Известна проблема высокой распространённости жировых болезней печени сегодня. Вопрос диагностической дифференциации неалкогольной и алкогольной жировых болезней печени (НАЖБП и АБП) изучался во многих исследованиях, были предложены возможные решения, но, по настоящий момент, ни одно из них не используется в широкой практике в виду наличия существенных недостатков у каждого способа.В то же время, своевременно выставленный диагноз напрямую влияет на качество и, часто, продолжительность жизни пациента.В обзоре представлены все современные методы лабораторной диагностики, способные выявить различия между НАЖБП и АБП, с указанием основных известных характеристик каждого метода.
Liver cirrhosis continues to be an acute problem of modern medicine due to the high rates of its prevalence and mortality. The high mortality rate is caused by the development of the number of life–threatening complications in decompensated forms of liver cirrhosis – hepatorenal syndrome, infections and varicose bleeding. Hepatorenal syndrome and infections are the result of immunological shifts occurring during decompensation of liver cirrhosis. Currently available literature data do not allow us to create a complete picture of the functional state of various links of adaptive immunity with decompensated liver cirrhosis. The aim of the research was to study the characteristic features of adaptive immunity in patients with decompensated liver cirrhosis. Material and methods. The prospective cohort study included 136 patients with decompensated liver cirrhosis, who received inpatient treatment in the hepatological department of the multidisciplinary hospital. The cohort of examined patients was divided into two groups, one of which included patients with liver cirrhosis of viral origin (n = 78), the other – patients with alcoholic liver cirrhosis (n = 58). In addition to the generally accepted standard methods, the patient examination program included immunological tests: identification of T- and B-lymphocytes, immunoregulatory and activated subpopulations of T-lymphocytes by the method of immunophenotyping peripheral blood mononuclear cells using monoclonal antibodies. The serum levels of immunoglobulins IgM, IgG, IgA, circulating immune complexes were determined by immunoturbidimetric method. Results. The study of indicators of the humoral link of adaptive immunity revealed an increase in the number of B cells, an increase in IgM, IgG, IgA and circulating immune complexes in patients with decompensated liver cirrhosis. The cellular link of adaptive immunity was characterized by an increase in the relative content of T helper cells, activated T cells against the background of a decrease in the number of immature T cells and T regulatory cells. Conclusions. The distinctive features of adaptive immunity in patients with decompensated liver cirrhosis are simultaneous activation of both humoral and cellular components, which, apparently, supports the systemic inflammatory process and the associated progressive liver fibrosis.
Hepatorenal syndrome is a life-threatening complication of liver cirrhosis. 90% of patients with liver cirrhosis die within 2 months since the onset of hepatorenal syndrome development. For many years the hypothesis of the hemodynamic mechanism of hepatorenal syndrome development was accepted as the only true one, according to this hypothesis compensatory systemic vasodilation in response to portal hypertension causes renal ischemia and the development of functional specific acute kidney damage, the so-called “hepatorenal syndrome – acute kidney damage”. In recent years some works were published that substantiate the role of a systemic inflammatory reaction in the development of hepatorenal syndrome; this inflammatory reaction being associated with activation of innate immunity cells in response to a bacterial infection, including that to the microflora of the intestine which is adjacent to the liver. Data has been obtained which indicated that Toll-like receptors (TLRs), in particular TLR4 and TLR9 are involved in the development of hepatorenal syndrome.
Нетуберкулезные микобактерии являются повсеместно распространенными микроорганизмами, способными вызывать хроническую трудноизлечимую инфекцию микобактериоз легких. Множественные публикации последних десятилетий свидетельствуют о повсеместном росте заболеваемости легочной инфекцией, вызванной Mycobacterium. В государственном учреждении «Республиканский научно-практический центр пульмонологии и фтизиатрии» с 2014 года проводится мониторинг распространения и видовой принадлежности нетуберкулезных микобактерий. Пандемия COVID-19 внесла значимые коррективы в работу всех служб системы здравоохранения, оказывающих помощь пациентам с патологией респираторной системы. К настоящему времени опубликованы данные, посвященные влиянию новой коронавирусной инфекции на возникновение и течение заболеваний органов дыхания. В статье представлены данные ретроспективного анализа видовой структуры нетуберкулезных микобактерий, выделенных от пациентов с хронической респираторной патологией в Республиканской референс-лаборатории ГУ «РНПЦ пульмонологии и фтизиатрии» за два сравниваемых периода – до пандемии (2019 г.) и в период пандемии COVID-19 (2020–2022 гг.). Получены данные о спектре клинически значимых Mycobacterium. Mycobacterium МАС-комплекса (M. avium) выявлены в 44,35% случаев микобактериоза легких в период пандемии COVID-19. В этот период изменения в видовой структуре нетуберкулезных микобактерий связаны с уменьшением их видового разнообразия и увеличением значимости M. gordonae. Non-tuberculosis mycobacteria are ubiquitous microorganisms capable of causing a chronic intractable infection – nontuberculous mycobacterial pulmonary disease. Multiple publications in recent decades indicate a widespread increase in the incidence of lung infection caused by Mycobacterium. The state institution "Republican Scientific and Practical Center of Pulmonology and Phthisiology" has been monitoring the spread and species of non-tuberculosis mycobacteria since 2014. The COVID-19 pandemic has made significant adjustments to the work of all health services providing care to patients with respiratory pathology. To date, data have been published on the impact of the new coronavirus infection on the occurrence and course of respiratory diseases. The article presents data from a retrospective analysis of the species structure of non-tuberculosis mycobacteria isolated from patients with chronic respiratory pathology in the Republican Reference Laboratory of the State Institution "RNPC of Pulmonology and Phthisiology" for two compared periods: before the pandemic (2019) and during the COVID-19 pandemic (2020–2022). Data on the spectrum of clinically significant Mycobacterium were obtained. Mycobacterium of the MAC complex (M. avium) was detected in 44.35% of cases of mycobacteriosis of the lungs during the COVID-19 pandemic. During the COVID-19 pandemic, changes in the species structure of non-tuberculosis mycobacteria are associated with a decrease in their species diversity and an increase in the importance of M. gordonae.
