (n = 3), NAFLD in 1 % (n = 1), AIH in 1 % (n = 1). In 10 % (n = 9), a combined liver lesion was observed, in 5 % (n = 4), no previous liver disease was known. The highest five-year survival rate (100 %) was found in the group of patients who received antiviral therapy (AVT) before and after liver transplantation.Conclusions. NAFLD, ALD, and chronic hepatitis B patients began to seek medical help more frequently. An increase in the number of patients with autoimmune LC and LC associated with chronic hepatitis C virus (HCV) infection was observed. The conducted analysis of trends in the structure of HCC patients showed that chronic HCV and HBV infection is the main prerequisite for the development of cancer. Liver transplantation is the most effective treatment for HCC. AVT before and after liver transplantation allows a statistically significant increase in the five-year posttransplant survival of HCC patients with chronic hepatitis C to be achieved.

The presence or development of liver disorders can significantly complicate the course of critical illness and terminal conditions. Systemic hemostatic disorders are common in Intensive Care Units patients with cholestatic liver diseases, so the study of the mechanisms of their development can contribute to the understanding of the development of multiorgan failure in critical illness.The review discusses current data on changes in hemostatic parameters in patients with cholestatic liver diseases, proposes a mechanism for the development of such disorders, which involve interactions of phospholipids with platelet and endotheliocyte membranes. It is suggested that a trend for thrombosis in patients with cholestatic liver disease is due to increased accumulation of bile acids in the systemic circulation. Available data demonstrate that the antiphospholipid syndrome may predispose to the formation of blood clots due to alterations of phospholipid composition of membranes of platelets and vascular endothelial cells by circulating antiphospholipid antibodies. Clarifying the mechanisms contributing to changes of the blood coagulation system parameters in liver disorders will aid to development of optimal correction of hemostatic disorders in patients with chronic liver diseases.

Rationale. The article presents the data obtained by an improved method of contrast-enhanced ultrasound (CEUS) in patients with chronic viral hepatitis. Methods. We compared the quantitative and qualitative CEUS parameters in 2 groups of patients: the 1st group was administered 2.5 ml of the contrast agent, and the 2nd group was administered 1.0 ml of the contrast agent. Results. The results showed that the quantitative parameters had no statistical differences in the arterial and portal phases. Conclusion. The parameters of the late venous phase were not clinically significant, since the study objective included the assessment of diffuse liver disease, not focal liver lesions.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Liver is frequently involved in the pathological process. Wide range of clinical manifestations can be seen: from asymptomatic lesion with normal liver function tests to cirrhosis with portal hypertension. Biopsy plays the key role in diagnosis of the hepatic sarcoidosis. It is essential for morphological diagnosis to exclude other causes of granulomatous liver disease, most often - primary biliary cholangitis. Nowadays there are no standard treatment protocols for patients with hepatic sarcoidosis.

Diagnosis of liver disease in particular non-alcoholic fatty liver disease (NAFLD) is largely determined by methods that are informative, safe, non-invasive, highly sensitive and can be used in all patients without exception. One of these methods is gas chromatography-mass spectrometry (GC-MS). Our study presents the results of serum metabolome assessment by the GC-MS method in male patients for the diagnosis of NAFLD at the stage of non-alcoholic steatohepatitis. In serum samples obtained from 25 patients, 319 compounds were identified, among them 109 were annotated. In patients with NAFLD, there was a significant increase in indole carboxylic and fatty acids, hypoxanthine, hydroxycarboxylic and phenylcarboxylic acids. The results of the study showed that low-molecular metabolites in particular reduced levels of 4-hydroxybutyric acid and 360 compounds suggests possible influence of metabolites on the pathogenesis of NAFLD, and an elevated level of sugar alcohol suggests a possible damaging effect on liver cells. For the detected compounds 4-hydroxybutyric acid, compound-360 and sugar alcohol, high specificity and sensitivity values, high confidence intervals and AUC values were shown, which indicates the possibility of using mass spectrometry analysis of plasma metabolome at high levels of steatohepatitis with high degree of reliability and probability.

