Журнал «Актуальная инфектология» 1 (2) 2014
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Dynamics of Clinical-Biochemical and Immunological Parameters in Patients with Acute Hepatitis B Accompanied by Chronic Alcohol Consumption in Hepatotoxic Doses
Авторы: Rуabokon E.V., Furyk E.A. - Zaporizhya State Medical University, Ukraine
Рубрики: Инфекционные заболевания
Разделы: Клинические исследования
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The aim of work — identify changes clinical, biochemical parameters and cytokine status of patients with acute hepatitis B with concomitant chronic used of alcohol in hepatotoxic doses in dynamics of the disease. The observation was 133 patients with acute hepatitis B. When dividing patients with acute hepatitis B into groups take into account the presence or absence chronic used of alcohol in hepatotoxic doses using the classification of alcohol consumption based on the frequency and dose of alcohol consumed. І group consisted of 52 patients with concomitant chronic used of alcohol in hepatotoxic doses, ІІ group consisted of 81 patient without that factor.
In the analysis of clinical and biochemical data revealed that the prodromal period in patients with acute hepatitis B with chronic used alcohol in hepatotoxic doses averaged (5,8±0,5) day and was longer (р<0,05), than in patients with II group — (4,6±0,3) days. Different variants of prodromal period were recorded in patients in both groups equally. Recording frequency of clinical signs in most patients in both groups were not statistically different (р>0,05). However, only in patients with acute hepatitis B with chronic used alcohol in hepatotoxic doses were marked hemorrhagic manifestations (5,8 %) and itching (7,7 %).
Acute hepatitis B in patients with chronic used alcohol in hepatotoxic doses characterized by higher levels of hyperbilirubinemia, and during convalescence maintaining higher, alanine aminotransferase activity compared with group II patients.
In the presence of chronic used of alcohol in hepatotoxic doses in patients during convalescence of acute hepatitis B after basic treatment is characterized by persistence of circulating HBsAg (100 % against 64,2 %, χ2=14,21, р<0,01), lower incidence of seroconversion HBeAg — anti-HBe (45,0 % against 76,5 %, χ2=9,67, р<0,05) lower ((р<0,01) quantitative content of anti-HBe in serum compared with patients with acute hepatitis B without concomitant liver disease.
It is shown that in patients with acute hepatitis B with concomitant chronic used of alcohol in hepatotoxic doses in acute period of the disease is characterized by low levels of interleukin-2 and high levels interleukin-8 in the serum, compared with patients without this cofactor. In the convalescence period in these patients an imbalance in cytokine status at the expense of low levels of interleukin-2 and a high level of interleukin-6 and interleukin-8 in serum.
В работе показано, что у больных острым гепатитом В с сопутствующим хроническим употреблением алкоголя в гепатотоксических дозах разгар заболевания характеризуется низким содержанием уровня интерлейкина-2 и высоким уровнем интерлейкина-8 в сыворотке крови по сравнению с пациентами без этого сопутствующего фактора. В период реконвалесценции у этих больных сохраняется дисбаланс цитокинового статуса за счет низкого содержания интерлейкина-2 и высокого уровня интерлейкина-6 и интерлейкина-8 в сыворотке крови, что сопровождается высокой активностью аланинаминотрансферазы, более частой циркуляцией в крови HBsAg и меньшей частотой сероконверсии с появлением anti-HBe.
У роботі показано, що у хворих на гострий гепатит В із супутнім хронічним вживанням алкоголю в гепатотоксичних дозах розпал захворювання характеризується низьким умістом інтерлейкіну-2 та високим рівнем інтерлейкіну-8 у сироватці крові порівняно з пацієнтами без цього супутнього фактора. У період реконвалесценції у цих хворих зберігається дисбаланс цитокінового статусу за рахунок низького вмісту інтерлейкіну-2 та високого рівня інтерлейкіну-6 й інтерлейкіну-8 у сироватці крові, що супроводжується високою активністю аланінамінотрансферази, частішою циркуляцією в крові HBsAg та меншою частотою сероконверсії з появою anti-HBe.
acute hepatitis B, cytokines, chronic alcohol consupmtion in hepatotoxic doses.
острый гепатит В, цитокины, хроническое употребление алкоголя в гепатотоксических дозах.
гострий гепатит В, цитокіни, хронічне вживання алкоголю в гепатотоксичних дозах.
Статья опубликована на с. 26-28
Introduction
Hepatitis B at present one of the most common infectious diseases an important public health problem in many countries. Leading role in the pathogenesis of HBV play immune responses, including changes in cytokine balance, since cytokines are directly involved in the development of inflammation, an adequate immune response and liver regeneration. The imbalance in the system cytokine regulatory chain is a key element of immune disorders in liver disease and imbalance of cytokine production of T-helper 1 and T-helper 2 types plays an important role in the immunopathogenesis and progression of chronic HBV-infection.
Among the combined lesions of the liver, special attention is currently paid to viral and alcoholic. Long-term alcohol consumption leads to various disorders of the structure and functions of the liver are steatosis, steatohepatitis, or even cirrhosis.
The aim of work — identify changes clinical, biochemical parameters and cytokine status of patients with acute hepatitis B with concomitant chronic used of alcohol in hepatotoxic doses in dynamics of the disease.
