[The prognostic value of biochemical indicators under neonatal hepatitis of different etiology].

Recently, the share of children with verified neonatal hepatitis induced by genetic predisposition, malformations of biliary tracts, inborn infections with affection of hepatobiliary system increased. The comprehensive biochemical examination of 62 children aged from 1.5 months to 2 years old with diagnosis of neonatal hepatitis. The changes of standard indicators of cytolysis, cholestasis and protein metabolism were on average moderate in group with reliable increase of protein concentration of acute phase of inflammation. The peak changes of biochemical indicators during primary examination are revealed in group of children with malformations of hepatobiliary system conditioned by viruses of herpetic group and in the process of development of expressed fibrosis of liver up to first year of life. The detection of proteins of acute phase makes it possible to objectively evaluate the presence of prolonged inflammatory process in liver and to promote prognosis of course of neonatal hepatitis in children of early age and timely correction of therapy and improvement of outcomes of disease. The detection of C-reactive protein, alpha2-macroglobulin and alpha1-antitripsin is recommended to be included into algorithm of examination of children with neonatal hepatitis.

[Minimization of endogenous intoxication syndrome by individual choice of drugs for therapy of chronic hepatitis].

The results of clinical and laboratory examination of 107 children suffering from chronic hepatitis B or C were analysed. The biochemical criteria of the endogenous intoxication were investigated. Specific blood tests with antiviral drugs were conducted before the treatment and individual therapy schemes were assigned according to the tests' results. The early and sustained virological response rates during the individual antiviral treatment of the children with chronic hepatitis C proved to be 70.83 and 62.5% respectively.

[Characteristics of immune response to etiotropic and pathogenetic therapy in children with chronic hepatitis C].

Features of the immune response of children with chronic hepatitis C to the antiviral and pathogenetic therapy have been studied. It is shown that the antiviral therapy is accompanied by stimulation of the immune response as manifested by the synthesis of cytokines (IL-4, IFN-alpha, IFN-gamma) with retention of increased production of IFN-a for more than two years after the end of the course of treatment. In children that previously received interferon inductor (cycloferon) for 12 months, high level of IFN-a production is retained, which ensures antiviral protection. Phytotherapy did not influence the production of cytokines.

[Rational pharmacotherapy and correction of immunity disorders in children with chronic hepatitis (clinical review)].

The data on the efficacy of antivirals and their impact on the virologic and immunologic indices in HCV- and HBV-infected children are presented. The best therapeutic effect in the management of children with chronic virus hepatitis was provided by combined antiviral therapy of different action. In the treatment of babies the drugs of choice could be viferon or cycloferon, for the 2-year older children with chronic hepatitis B the combination of viferon + cycloferon should be recommended and for those with chronic hepatitis C the combination of interal + cycloferon could be used. The cycloferon combination with interferons-a makes it possible to generate the Th1 cellular immune response, to minimize the side effects of interferons and chemotherapeutics and to improve their tolerability. The complex therapy of patients with chronic hepatitis B and lambliasis, using cycloferon and macmiror, provided stable effect, less frequent relapses oflambliasis and minimum side effects of the specific therapy. The repeated isolation of lamblia within a 1-year observation period was recorded only in 16.6% of the children treated with cycloferon vs. the control (40.0%).

[Pathogenetically substantiated therapy of patients with virus hepatitis C, quality of life, and the disease outcome risk (clinical survey)].

The aspects of virus hepatitis C immunopathogenesis are discussed. The main attention is paid to higher production of Th1 cytokines providing active protection of the host from HCV. The up-to-date approaches to the therapy of chronic hepatitis C, described in the literature and the original ones, including the triple therapy with immunomodulators of various mechanisms of action, i.e. cycloferon (injections and tablets), galavit and derinat are presented. The comparative efficacy of the therapy is estimated. Cycloferon is shown to be the drug of choice in the treatment of patients with virus hepatitis addicted to narcotics. The clinical and laboratory efficacy of the metabolic hepatoprotector remaxol with antioxidant activity is described. Its high effictivity and satisfactory tolerability (side effects requiring discontinuation of the drug use were recorded only in 0.3% of the cases), as well as the minimal risk of no biochemical remission after its use allow to conseder remaxol as a highly efficient metabolic hepatoprotector for pathogenetic therapy of chronic hepatitis.

[Hepatoprotective activity of remaxol in patients with chronic hepatic disorders].

This milticentre randomized clinical study of the efficiency of remaxol infusion solution (hepatoprotective medicine for chronic liver dysfunction) included 494 patients with chronic hepatitis B and C. 294 of them staying in 7 clinics were given remaxol and 200 ones received placebo. Randomization was achieved by the envelope method. A detailed description of clinical and laboratory characteristics of the diseases is presented. Effects of remaxol vs placebo on the functional activity of affected liver are discussed. Results of laboratory and clinical analysis indicate that mechanism of remaxol action is based on hepatoprotective, antioxidative, and anticholestatic activities of the drug.

[Chemotherapy of chronic viral hepatitis B: randomized multicenter investigation results].

During treatment of patients with chronic hepatitis B the best therapeutic effect was obtained with the inclusion in the scheme of antiviral therapy cycloferon. Complete stable remission was achieved in 54.1% of patients in combination cycloferon with lamivudin, but the appointment of alpha-interferon with cycloferon provided remission 44.1% of patients resistant to treatment with lamivudin. Therapy of chronic hepatitis B with cycloferon can reduce the frequency and severity of side effects, prevents the development of resistance to lamivudin and the emergence of mutant viruses.

[Cycloferon efficacy of therapy of chronic hepatitis B (results of randomized multicentre study)].

The best therapeutic effect in the treatment of patients with chronic hepatitis B was observed with the use of cycloferon in the scheme of the antiviral therapy. The combination of cycloferon with lamivudine provided complete stable remission in 54.1% of the patients, whereas the use of a-interferon in combination with cycloferon provided remission in 44.1% of the lamivudine-resistant patients. The use of cycloferon in the therapy of chronic hepatitis B made it possible to lower the frequency and manifestation level of the side effects and prevented the lamivudine resistance development and generation of the virus mutants.

[Dynamics of immunological indices in patients with chronic viral hepatitis B and the effect of thymalin therapy]. / Dinamika immunologicheskikh pokazatelei u bol'nykh khronicheskim virusnym gepatitom B i vliianie timalinoterapii.

The work deals with the results of the study of T-lymphocytes and their subpopulations (active, thermostable, theophylline-sensitive and theophylline-resistant) in 102 children with chronic viral hepatitis B, depending on the effectiveness of thymalin therapy. The sensitization of lymphocytes to specific antigens was studied. Among patients with chronic viral hepatitis B and cirrhosis of the liver the homozygous phenotype of haptoglobin is registered essentially more frequently (63.6% and 82.4% respectively) than among healthy persons (44.0%). The patients of this group showed a decrease in the number of T-lymphocytes, disturbances in the suppressor/helper ratio: hypersuppression in persisting hepatitis and hyposuppression in active hepatitis. In 71.6% of cases thymalin therapy produced an effect manifested by clinico-biochemical remission, an increase in the number of T-lymphocytes, thermostable cells and the normalization of the T-suppressor/T-helper ratio. In these patients sensitization to HBsAg essentially decreased (from 30.5% to 13.9%), while sensitization to human liver lipoprotein retained its high level even after treatment with thymalin.