Aim. Study of the social consequences of cognitive disorders in minimal hepatic encephalopathy (MHE) in patients with chronic genotype 1 hepatitis C and the possibilities of their pharmacological correction with L-ornithine-L-aspartate (LOLA, Hepa-Merz). Materials and methods. The study group included 60 male patients diagnosed with chronic hepatitis C, genotype 1 with fibrosis stage F1 according to the METAVIR scale, and presented with MHE. The average age of the patients was 34.2±5.3 years. The control group included 20 healthy men aged 34.1±5.8 years without liver disease. Intermittent treatment with LOLA was given to the study group at 15 g once daily in the morning for 2 months with 2-month off-treatment intervals, with the total treatment duration of 12 months. In the course of treatment, MHE dynamics was assessed using the critical flicker fusion frequency (CFF) test and the number connecting test (NCT), as well as by serum concentrations of ammonium ion. The LOLA efficacy endpoint was the change in the frequency of violations of traffic rules (traffic code). Results and discussion. A significant decrease in the concentration of ammonium ion was observed after 5 months of treatment (135.53 and 82.9 μmol/L, p=0.002) and maintained throughout the study. The results of the CFF test significantly improved by the end of the 1st month of LOLA treatment (p=0.008), remaining at the achieved level for 9 months. The NCT parameters reached their minimum values after 5 months (p

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Data on the changes in hepcidin levels in heart failure (HF) patients are contradictory and do not give an answer about its effect on the progression of multiple organ failure. Since the model of end-stage liver disease excluding INR (MELD-XI) reflects the severity of liver and kidney dysfunction, these markers have been suggested to be associated with decompensated HF.Aim. To assess the MELD-XI score and serum hepcidin levels in patients with decompensated HF with different values of left ventricular ejection fraction (EF).Material and methods. The study included 68 patients (29 women, 39 men; mean age 72,3±11,7 years) hospitalized due to decompensated HF. Patients were divided into three groups: reduced (HFrEF) (n=20), mid-range (HFmrEF) (n=23), and preserved EF (HFpEF) (n=24)). Upon admission, along with standard diagnostic tests, all patients were examined for hepcidin-25 levels by enzyme-linked immunosorbent assay. MELD-XI score was calculated. Statistical processing was carried out using the software package Statistica 8.0.Results. Hepcidin levels in the HFrEF group (31,63 ng/ml [22,0; 71,6]) were significantly higher than in the HFmrEF (23,89 ng/ml [21,1; 27,9]) (p10,4 were more likely to have NYHA class III-IV HF, HFrEF and significantly higher levels of hepcidin (pConclusion. Hepcidin level and MELD-XI score in patients with decompensated HF are inversely related to left ventricular EF. There is a direct relationship between hepcidin levels and other clinical parameters: body mass index, the presence of chronic obstructive airway diseases and cardiac arrhythmias.

Aim of investigation. To study the vascular wall changes of common carotid artery and internal carotid arteries in patients with abdominal obesity (AO) and different forms of nonalcoholic fatty liver disease (NAFLD). Material and methods. The study involved 60 patients with AO (waist circumference ≥80 cm in women and ≥94 cm in men) and NAFLD who provided written informed consent to participate in the study. The age of the patient ranged from 18 to 59 years. Patients’ symptoms, past history, were evaluated to exclude alcoholic or drug-induced liver disease, anthropometric parameters were studied. All patients underwent a complex of laboratory and instrumental tests required by the Russian guidelines for diagnosis and treatment of NAFLD (2015). Severity of pathological changes in the liver tissue (fibrosis and steatosis) was assessed by noninvasive Steatoskrin diagnostic method (Biopredictive laboratory, France). Measurement of the intima-media complex thickness of the common carotid artery (IMT CCA) was performed by standard procedures at Voluson 730 Expert device, equipped with 7,5 MHz linear phased array transducer. The presence of early atherosclerotic markers was evaluated by local thickening of the IMT CCA over 0.86 mm in any point of the carotid artery (IMT CCA max). The data were processed by comparative and correlation analysis. Results. The relationship between the presence of NAFLD, initial manifestations of atherosclerosis and insulin resistance was established. This resulted in the rank of prognostic factors based on severity of carotid artery changes, making it possible to conclude individual atherosclerotic risk score for AD and different forms of NAFLD. Conclusion. The results of the study require more profound examination of patients with NAFLD to evaluate both liver and cardiovascular diseases risk.

Aim of review. To summarize the modern data on the course, diagnostics and treatment approach in seronegative autoimmune hepatitis (SAH). Summary. The number of articles devoted to SAH is quite low at the present time, while all of them are based on the small case series or single cases. Absence of elevated serum γ-globulins, immunoglobulin G and autoantibodies is most commonly seen in acute onset of the disease that is probably caused by delay of humoral immune response of the disease. According to available information one can postulate following: 1) clinical vigilance for SAH, especially at liver diseases with high biochemical activity; 2) performing liver biopsies in all cases of unclear diagnosis; 3) application of standard scoring diagnostic system at autoimmune hepatitis; 4) prescription of immunosuppressive therapy at justified suspicion for SAH (at ruling out of the other causes for liver disease). Conclusion. SAH is a rare type of autoimmune hepatitis which is observed mostly at the acute onset of the disease and require obligatory morphological confirmation.

