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The issues of steatohepatitis treatment in the pathogenesis of which a major role plays lipid accumulation in hepatocyte and increased processes of free radical oxidation of lipids. Developed a method of treatment of patients with alcoholic and nonalcoholic steatohepatitis with the inclusion of a combination of essential phospholipids (EPL) and silymarin (SM). A comparative assessment of results of treatment with the inclusion of a combination of EPL and SM, Essentiale and Carsil in 60 patients with alcoholic and nonalcoholic steatohepatitis. Revealed the preferential efficiency of combination EPL and SM in these patients in regard of shortening the time clinical manifestations of disease, reducing transaminase activity, normalization of the cholestasis and cholesterol. Given practical recommendations of treatment patients with alcoholic and nonalcoholic steatohepatitis with the inclusion of a combination of EPL and CM.

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AIM: To reveal the influence of age-related changes in the liver and elasticity according to fibroelastometria to determine the effectiveness of this method in the diagnosis of liver fibrosis in chronic diffuse liver diseases in the elderly patients. MATERIALS AND METHODS: The study included 431 patients with chronic diffuse liver diseases (HDLD) aged 60 to 74 years. Of these, 56 patients had chronic liver disease. All patients underwent comprehensive clinical, instrumental and laboratory examination, indirect ultrasonic liver elastometry (fibroelastometria). RESULTS: All patients were identified in 5 groups (g): I gr. had HDLD viral etiology (n = 84), II gr--alcoholic etiology (n = 38), III gr.--non-alcoholic fatty liver disease (NAFLD) (n = 206) - IV gr.--chronic cholestatic hepatitis and primary biliary cirrhosis (n = 38), V gr. (n = 65), patients that after full thorough examination of data for chronic liver disease hadn't received. According to the results of fibroelastometria elasticity of the liver in group V corresponded to METAVIR F0 and amounted to 4.9 +/- 1.3 kPa. The highest efficiency of liver fibroelastometria was obtained in the determination of stage 4 fibrosis METAVIR in I-IV grams, while the accuracy of the method was 92% with a sensitivity of 100%. CONCLUSION: Age-related changes in the liver in the absence of HDLD in elderly patients have no significant effect on its elasticity. The obtained data allow to evaluate the results of liver fibroelastometria in elderly patients with various etiologies of HDLD on the same criteria as for patients of younger age groups.

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AIM: To ascertain prevalence of chronic hepatitides (CH) of polyvirus etiology and to characterize a course of such polyvirus CH. MATERIAL AND METHODS: A total of 15000 patients with chronic diseases of the liver (CDL) of different etiology were examined for markers of hepatotropic viruses, 312 patients with CH aged 18-59 years were examined clinically, biochemically, virusologically and morphologically. RESULTS: CH of polyvirus etiology are rather prevalent. A replicative form of HBV has a significant effect on the activity of the pathological process in mixed hepatitis. Incidence of chronic HBV and HCV infection rises with age. Viral hepatitis A in drug addicts runs an atypical course. CONCLUSION: Adequate epidemiological analysis, diagnosis and antiviral treatment, follow-up of CDL of mixed viral etiology, monitoring of drug addiction, healthy life style are able to reduce prevalence of mixed hepatitis.

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AIM: To characterize quantitatively and functionally interleukines (IL) in chronic gastrointestinal diseases (CGD) depending on the affected organ, etiology, activity and stage of the disease. MATERIAL AND METHODS: Levels of IL-1 beta, IL-4, IL-6, IL-8, tumor necrosis factor alpha (TNF-alpha), gamma interferon (Inf-gamma) in peripheral blood of 300 patients with chronic hepatitis, gastroduodenal ulcer, cholelithiasis, glutenic enteropathy and other CGD were measured by enzyme immunoassay. RESULTS: CGD are accompanied by cytokine imbalance the severity of which depended on the etiological factor (virus, alcohol, etc.), the disease activity, stage and kind of IL. A maximal IL rise was seen in exacerbations of ulcer, cholelithiasis, chronic viral, autoimmune diseases. At early disease stages higher were the levels of Inf-gamma, IL-1 beta, IL-8, IL-6; at late stages--of TNF-alpha, IL-4. In patients with highly and moderately active CGD content of IL reached 250-750 pg/ml that is 3-5 times higher than in inactive CGD. In alcohol-induced CGD and metabolic disturbances IL level was under 150 pg/ml. CONCLUSION: Assessment of the cytokine spectrum in CGD holds prognostic importance as this spectrum allows conclusion on the disease activity, its progression.

