Objective: to study the values of fibrosis indices and transient elastometry in patients with chronic HCV infection who received antiviral therapy.Materials and methods: The study included 64 patients with chronic HCV infection who received antiviral therapy with direct-acting antiviral drugs or a combination of peginterferon and ribavirin.The fibrosis indices AAR, APRI and FIB-4 were calculated before the start of therapy and 6 months after its completion. Values of AAR>1, APRI≥1,5, and FIB-4≥1,45 were considered indicators of severe fibrosis. We studied the dynamics of fibrosis indices and elastometry values depending on the treatment regimen, their correlation and the prognostic significance of fibrosis indices in relation to elastometry.Results. Among patients treated with direct-acting antiviral drugs, a sustained virologic response was achieved in 100%, and peginterferon-containing regimen – in 85%. Elastometry and APRI and FIB-4 indices decreased in both groups. In patients without liver cirrhosis, the average elastometry after treatment decreased from 9,5±1,7 kPa to 6,7 ± 1.4 kPa (p = 0,0006). In patients with liver cirrhosis, the median of elastometry decreased from 20 to 11,7 kPa (p = 0,0006), the median of APRI decreased from 2,09 to 0,61 (p = 0,005), FIB-4 from 3,95 up to 2,22 (p = 0,022). The prognostic significance of FIB-4 in relation to elastometry before treatment was 81%, after – 82%.Conclusion. Successful etiotropic therapy leads to an improvement in values of liver fibrosis indices and transient elastometry in patients with HCV infection, including liver cirrhosis, regardless of the treatment regimen. The FIB-4 index showed the highest sensitivity and prognostic significance in determining severe fibrosis.
РезюмеЦель: изучение показателей индексов фиброза и транзиентной эластометрии у пациентов с хронической HCV-инфекцией, получивших противовирусную терапию.Материалы и методы: в исследование были включены 64 пациента с хронической HCV-инфекцией, получивших противовирусную терапию препаратами с прямым противовирусным действием или комбинацией пегинтерферона и рибавирина.Индексы фиброза AAR, APRI и FIB-4 рассчитывались до начала терапии и через 6 месяцев после ее завершения. Значения AAR>1, APRI≥1,5 и FIB-4≥1,45 считались показателями выраженного фиброза. Были изучены динамика индексов фиброза и показателей эластометрии в зависимости от схемы лечения, их корреляция и прогностическая значимость индексов фиброза по отношению к эластометрии.Результаты. Среди пациентов, получивших терапию препаратами с прямым противовирусным действием, устойчивый вирусологический ответ был достигнут у 100%, пегинтерферон-содержащую схему -у 85%. Показатели эластометрии и индексов APRI и FIB-4 уменьшились в обеих группах. У пациентов без цирроза печени средние показатели эластометрии после лечения с 9,5±1,7 кПа снизились до 6, 7±1,4 кПа (р=0,0006). У пациентов с циррозом печени медиана значений эластометрии уменьшилась с 20 до 11,7 кПа (р=0,0006), медиана значений APRI уменьшилась с 2,09 до 0,61 (p=0,005), 95 до 2,22 (p=0,022). Прогностическая значимость FIB-4 по отношению к эластометрии до лечения составила 81%, после -82%.Заключение. Успешная этиотропная терапия приводит к улучшению показателей индексов фиброза печени и транзиентной эластометрии у пациентов с HCVинфекцией, в том числе и при циррозе печени, независимо от схемы лечения. Индекс FIB-4 показал наивысшую чувствительность и прогностическую значимость в определении тяжелого фиброза.
The patients entered the viral hepatitis department among which were the persins taking naerotic agents intravenously are examined. It is established that accompanying use narcotic agents has a definite negative effect on the clinical course, laboratory and instrumental, immunologic indices in viral hapatitis.
Aim. To identify clinical, epidemiological and laboratory-instrumental features of acute hepatitis C at the present stage according to the infectious hospital data. Methods. The study included 111 patients with acute hepatitis C aged from 18 to 79 years who were hospitalized in Republican Clinical Infectious Diseases Hospital named after A.F. Agafonov in 2011 - I quarter of 2017. Acute hepatitis C was diagnosed in accordance with the guidelines of the Ministry of Health of the Russian Federation. Results. In the study group, females aged 21 to 40 years, non-working, predominantly living in Kazan with medical transmission of infection (34 %) prevailed. The disease was mild and moderately severe (71 %). The icteric form was observed in 94 % of patients, in 3.6 % - with a cholestatic component. When comparing laboratory parameters, markers of cytolysis and cholestasis differed significantly in patients depending on the severity (p<0.001). Changes in the gallbladder walls (an ultrasound marker of cholestasis) were revealed in 21.4 % of patients. On specific examination, the viral RNA was detected in 100 % of patients. Analysis of serological markers revealed predominance of antibodies to core and NS3 proteins, M class antibodies were detected only in half of the patients. Specific antibodies were absent (“dark diagnostic window”) in 3 % of patients with mild and 6 % of moderate form of the disease. Conclusion. The feature of the course of acute viral hepatitis C was the predominance of moderate forms (71 %) with medical transmission of infection. Icteric forms of acute viral hepatitis C were diagnosed in 94 % of patients (in 3.6 % cases with the development of cholestatic component). PCR is a mandatory method of specific diagnosis of acute viral hepatitis C, and in case of a “dark diagnostic window” becomes the leading method.
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