Aim of investigation. To estimate epidemiology of the liver cirrhosis (LC) in Chelyabinsk region in 2006-2015. Results. Statistically significant increase of the both total (254.1-391.8 per 100,000 population) and primary (43.3-67.3 per 100,000 population) incidence of the liver diseases was detected. For the 10-year period of monitoring considerable sporadic fluctuations due to the liver diseases were noted. Since 2013 there was a gradual gain in mortality which in 2015 reached 38.35. By 2015 the decline in mortality due to alcohol-induced LC down to 12.6 cases per 100,000 population alone with increase of female proportion up to 42.5% was noted. No less than 50% of LC motility was due to the working-age patients. The basic direct cause of death in LC patients is hepatocellular failure, in 12.84±0.6% of the cases patients died of gastro-intestinal bleeding. Over the half of the cases of annual motility was due to out-hospital cases. By 2015 liver disease associated motility increased by 31.5% and reached 16.91. The number of hospital admissions of patients with liver diseases for the last 10 years decreased and made 95,8±5,5 cases per 100,000 population, the rate of decrease was 8.7%. Conclusions. The negative trends require further improvement of the healthcare management for LC patients. However objectively restrictions in utilization of the available range of treatment-and-prophylactic actions for treatment of LC in the outcome of viral hepatitis (in drug addicts, alcoholic or asocial patients) due to their low treatment compliance.

According to the World Health Organization estimates, non-alcoholic fatty liver disease (NAFLD) will be ranked number one in the liver diseases pattern by 2020. Liver transplantation in patients with cirrhosis as the outcome of NAFLD currently ranks next to the viral liver cirrhosis. According to current concepts, NAFLD is a liver disease defined as fatty dystrophy, fatty degeneration with inflammation and possible outcome in cirrhosis. The causal relationship between NAFLD and diabetes mellitus is the subject of numerous discussions. Insulin resistance is the binding pathogenetic link between one and the other disease. First of all, insulin resistance is carried out at the level of hepatocyte. Until now, there is no standard therapy for NAFLD. Correction of body weight, changes in food addiction, physical activity is the most effective measures to prevent the development of NAFLD and diabetes mellitus. None of the drugs used for the treatment of NAFLD has evidence base for the effect on the histological pattern of NAFLD.

Aim: to improve diagnostic algorithms for liver, pancreas and bile ducts with the use of multiparametric elastography (MPE). Methods: From 2013 to 2017 in “Clinical hospital №1” were examined 387 patients with liver disease (n=180), diseases of the pancreas (n=127), diseases of the bile ducts (n=80). With the aim of improvement of the algorithms of surveys were conducted MPE: transient, compression elastography, shear wave elastography, compression elastography with endosonography. Results. It defined in terms of dynamic observation of the MPE. Additional conducting of any type of elastography with already-chosen option, and the obtained result is not reasonable: negative correla tion (r from -0,017 to -0,095). The MPE with diffuse liver diseases has greatest value in the dynamic observation of patients: AUC = 0,991 (95%, 0,944-0,997) and in focal liver disease (AUC = 0,991 (95%, 0,944-0,997), compared with its implementation at admission (AUC = 0,702 (95%, 0,602-7,443). Shear wave elastography and the comprassion elastography with endosonography, particularly in the definition of “zone of interest” for subsequent morphological studies, with the aim of diagnosis: AUC = 0,907 (95% CI 0,889 - 0,933), and AUC = 0,903 (95% CI 0,875 - 0,921), respectively. Conclusions. MPE was the most valuable in the dynamic observation of patients with diffuse liver diseases (AUC = 0,991 (95% CI 0,944-0,997), focal pathology (AUC = 0,991 (95% CI 0,944-0,997)). Biopsy remains the main method for primary diagnosis: AUC = 0,999 (95% CI: 0,901-1,000).

Purpose of the study: To investigate the role and clinical inflammatory (IL-17A, IL-23, IL-33) and anti-inflammatory (IL-35) cytokines in patients with of form without erythema of Borrelia infection. Materials and methods: We studied 30 patients with of form without erythema of Lyme borreliosis. The diagnosis was based on epidemiological, medical history, clinical and laboratory, serological data. The blood serum interleukins level was detected from patients at admission to the infectious hospital and on the 10th day of hospitalization, as well as from 30 healthy donors. Groups of investigated persons were matched by sex and age. Blood serum analysis was carried out in the laboratory of directed regulation inter microbe interactions in the exo- and endoecological systems in Kirov State Medical University. Statistical analysis was performed using StatSoft Statistica v 10.0. Results: Patients with form without erythema of Lyme borreliosis oft have lesions of the respiratory system (60,0%), nervous system (53,3%), cardiac disorders (40,0%), rarely – liver disease (26,7%), joints (10,0%). In blood serum of patients with form without erythema at admission and at hospital discharge concentrations of IL-17A, IL-23, IL-33 are authentically higher compared with healthy donors. The content of anti-inflammatory IL-35 in patients with a form without erythema during hospitalization and at discharge is authentically lower than in healthy donors. Conclusion: Patients with form without erythema of Lyme borreliosis have early combined Th1-Th2 immune response (increased content of blood serum IL-23 and IL-33). Elevated concentrations of IL-17A and IL-33 serum in patients with form without erythema indicate the presence of autoimmune or allergic reactions. Patients with form without erythema have inflammatory processes limited moderately by inflammatory reactions on the part of Treg-system (lack of IL-35 production).