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AIM: To estimate interleukines levels in chronic hepatitis (CH) in respect to CH etiological factor, activity and stage. MATERIAL AND METHODS: Enzyme immunoassay (kits from proteinovy Kontur, St-Petersburg) determined levels of IL-1 beta, IL-4, IL-6 and TNF-alpha in the peripheral blood of 250 patients with chronic hepatitis C (CHC), B (CHB), D (CHD) and G (CHG). RESULTS: IL concentrations in chronic viral hepatitis depend on etiological factor (CHC, CHB, CHD, CHG), activity (high, moderate, low), stage (chronic hepatitis, cirrhosis). IL occur in high quantities in CHC, in moderate concentrations in CHB and in minimal ones in CHG. Maximal IL levels were observed in high hepatitis activity at the stage of hepatic cirrhosis. TNF-alpha and IL-4 concentrations rose more frequently and higher than IL-6 and IL-1 beta (43 and 34%, up to 315 pg/ml and 256 pg/ml, respectively).

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AIM: To study the spectrum of antibodies in chronic hepatitis C (CHC) against various antigenic structures of hepatitis C virus (HCV) and changes in their quantity in response to interferon treatment. MATERIAL AND METHODS: Enzyme immunoassays (kits by Diagnostic Systems, N. Novgorod) were used in examination of 144 CHC patients with circulation of HCV antibodies in peripheral blood. RESULTS: IgG antibodies to cor, NS3, NS4 HCV antigens were present in the highest percentage (75-100%) and concentration (2.5-1.9 units). IgM antibodies to cor HCV, IgM and IgG to HS5 HCV were detected in 36-63%, concentration of the antibodies ranged 0.7-1.7 units. Interferon therapy reduced frequency and amount of virus-specific antibodies to various antigenic structures of HCV, primarily IgM to cor, NS5-HCV, anti-IgG NS5-HCV. CONCLUSION: In CHC a wide spectrum of antibodies to HCV antigenic structures are produced. They have different biological properties. Interferon treatment diminished their frequency and amount. This allows to consider changes in the amount of virus-specific antibodies in CHC as a criterion of antiviral treatment effectiveness.

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Patients with chronic hepatic disease have higher superoxide dismutase (SOD) activity and lower erythrocytic glutathione levels. There was a decrease in plasma SOD activity in cirrhosis, a feedback between the dismutase and oxidase activities of ceruloplasmin in cholestatic damages to the liver. Drug therapy resulted in positive dynamics in the levels of SOD, glutathione peroxidase, glutathione, ceruloplasmin, which is likely to be associated with the control of the enzymatic mechanisms of antioxidative protection. It is suggested that the enhanced erythrocytic SOD activity in hepatic diseases might trigger free radical oxidation.

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Chronic viral diseases of the liver are associated with changes in immune reactions mediated by T and B lymphocytes and dependent in severity on etiological factor (virus of hepatitis B, delta, C, their combination), the disease stage (hepatitis, cirrhosis), the process activity, kind of immune correction. HBsAg, viral hepatitis B marker, was detected in 21.2% of 1400 cases with chronic active hepatitis and liver cirrhosis. 32% of HbsAg-seropositive patients had antibodies to delta-antigen. Antibodies to HBsAg, HCV were found in 27.7 and 14.9% of the above patients. Chronic viral diseases of the liver with persistence of HBV, HDV and HCV markers are characterized by a complex of immune disorders, including a moderate rise in peripheral blood of IgM, IgG, IgA, IgE, Ig kappa, lambda, immune complexes, cryoglobulins, autoantibodies to subcellular structures as well as changes in regulatory (suppressor, helper) and effector (lymphokine-producing) functions of T lymphocytes, inhibition of phagocytosing capacity. The above shifts in immune status, clinical and biochemical activity of the disease are more pronounced in chronic active hepatitis with HCV markers compared to BHV. Of maximal intensity they were in combined viral infection HBV+HDV or HBV+HCV.

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A reciprocal type of the relationship between superoxide dismutase (SOD) and hepatic ceruloplasmin levels in the liver and plasma has been demonstrated. This acts as an integrating mechanism of antioxidant resistance in hepatobiliary diseases. The value of SOD/ceruloplasmin ratio is presented which was low in primary biliary cirrhosis and chronic cholestatic hepatitis. A statistical significance for the differences between biochemical indices of cholestasis (bilirubin, cholesterol, alkaline phosphatase) was less than for SOD/ceruloplasmin ratio. The latter proved more informative in the diagnosis of cholestasis.

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