The purpose of the research is to study the informativeness of the technology of Controlled Attenuation Parameter (CAP) in Shear Wave Elastography (SWE) in determining the degree of severity of liver steatosis depending on the elastometric quantitative values of liver fibrosis in a one-time study in a given volume of parenchima liver in patients with non-alcoholic fatty liver disease (NAFLD).Materials and methods of research. The study included 169 patients with NHTSA between the ages of 19 and 81, the average age was 41.7 ±11.3 years, examined in the “City Clinical Hospital No. 1” of the Ministry of Health, Chuvashia (Cheboksary, Russia). Patients with functional disorders of bile evacuation (n= 72) were the first group; the 2nd group were the patients with liver steatosis without manifestations of liver fibrosis (n = 28); the 3rd contained the patients with cirrhosis of the liver (n = 25); patients with chronic viral hepatitis B and C (n= 44) were in the 4th group. All patients were screened with ultrasonic shear wave elastography with elastometry in one-dimensional (TE) (FibroScan 502 TOUCH, France) and two dimensional (2DSWE) modes (Aixplorer, Supersonic Imagine, France). Elastometry (kPa) and steatometry (dB/m) were completed simultaneously within the same volume of the analyzed liver tissue with two sensing devices of “FibroScan 502 TOUCH”. The statistical processing was carried out with the help of IBM SPSS Statistics 10.0. The results are reflected in the form of median (Me), minimum (min), maximum (max) and medium (Emean) values, standard deviation (SD) of Jung’s elasticity module. Correlational analysis of the received values of parameters F and S was made with the descriptive method of Bland-Altman and the method of Spearman.Results and discussion. The average quantitative values of the severity of liver steatosis in patients with cirrhosis of liver had reliably lower values (234.5±62.1 dB/m) than in those suffering from steatosis of the liver without fibrosis (347.5±37.6 dB/m) and patients with chronic viral hepatitis (245.9±57.3dB/m, p lt; 0.001). The values of fibrosis in the same amount of the tested liver tissue with liver cirrhosis (45.5± 22.3 kP) were higher than similar rates in the other groups of patients with NAFLD (p lt; 0.001). Diagnostic informational content of the method of controlled ultrasound attenuation in establishing the degree of manifestation of liver steatosis had a higher specificity with II degree of liver steatosis (99.29% with a sensitivity of 84.92%).The results of the study allow us to recommend ultrasound elastography with the technology of controlled ultrasound attenuation to determine the severity of liver steatosis for both primary diagnosis and for dynamic monitoring of the liver condition of patients with NAFLD.
Рассмотрена роль первичных фибробластов и линий диплоидных клеток фибробластов человека в формировании противоинфекционного иммунитета. Обсуждается адекватность клеточной модели на основе фибробластов для изучения молекулярных механизмов иммунопатогенеза вирусных инфекций. Рассмотрена возможность использования фибробластов для изучения особенностей действия иммунотропных препаратов. Обсуждается перспективность клеточной модели на основе аттестованных линий диплоидных клеток фибробластов для изучения механизмов действия новых и известных иммуномодуляторов.
The article highlights the results of a study of a new method for diagnosing non-alcoholic fatty liver disease in a living organism by determining the serum level of the marker Secreted frizzled related protein-4 (SFRP4) with histological confirmation of the results. In a chronic experiment, the parameters of two groups of experimental animals were studied: control and experimental, 15 rats each. The control (reference) group of animals was in the usual feed and drinking mode, the experimental received food with a high content of carbohydrates and fats. The results of biochemical blood tests and autopsy biomaterials on day 180 of the experiment indicated the presence of fatty changes in the liver in the experimental group of animals. The importance of circulating adipokine SFRP4 in the diagnosis of non-alcoholic fatty liver disease (NAFLD) has been confirmed. A histologically confirmed direct correlation of SFRP4 with the degree of liver fibrosis in NAFLD was revealed. The place of SFRP4 in the pathogenesis of non-alcoholic fatty liver damage is explained. It is noted that in case of successful extrapolation of the results of the study on the human body, information will become a successful solution to one of the most pressing problems of modern hepatology.
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