α1-Antitrypsin (α1-AT) deficiency is a common genetic disorder characterized by low serum α1-AT levels and a clinical manifestation of pulmonary emphysema and liver disease. In addition to its classical manifestations, α1-AT deficiency frequently accompanies granulomatosis with polyangiitis (GPA); in this case the role of α1-AT deficiency in the clinical course of GPA has not been defined. Objective: to estimate the prevalence of pathological α1-AT phenotypes in GPA and other systemic vasculitides (SV) and to determinate their impact on the clinical course of GPA. Subjects and methods. The investigation enrolled 86 patients with SV, including GPA (n=47), microscopic polyangiitis (MPA) (n=16), eosinophilic granulomatosis with polyangiitis (EGPA) (n=12), and polyarteritis nodosa (PAN) (n=11). A control group included 46 healthy donors. Isoelectric focusing was used to phenotype α1-AT in blood samples and its concentrations were determined. The phenotypes of α1-AT were compared with the overall SV activity index using the Birmingham Vasculitis Activity Score (BVAS), the vasculitis damage index (VDI), the nature of an organ lesion, and the markers of immune inflammation (proteinase 3-antineutrophil cytoplasmic antibodies, total IgG, and C3 and C4 fractions of the complement system). Results and discussion. Pathological α1-AT phenotypes were detected in 17% (8/47) of the patients with GPA, 6.25% (1/16) of those with MPA and absent in EGPA and PAN. Patients with GPA had PiZZ (n=1), PiMZ (n=4), PiMF (n=2), and PiMS (n=1) phenotypes; those with MPA had a PiMS-phenotype. The detection of a pathological α1-AT phenotype in patients with GPA was characterized by the high values of BVAS and VDI (p

Фиброз печени и его конечная стадия цирроз являются одной из причин летальных исходов при хронических заболеваниях печени. Алкоголь и его метаболиты вызывают накопление внеклеточного коллагена, приводящего к фиброзу, вследствие цитокинового дисбаланса, процессов фиброгенеза и фибролиза. Цель. Изучить иммуновоспалительные факторы, ассоциации полиморфизма гена коллагена I типа COL1A11 C/A (rs1107946) с развитием фиброза печени у пациентов, злоупотребляющих алкоголем. Методика. Генотипировано 46 пациентов с фиброзом печени, злоупотребляющих алкоголем (срок употребления алкоголя 15,69,5 лет). Группы сформированы в зависимости от стадии фиброза печени, определенного методом непрямой эластометрии: 1я F01 (n20), 2я F34 (n36). Критерии исключения: острый алкогольный гепатит, хронические заболевания печени неалкогольного генеза, общие воспалительные и аутоиммунные процессы. У всех больных определяли концентрации интерлейкина (ИЛ)6, ИЛ8, ФНОальфа, VEGFA, sICAM1, ЭТ1. Полиморфизм гена COL1A11 определяли методом RealTime PCR. В качестве контрольной группы полиморфизма гена коллагена были обследованы 30 здоровых мужчин и женщин. Результаты. Уровни ИЛ6, ИЛ8, sICAM1, ET1 зависили от степени алкогольного фиброза печени: во 2й группе они были выше, чем в 1й (p0,05). Плотность печени статически значимо (p0,05) коррелировала с уровнем ИЛ6 (r0,6), ИЛ8 (r0,77), sICAM1 (r0,58), ET1 (r0,56). Cтатически значимых различий уровней ФНОальфа и VEGFA между группами не выявлено (р0,05). У больных с фиброзом печени, страдающих алкогольной зависимостью, частота встречаемости аллеля А статически значимо выше, чем в контрольной группе (38,3 против 12,5, 2 7,6212 р0,005768). Частота гетерозигот СА существенно не отличается в группе больных и контрольной группе (38 и 25 соответственно, р0,4425). Гомозиготы АА были выявлены только в группе больных с фиброзом печени, частота встречаемости составила 19,1. Заключение. Выявлена прямая корреляционная связь между уровнем цитокинов (IL8, IL6), молекул эндотелиальной дисфункции (EТ1, sICAM1) с уровнем фиброза печени. Наличие аллеля А гена COL1A11 может являться одним из генетических факторов развития фиброза печени у больных, злоупотребляющих алкоголем., Liver fibrosis and its final stage cirrhosis is one of the causes of deaths in chronic liver diseases. Alcohol and its metabolites mediate the accumulation of extracellular collagen, leading to fibrosis mediated by cytokine imbalances, processes of fibrogenesis and fibrolysis. The purpose. To investigate the immuneinflammatory factors and association between the COL1 A11 C/A (rs1107946) polymorphism and liver fibrosis in patients abusing alcohol. Мethods. 46 patients were genotyped (the period of alcohol consumption was 15.69.5 years) with liver fibrosis, alcohol abusers. They were divided into 2 groups depending on the stage of liver fibrosis: 1 F01, n10 2 F34, n36. Exclusion criteria were chronic nonalcoholic liver disease, acute alcoholic hepatitis, general inflammatory and autoimmune diseases. We analyzed serum concentrations of interleukin (IL)6, IL8, TNF, VEGFA, sICAM1, ET1 and polymorphism of the COL1A11 gene was determined using the RealTime PCR analysis. The stage of liver fibrosis was identified with the elastography method (FibroScan, Echosens, France). Results. The levels of IL6, IL8, sICAM1, ET1 depended on the degree of alcoholic liver fibrosis. The liver fibrosis was significantly correlated with the level of IL6 (r 0.6), IL8 (r 0.77), sICAM1 (r 0.58), ET 1 (r 0.56) (p 0.05). There were no significant differences in the levels of TNFalpha and VEGFA between two groups (p 0.05). It was found that the frequency of allele A among patients was 38.3 which is significantly higher than in the control group (12.5 р0.005768). The frequency of heterozygotes CA was not significantly different between the group of patients and the control group (38 and 25 respectively, p 0.4425). Homozygous AA genotypes were revealed only in patients with liver fibrosis, the frequency was 19.1. Conclusion. A positive correlation between the level of cytokines (IL8, IL6), endothelial dysfunction molecules (ET1, sICAM1) and the level of liver fibrosis was revealed. The presence of allele A of the COL1A11 gene may be one of the genetic factors involved in the development of liver fibrosis in patients abusing alcohol., №3 (2019)

