The chronic hepatitis under pulmonary, extra-pulmonary and abdominal tuberculosis.

Abstract

The poly-morbidity is an actual problem of clinical medicine. The chronic hepatitis and tuberculosis are among widespread socially significant diseases while their relationship needs further investigation. The purpose of study is to analyze rate of occurrence, structure and clinic а chronic hepatitis taking course in comorbidity with tuberculosis of various localizations. The technique of continuous sampling was applied to carry out cohort randomized single-staged study analyzing rate structure and clinic of chronic hepatitis in 1189 patients with tuberculosis including pulmonary (n=1125), extra-pulmonary (n=24), abdominal (n-40) localizations. The chronic hepatitis is established in 45% of all cases and in half of cases out of them at the stage of exacerbation (53.2%) when the disease is presented by viral (59.6%) predominantly hepatitis C, alcoholic (25.7%), non-alcoholic (9.8%) and medicinal (4.9%) steatohepatits. The chronic hepatitis associates with pulmonary tuberculosis 3.4-1.7 times more often than with extra-pulmonary and abdominal tuberculosis. The chronic hepatitis is characterized by minimal and moderate activity of inflammation. The chronic hepatitis in case of abdominal tuberculosis manifests more expressed alterations of all laboratory syndromes of hepatitis. The medicinal hepatitis was established only in case of pulmonary tuberculosis. The chronic hepatitis С and B progresses in a comorbide way, is characterized by little symptoms, cytolysis with 2.3-2.8 standards of ALT, AST, minimal parenchymatous jaundice and cholestasis with activity of GGTP 2.86 of standards, mesenchymal inflammation in 3.1-3.4 times more often in case of its comorbidity with extra-pulmonary and abdominal tuberculosis. The alcoholic steatohepatitis is characterized by higher cytolysis, predominance of activity of AST over ALT, more expressed parenchymatous jaundice and cholestasis. The non-alcoholic steatohepatitis is characterized by poly-morbidity with diabetes mellitus type II also, cardiovascular pathology, steatosis of liver, the lowest parameters of markers of cytolysis, mesenchymal inflammation, jaundice, cholestasis and normal values of markers of hepatic cellular inadequacy. The medicinal hepatitis is characterized by increasing of asthenia, nausea, development of jaundice, skin itching, hepatomegaly,cytolysis, cholestasis, hyper-bilirubinemia against the background of specific poly-chemotherapy.