Material and Methods
The observation was 133 patients with acute hepatitis B. When dividing patients with acute hepatitis B into groups take into account the presence or absence chronic used of alcohol in hepatotoxic doses using the classification of alcohol consumption based on the frequency and dose of alcohol consumed. І group consisted of 52 patients with concomitant chronic used of alcohol in hepatotoxic doses, ІІ group consisted of 81 patient without that factor.
Results and Discussion
In the analysis of clinical and biochemical data revealed that the prodromal period in patients of І group averaged 5.8 ± 0.5 days and was longer (р < 0.05), than in patients with II group — 4.6 ± 0.3 days. Different variants of prodromal period were recorded in patients in both groups equally. Recording frequency of clinical signs in most patients in both groups were not statistically different (р > 0.05). However, only in patients I group were marked hemorrhagic manifestations (5.8 %) and itching (7.7 %).
As a result biochemical studies of blood in the midst of acute hepatitis B patients І group average of total bilirubin in serum was 203.8 ± 11.5 mkmol/L and was higher (р < 0.05) from this index 170.3 ± 6.6 mkmol/L patients II group. When comparing the severity of cytolytic syndrome in the midst of acute hepatitis B found no statistically significant difference between groups I and II (р > 0.05). All patients in both groups had positive HBsAg, anti–HBcor IgM, and incidence of positive HBeAg did not differ (χ2 = 1.42, р > 0.05) in the studied groups.
Analysis of cytokine research status of patients with acute hepatitis B during hospitalization showed that the content in the serum interleukins IL-2, IL-6, IL-8 and TNF-α in patients I and II groups exceeded (р < 0.05–0.01) indicators of healthy people. However, comparing the contents of these cytokines in the serum showed that the content of IL-2 in serum patients I group was lower by 39.1 % (р < 0.05), than in patients without the confounding factors. Content IL-8 in serum of patients I group was, however, higher by 25.1 % (р < 0.01) than that patients in II group.
The period of convalescence was accompanied by a decrease (р < 0.05–0.01) content of the studied cytokines in serum of patients in both groups compared with the corresponding figures during the height of acute hepatitis B. Comparative analysis showed that patients I group content of IL-2 in serum remained low (2.1 times, р < 0.01), and the content of IL-6 (1.9 times, p < 0.05) and IL-8 higher above (23.7 %, р < 0.05), than II group. At the time of discharge from the hospital contents IL-2 in serum of patients I group decreased significantly and tended to lower (р > 0.05) than that of healthy people. Patients II group in period of convalescence marked normalization of inflammatory cytokines while maintaining elevated compared with healthy people, the content of proinflammatory cytokines in the blood serum.
In convalescence on the background normalization of total bilirubin in the majority of patients in both groups decreased activity of ALT in serum of patients I group was slower than in patients of II group. The activity of this enzyme at discharge remained higher (р < 0.05) in patients I group and was 2.33 ± 0.17 mmol/L•h to 1.82 ±± 0.07 mmol/L•h patients II group.
The delay in the recovery of patients with acute hepatitis B that runs on a background chronic used of alcohol in hepatotoxic doses compared with patients II group, the results also show the dynamics of the marker profile of patients. Thus, in patients of I group frequently (χ2 = 14.21, р < 0.01) remained in the blood circulation of HBsAg (100 % against 64.2 %) and less (χ2 = 9.67, р < 0.05) was recorded seroconversion HBeAg — anti-HBe in serum (45 % against 76.5 %) than in patients II group. A comparative analysis of the quantitative content of anti-HBe in serum showed lower levels of these antibodies in patients I group (р < 0.01) than the corresponding figure patients II group was 0.38 ± 0.07 units against 0.73 ± 0.08 units according to the groups.
Conclusions
1. Acute hepatitis B in patients with chronic used alcohol in hepatotoxic doses characterized by longer (p < 0.05) prodrome, in the midst distinct clinical manifestation of the disease with the advent of cholestatic (7.7 %) and hemorrhagic manifestations (5.8 %), higher levels of hyperbilirubinemia (p < 0.05), and during convalescence maintaining higher (p < 0.05), alanine aminotransferase activity compared with group II patients.
2. In the presence of chronic used of alcohol in hepatotoxic doses in patients during convalescence of acute hepatitis B after basic treatment is characterized by persistence of circulating HBsAg (100 % against 64.2 %, χ2 = 14.21, р < 0.01), lower incidence of seroconversion HBeAg — anti-HBe (45.0 % against 76.5 %, χ2 = 9.67, р < 0.05) lower (р < 0.01) quantitative content of anti-HBe in serum compared with patients with acute hepatitis B without concomitant liver disease.
3. In patients with acute hepatitis B from chronic used of alcohol in hepatotoxic doses as compared to patients II group, the height of the disease is characterized by a lower content of IL-2 (39.1 %, р < 0.05) and higher levels of IL-8 (25.1 %, р < 0.05) in serum. After basic treatment in these patients remains cytokine imbalance status by lower levels of IL-2 (2.1 times, р < 0.01) and higher levels of IL-6 (1.9 times, р < 0.05) and IL-8 (23.7 %, р < 0.05) in serum.
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