The overlap syndrome in hepatology traditionally defined as the simultaneous presence in a patient of clinical or laboratory signs of two different autoimmune liver diseases. The most common combination is autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC). In this case, a differential diagnosis based on clinical signs is often difficult. Routine laboratory tests indicate the presence of both parenchymal and cholestatic variants of liver damage. There are no international criteria that clearly define the case of overlap syndrome. There is a set of descriptive criteria presented by the International Group for the Study of Autoimmune Hepatitis (IAIHG), which includes not only biochemical and serological indicators, but also the histological examination of the liver. Usually, in the case of overlap syndrome, the course of the liver disease is more aggressive. For example, in case of combination of PBC and AIH, severe fibrosis is more frequent at the time of diagnosis, hepatocellular insufficiency develops faster and indications for liver transplantation appear earlier. The management of patients with overlap syndrome in each case is individual and focused on the prevailing component: autoimmune hepatitis or primary biliary cholangitis. The feasibility of combined immunosuppressive therapy and ursodeoxycholic acid (UDCA) has not been completely clarified. Moreover, this applies both to individual publications and to the consensus documents of the International Group for the Study of Autoimmune Hepatitis. In the absence of a sustained response in the case of a combination therapy, tactics may be revised in favor of monotherapy with UDCA, given the high percentage of complications with continued treatment with immunosuppressants., Традиционно под перекрестным синдромом в гепатологии понимают одновременное наличие у пациента клинических или лабораторных признаков двух разных аутоиммунных заболеваний печени. Чаще всего встречается сочетание аутоиммунного гепатита и первичного билиарного холангита. Дифференциальный диагноз, основанный на клинических признаках, часто бывает затруднен. Рутинные лабораторные исследования указывают на наличие как паренхиматозного, так и холестатического варианта поражения печени. Международных критериев, которые бы четко определяли случай перекрестного синдрома, не существует. Есть набор описательных критериев, представленный Международной группой по изучению аутоиммунных гепатитов, который содержит не только биохимические и серологические показатели, но и в обязательном порядке данные гистологического исследования печени. Обычно в случае перекрестного синдрома заболевание печени протекает более агрессивно. Так, при сочетании аутоиммунного гепатита и первичного билиарного холангита на момент установления диагноза чаще наблюдается распространенный фиброз, быстрее развивается гепатоцеллюлярная недостаточность и появляются показания для трансплантации печени. Тактика ведения пациентов с перекрестным синдромом индивидуальная и ориентирована на преобладающий компонент: аутоиммунный гепатит или первичный билиарный холангит. Целесообразность проведения комбинированной иммуносупрессивной терапии в сочетании с лечением урсодезоксихолевой кислотой не выяснена. Это касается как отдельных публикаций, так и документов Международной группы по изучению аутоиммунных гепатитов. При отсутствии устойчивого ответа в случае проведения комбинированной терапии тактика может быть пересмотрена в пользу монотерапии урсодезоксихолевой кислотой, учитывая большую частоту осложнений при продолжении лечения иммуносупрессантами., Традиційно під перехресним синдромом у гепатології розуміють одночасну наявність у пацієнта клінічних або лабораторних ознак двох різних автоімунних захворювань печінки. Найчастіше трапляється поєднання автоімунного гепатиту і первинного біліарного холангіту. Диференційний діагноз, який ґрунтується на клінічних ознаках, часто буває утруднений. Рутинні лабораторні дослідження вказують на наявність як паренхіматозного, так і холестатичного варіанта ураження печінки. Міжнародних критеріїв, які б чітко визначали випадок перехресного синдрому, не існує. Є набір описових критеріїв, представлений Міжнародною групою з вивчення автоімунних гепатитів, який містить не лише біохімічні та серологічні показники, а і в обов’язковому порядку дані гістологічного дослідження печінки. Зазвичай у разі перехресного синдрому захворювання печінки перебігає агресивніше. Так, при поєднанні автоімунного гепатиту і первинного біліарного холангіту на момент установлення діагнозу частіше спостерігається поширений фіброз, швидше розвивається гепатоцелюлярна недостатність і з’являються показання для трансплантації печінки. Тактика ведення пацієнтів з перехресним синдромом індивідуальна та орієнтована на переважаючий компонент: автоімунний гепатит або первинний біліарний холангіт. Доцільність проведення комбінованої імуносупресивної терапії в поєднанні з лікуванням урсодезоксихолевою кислотою не з’ясована. Це стосується як окремих публікацій, так і документів Міжнародної групи з вивчення автоімунних гепатитів. За відсутності стійкої відповіді в разі проведення комбінованої терапії тактика може бути переглянута на користь монотерапії урсодезоксихолевою кислотою з огляду на велику частоту ускладнень при продовженні лікування імуносупресантами.

