Patologìâ (Apr 2018)
The interaction of morphological changes in the liver with the development of extrahepatic manifestations in patients with chronic hepatitis C
Abstract
Abstract The purpose of the work was to analyze the connections of morphological changes in the liver with the manifestation of clinical signs of extrahepatic manifestations in patients with CHC. Material and methods. The study included 86 patients with CHC. The correlation analysis of expressiveness degree of liver fibrosis and histological activity depending on the presence of clinical signs of extrahepatic manifestations of disease and changes of autoimmune parameters was carried out. Results. It was found that the incidence of mixed cryoglobulins in the blood of patients with CHC had a dependence on the degree of fibrosis of the liver. In the presence of liver fibrosis F 3–4 mixed cryoglobulins were found in 94.2 % versus 64.7 % of patients with stages of liver fibrosis F 12 (P < 0.01). In patients with stages of liver fibrosis F 3–4, the quantitative content of mixed cryoglobulins, RF-IgM and CIC was higher than those of patients with stages of liver fibrosis F 1–2. In patients with fibrosis in the liver F 3–4 cryoglobulinema incidence of vasculitis with formation of Meltzer’s triad was higher than in patients with liver fibrosis F 1–2 (19.2 % versus 2.9 %, P < 0.05). Content of mixed cryoglobulins correlated with the degree of fibrosis of the liver (r= +0.49, P < 0.01). A factor A3 was more often detected in patients with stage F 3–4, compared with patients with stage F 1–2 of fibrosis (81.5 % versus 19,2 %, P < 0.01). Conclusions. CHC patients with liver fibrosis F 3–4 are characterized with more frequent appearance of mixed cryoglobulins, higher content of RF-IgM and CIC in serum than in patients with liver fibrosis F 1–2. This explains the higher frequency of clinical manifestations of extrahepatic manifestations of immunocomplex genesis in patients with F 3–4 fibrosis. Histological activity of A3 in patients with CHC is most often combined with fibrosis of the liver F 3–4, which causes a high frequency of cryoglobulinemic vasculitis development in these patients.
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