Вирусные циррозы печени: клинический профиль современного пациента, танатогенез и патоморфология

Abstract

Objective. To analyze the profile of a patient with virus-related liver cirrhosis examined at different levels of healthcare, to identify the main causes of death, and describe morphological changes in liver tissue. Patients and methods. This study included 921 patients with chronic viral hepatitis (CVH) treated in day hospitals, 844 patients treated in inpatient facilities, and 455 CVH patients who died. We analyzed autopsy results of 97 patients with clinical signs of liver cirrhosis and described morphological characteristics of liver tissue depending on the Child–Turcotte–Pugh score. Results. Chronic hepatitis C is the most prevalent form of hepatitis in both inpatient and outpatient units. The highest incidence of latent hepatitis B was observed among inpatients. The majority of outpatients with virus-related liver cirrhosis were employable (or employed), socially adapted, not addicted to alcohol, and had compensated disease (class A in 97%) with minimal clinical manifestations, and were motivated for treatment and examination. The mean age of inpatients was 50 years; 100% of them had some comorbidities; 90% of them had subcompensated or decompensated cirrhosis; 60% of them systematically abused alcohol. Conclusion. The majority of deceased patients were employable, abused alcohol, and were not systematically followed-up by a specialist. Almost one-third of them (30%) had subcompensated disease and incomplete cirrhotic transformation of hepatic tissue; they died due to other reasons. This affects the course of chronic virus-related hepatitis and comorbidities and necessitates the creation of integrated comprehensive models of healthcare. Key words: virus-related liver cirrhosis, comorbidity, morphological examination, latent hepatitis, chronic viral hepatitis