Leukemic reactions (LR) are abnormal blood reactions similar to leukemic (subleukemic), but they are different in their pathogenesis; LRs never transform into leukemia. The article presents several clinical cases, the course of which was complicated by the development of LR. The modern recommendations for the diagnosis, classification of LR, differential diagnosis of LR are shown in the article. The article represents the management of patients with LR depending on the somatic disease that provoked the occurrence of LR., Лейкемоидные реакции (ЛР) представляют собой патологические реакции крови, сходные с лейкемическими (сублейкемическими), но отличные от них по патогенезу и никогда не трансформирующиеся в лейкоз. Представлено несколько клинических случаев, течение которых осложнилось развитием ЛР. Изложены современные рекомендации по диагностике, классификации, дифференциальной диагнос­тике ЛР. Рассмотрена тактика ведения пациентов с ЛР в зависимости от основного соматического заболевания, спровоцировавшего возникновение ЛР., Лейкемоїдні реакції (ЛР) — патологічні реакції крові, подібні до лейкемічних (сублейкемічних), але відмінні від них за патогенезом і ніколи не трансформуються в лейкоз. Наведено кілька клінічних випадків, перебіг яких ускладнився розвитком ЛР. Викладено сучасні рекомендації з діагностики, класифікації, диференціального діагнозу ЛР. Розглянуто тактику ведення пацієнтів з ЛР залежно від основного соматичного захворювання, яке спровокувало виникнення ЛР.

Currently, the world is marked rise in the number of patients with liver disease. Approximately 100,000 patients hepatitis complicated by acute liver failure, with mortality in this disease reaches 70-90% despite the use of modern methods of treatment Currently, there are more than 20 concepts of this disease. In 15-20% of cases the cause of acute liver failure can not be established. Most clinicians believe that the pathogenesis of liver failure is a strong humoral and hyperimmune response, resulting in massive necrosis of liver cells. Diagnosis of liver failure based on anamnesis, clinical, biochemical and electroencephalographic changes. Traditional conservative therapy of acute liver failure in the first place based on the measures taken to address the etiological factor. Transplantation is an effective measure in acute liver failure. In the world there are a sufficient number of prognostic scales, criteria and risk factors of acute liver failure. Each of them has its own characteristics, but a unified system of prognostic estimation of arrester.

