Терапевтический архив (Apr 2011)
Clinical significance of intravital morphological investigation of the liver
Abstract
Aim. To demonstrate great importance of intravital morphological examination of the liver for differential diagnosis of chronic diffuse diseases (CDD) of the liver. Material and methods. A complete clinical examination, needle or intraoperative biopsy of the liver were made in 1045 patients with chronic diseases of the liver. Structural features of hepatic tissue were studied histologically. Variational statistics was used for analysis. Results. Viral markers were detected in 373 patients (HCV in 53%, TTV in 10%, HBV in 16%, HGV in 6%, CMV in 3%). Chronic hepatitis (CH) was caused by combined viral infection in 12% cases. CH variants were verified morphologically in 64% patients with provisional diagnosis CH. Objective evaluation of structural changes severity rested on algorithms of semiquantitative determination of the index of histological activity and fibrosis index. Hepatic cirrhosis of viral or alcohol etiology was detected in 4.8%, primary biliary cirrhosis - in 11.2%, non-alcoholic fatty disease of the liver - in 11.2% patients. Impaired glucose tolerance is an essential factor predisposing to non-alcohol fatty disease of the liver. Detection of vacuole-like nuclei in periportal hepatocytes is an early morphological sign of the fatty disease. Three percent of the patients had signs of minimal portal cholangitis. This correlated with TTV detection. Conclusion. Life-time morphological examination of the liver specifies activity and stage of the process in chronic hepatitis, confirms or detects abnormalities in hepatic architectonics, identifies clinically significant changes in cellular and intercellular components of hepatic tissue, detects and verifies rare hepatic affection. Such information is of importance for optimization of treatment policy and improvement of prognosis in CDD of the liver.
