Autoimmune liver disease (primary biliary cholangitis/autoimmune hepatitis-overlap) associated with sarcoidosis (clinical cases and literature review)

Clinical features of overlap autoimmune hepatitis/primary biliary cholangitis and morphological-proved sarcoid lesions (lungs, lymph nodes, skin) were performed. Data of long-term clinical observation presented in comparison with the results of laboratory datas, instrumental and morphological studies of liver tissue, lungs, skin. The modern aspects of pathogenesis of association autoimmune and granulomatous diseases arediscussed on the example of clinical cases of combination of cholestatic variants of autoimmune hepatitis and generalized sarcoidosis. Keywords: sarcoidosis, autoimmune hepatitis, primary biliary cholangitis, primary biliary cholangitis-autoimmune hepatitis-overlap, extrahepatic manifestations.

[Myocardial injury associated with chronic hepatitis C: Clinical types and pathogenetic components]

Heart injury is one of the extrahepatic manifestations of chronic hepatitis C (CHC). The paper gives Russian and foreign authors' data on a relationship between CHC and myocardial injury. It discusses different pathogenetic components (the direct effect of the virus, immunological components), through which hepatitis C virus can induce myocarditis and cardiomyopathies in patients with CHC.

[THE INFLUENCE OF CHRONIC HEPATITIS C ON ATHEROSCLEROSIS PROGRESSION]

We analysed the data of domestic andforeign authors on the relationship between hepatitis C and atherosclerosis. The possible role of the former condition as a risk factor of atherosclerosis even in very young patients is due to the properties of hepatitis C virus, mediators of inflammation, and metabolic disorders.

[Variant form of hepatic lesion: autoimmune hepatitis--primary biliary cirrhosis in patients with Sjögren's syndrome]

Two clinical observations of the variant form of hepatic lesion: autoimmune hepatitis--primary biliary cirrhosis with systemic manifestations are presented in patients with long-standing Sjogren's syndrome, one at the stage of lever cirrhosis, the other at stage F2 of fibrosis. Difficulties encountered in diagnostics and the necessity of changing the entire spectrum of autoimmune markers characteristic of Sjogren's syndrome, autoimmune hepatitis and primary biliary cirrhosis are discussed. The possibility of different forms of hepatic lesions in autoimmune hepatitis--primary biliary cirrhosis is emphasized.

[Aortoarteritis in HBV-associated liver cirrhosis: diagnostics, therapeutic strategy, and prognosis]

A case of decompensated liver cirrhosis in a women with a long silent period of HBV infection is presented. The first manifestation was generalized vasculitis involving small and medium-size vessels and elastic-type arteries with the development of aortoarteritis. Proper interpretation of manifestations of viral liver cirrhosis allowed for immunosuppressive treatment in combination with effective antiviral drugs. As a result, aviremia, regression of vasculitis and portal hypertension along with considerable improvement of the prognosis were achieved.

[Chronic viral hepatitis--one of the most important problems of current medicine]

Main aspects of the study of chronic virus infection now cover clinico-morphological characteristics, prognosis of chronic liver diseases (CLD) by HBV and HCV; characteristics of extrahepatic lesions produced by HBV and HCV; features of CLD of mixed etiology (viral and alcoholic); treatment of CLD of viral etiology. The hypothesis is suggested on the generalized character of HBV and HCV infection. Approach to the treatment of chronic viral hepatitis including extrahepatic manifestation is proposed.

[Role of chronic viral hepatitis in the development of hepatocellular carcinoma]

Role of HBV- and HCV-infections, liver cirrhosis, alcohol in the development of hepatocellular carcinoma, and hepatocyte dysplasia is considered.

[Assessment of survival and risk of hepatocellular carcinoma in patients with cirrhosis of mixed (viral, alcoholic) etiology]

AIM

To determine factors affecting overall survival and risk to develop hepatocellular carcinoma (HCC) in patients with hepatic cirrhosis (HC) of mixed (viral, alcoholic) etiology.

MATERIAL AND METHODS

Mono- and multi-variance analysis of prognostic effects of such factors as age of the patients, mixed infection VHB/VHC, markers of HBV replication, antibodies to nuclear antigen of HBV (HBcAb) without HBs-system in the serum ("isolated" HBcAb), duration of viral infection, alcohol intake and abuse, dilatation of the esophageal veins, some laboratory parameters were studied in 55 HC patients having at least one marker of hepatitis B virus (HBV) and/or hepatitis C virus (HCV), long history of alcohol abuse.

RESULTS

It was found that risk of HCC was associated with duration of alcohol abuse and infection, mixed HBV/HCV infection, age 60 and older. Of independent significance was only duration of alcohol abuse. Lethal outcomes in HC patients in the mixed infection were due to development of HCC (36%) and HC complications (64%). Survival of the patients was less in severe dilatation of the esophageal veins, high clinicolaboratory index, low level of serum albumin, presence of "isolated" BcAb and mixed viral infection.

CONCLUSION

Of the greatest prognostic efficacy in respect of survival was the model combining "isolated" HBcAb, the degree of esophageal veins dilatation and hepatitis activity.

[Extrahepatic manifestations of chronic hepatitis C]

AIM

To study incidence, special features and mechanisms underlying onset of extrahepatic lesions in HCV-infection.

MATERIALS AND METHODS

Extrahepatic symptoms of chronic hepatitis C and its outcome--hepatic cirrhosis were studied in 157 patients. HCV-infection was confirmed by ELISA II and polymerase chain reaction (detection in the serum of anti-HCV and HCVRNA, respectively). Morphological studies of the liver were made in 134 patients, of other organs and tissues--in 20 patients. Immunological tests were made in 124 patients. Thyroid hormones, antibodies to thyroglobuline were measured with radioimmunoassay in 74 patients.

RESULTS

Extrahepatic manifestations were found in 70(44.6%) patients with chronic hepatitis C (more frequently in hepatic cirrhosis), for the most part in women and in long-lasting disease. 54(43.5%) women had cryoglobulinemia, 27 of them showed it clinically. Patients with cryoglobulinemia and free of it exhibited varying frequency cutaneous vasculitis, Raynaud's syndrome, affection of the muscles and joints, nodular periartheritis, lesions of the lungs, myocarditis, autoimmune thyroiditis, Sjogren's syndrome, lichen ruber planus, porphyria cutanea tarda, immune cytopenia, autoimmune hemolytic anemia, hypoplastic anemia, monoclonal immunoglobulinopathy, B-cell lymphoma. Of high frequency were activity of rheumatic factor (66.9%), hypocomplementemia (31.8%), antinuclear antibodies (9.8%) and other immunological disorders.

CONCLUSION

Some extrahepatic lesions in HCV-infection are detailed: frequent mixed cryoglobulinemia and associated vasculitides of different sites, malignant lymphoproliferative diseases, more frequent than in HBV-infection involvement of the thyroid and salivary glands, some skin lesions.

[Electron microscopic study of the liver in chronic viral hepatitis C complicated by alcoholic liver disease]

Combination of HCV-infection and alcoholic liver disease is associated with enhancement of hepatocellular damage (lipid and hydropic degeneration become diffuse), a decrease of hepatocyte necrotic foci and lymphomacrophagal infiltration, an increase of hepatocyte apoptosis and liver fibrosis, absence of lymphoid follicles. An important role in the genesis of these liver alterations is attributed to the combination of viral and alcoholic factors with persistence of hepatitis C virus and liver reticulo-endothelial system depression.