Liver transplantation is a life-saving procedure for many forms of end-stage liver disease in pediatrics. Cytomegalovirus (CMV) is the most common and signifi cant posttransplant infection after pediatric liver transplant (PLT) with developing an episode of CMV infection or disease. It is well known that CMV increases risk of graft loss. The review presents aspects of etiology and epidemiology of CMV after PLT, approaches employed in diagnostics and prophylaxis of CMV, algorithms for valganciclovir dosing and methods to prevent complications associated with CMV. The latest data on current prevention strategies in pediatric liver transplantation centers in the world are also presented.

Цель исследования: установление связи изменений концентраций антиэндотоксиновых антител (АЭА) и фактора некроза опухолей (ФНО) с состоянием системы гемостаза и фибринолиза у больных хроническим гепатитом (ХГ) и циррозом печени (ЦП). Материалы и методы. Обследовано 37 больных ХГ и 60 — с ЦП. Контрольную группу составили 30 здоровых доноров. Результаты. При ХГ повышение АЭА выявлено в 51,3% случаев, а снижение — в 40,5%; при ЦП — в 46,6% и 44,2% случаев, соответственно. Значения ФНО при хронических диффузных заболеваниях печени (ХДЗП) были достоверно повышены, причем у больных ЦП они были выше, чем при ХГ. Анализ динамики факторов гемостаза и фибринолиза в двух подгруппах больных (I — концентрация АЭА]≤]10 мкг/мл, II — АЭА]>]10 мкг/мл) показал, что при повышении содержания АЭА чаще наблюдались явления гипокоагуляции, гиперфибринолиза, появление маркеров гипокоагуляционной фазы ДВС. Заключение. Полученные данные свидетельствуют о важном патогенетическом значении синдрома эндотоксемии в развитии нарушений гемостаза и фибринолиза при ХДЗП. Предлагается использовать определение содержания АЭА и ФНО для оценки выраженности гемокоагуляционных нарушений и в качестве предикторов развития ДВС-синдрома у больных ХГ и ЦП., Aim: to find the associations of anti-endotoxin antibodies (AEA) and tumor necrosis factor (TNF) with hemostasis and fibrinolysis in patients with chronic hepatitis (CH) and liver cirrhosis (LC). Materials and methods. We examined 37 patients with CH, 60 patients with LC, and 30 healthy donors as control group. Results. In patients with CH the increased AEA content was present in 51,3%, the reduced AEA content – in 40,5%. In patients with LC elevated AEA content was revealed in 46,6% and the reduced AEA — in 44,2%. TNF was signifi cantly elevated in all patients, and patients with LC had higher TNF than patients with CH. The comparison between two subgroups (I — AEA≤10 μg/ml, II — AEA>10 μg/ml) showed that increased AEA had mostly associated with hypocoagulation, hyperfibrinolysis, and hypocoagulation phase of DIC. Conclusion. The results show that the endotoxinemia plays important pathogenetic role for the development of both hemostasis and fibrinolysis disorders. We propose to use AEA and TNF contents to assess the severity of coagulation failure as well as a predictor of DIC-syndrom in patients with CH and LC., №3(72) (2017)

Aim. To assess safety and effectiveness of combination therapy by simvastatin with ursodezoxycholic acid in treatment of dyslipidemia in coronary heart disease patients. Material and methods. Totally 30 CHD patients (stable angina, 2nd functional class — 2FC) having metabolic syndrome (MS) had combination therapy by simvastatin (20 mg/day) and ursodezoxycholic acid (Ursosan in daily dose 15 mg per kg) during 30 days. For all included patients the non-alcoholic steatohepatits (NASH) was confirmed. Of them 25 (85%) had clinical predictors of fibrosis and liver cirrhosis. All patients had abnormal bodyweight and arterial hypertension, very high risk of cardiovascular complications (CCC). Results. After 30 days of therapy there was sugnificant lowering of ALT from 83,61 (1,81, 5,49) to 51,32 (2,41, 5,76) МЕ/l, а AST — from 78,44 (2,02, 4,23) to 42,12 (1,99, 6,32) МЕ/l (mediana). In 7 patients levels of ALT and AST were normal. Also there was significant lowering of dyslipidemia: in 19 (63,3%) there was normalization of some lipid profile components, and in 9 (30%) we reached target LDL cholesterol 1,8 mmol/l. Also there was tendency to bodyweight normalization: BMI decreased by 1,28 kg/m 2 in men and by 2,35 kg/m 2 in women. During the study we did not find any significant side effects. All patients completed the course of simvastatin plus UDCA. Conclusion. Combination treatment by simvastatin and UDCA makes possible the achievement of lipid profile parameters significant improvement and the decrease of serum transaminase activity in patients with CHD and NASH. If not contraindicated, statins and UDCA can be recommended in CHD and non-alcoholic liver disease to reduce the risk of CCC.

Chronic viral hepatitis is one of the most urgent problems of the healthcare. Viral hepatitis is not restricted with liver damage; they are like systemic disease proceeding with obligate development of extrahepatic manifestations. Among endocrine manifestations the most common are autoimmune thyroiditis and diabetes mellitus. The aim of the current study is the comparative evaluation of functional status of thyroid and pancreas in patients with chronic viral hepatitis combined with autoimmune thyroiditis and without it. 69 patients were observed in 3 clinical groups: I group — patients with autoimmune thyroiditis, II group — autoimmune thyroiditis with chronic viral hepatitis, III group — with chronic viral hepatitis.According to the study results the following was elicited: accurate increase in antithyroid peroxidase antibodies level in patients with autoimmune thyroiditis with chronic viral hepatitis, which could be caused by the presence of autoimmune inflammatory process in thyroid against moderate activity of chronic viral liver disease; statistically significant increase in antithyroid peroxidase antibodies level in patients with chronic viral hepatitis, likely connected with autoimmune inflammatory process in thyroid caused by HBV and HCV viral infections; accurate reduction of C-peptide and insulin levels in autoimmune thyroiditis patients with and without chronic viral hepatitis, which might be a predictor of probable diabetes mellitus associated with chronic hepatitis development., Хронические вирусные гепатиты — одна из актуальнейших проблем здравоохранения. Вирус-ные гепатиты не ограничиваются поражением печени и представляют собой системное заболевание, протекающее с закономерным развитием внепеченочных проявлений. Из эндокринных проявлений наиболее часто встречаются аутоиммунный тиреоидит и сахарный диабет.Цель настоящего исследования — сравнительная оценка функционального состояния щитовидной и поджелудочной желез у пациентов с хроническим вирусным гепатитом в сочетании с аутоиммунным тиреоидитом и без него. Обследовано 69 пациентов в трех клинических группах: I группа — с аутоиммунным тиреоидитом, II группа — с аутоиммунным тиреоидитом в сочетании с хроническим вирусным гепатитом, III группа — с хроническим вирусным гепатитом.По результатам исследования выявлено достоверное повышение уровня антител к тиреопероксидазе у пациентов с аутоиммунным тиреоидитом в сочетании с хроническим вирусным гепатитом, что может быть обусловлено наличием аутоиммунного воспалительного процесса в щитовидной железе, протекающего на фоне умеренной активности хронического вирусного заболевания печени; статистически значимое повышение антител к тиреопероксидазе у пациентов с хроническим вирусным гепатитом, вероятно связанное с аутоиммунным воспалительным процессом в щитовидной железе, этиологическим фактором которого является HBV- и HCV-инфекция; достоверное снижение уровня С-пептида и инсулина у пациентов с аутоиммунным тиреоидитом без хронического вирусного гепатита и в сочетании с ним, что может быть прогностическим предиктором возможного развития сахарного диабета, ассоциированного с хроническим вирусным гепатитом., Хронічні вірусні гепатити — одна з актуальних проблем охорони здоров’я. Вірусний гепатит не обмежується ураженням печінки і є системним захворюванням, що перебігає із закономірним розвитком позапечінкових проявів. З ендокринних проявів найчастіше зустрічаються автоімунний тиреоїдит і цукровий діабет.Мета цього дослідження — порівняльна оцінка функціонального стану щитоподібної і підшлункової залоз у пацієнтів із хронічним вірусним гепатитом у поєднанні з автоімунним тиреоїдитом і без нього. Обстежено 69 пацієнтів у трьох клінічних групах: I група — з автоімунним тиреоїдитом, II група — з автоімунним тиреоїдитом у поєднанні з хронічним вірусним гепатитом, III група — з хронічним вірусним гепатитом.За результатами дослідження виявлено вірогідне підвищення рівня антитіл до тиреопероксидази у пацієнтів з автоімунним тиреоїдитом у поєднанні з хронічним вірусним гепатитом, що може бути обумовлене наявністю автоімунного запального процесу в щитоподібній залозі, хронічного вірусного захворювання печінки, що перебігає на тлі помірної активності; статистично значуще підвищення антитіл до тиреопероксидази в пацієнтів із хронічним вірусним гепатитом, імовірно пов’язане з автоімунним запальним процесом у щитоподібній залозі, етіологічним фактором якого є HBV- і HCV-інфекція; вірогідне зниження рівня С-пептиду й інсуліну в пацієнтів з автоімунним тиреоїдитом без хронічного вірусного гепатиту і в поєднанні з ним, що може бути прогностичним предиктором можливого розвитку цукрового діабету, який асоціюється з хронічним вірусним гепатитом.