Chronic Viral Hepatitis B (first example)
Patient G-va R. T., 19, appealed for medical aid to the Department of Propedeutics of Internal Diseases of Volgograd State Medical University on April, 20, 2003 with complaints of the lack of appetite and a feeling of heaviness and aching pains in the right hypochondrium after fat food intake which had appeared about 1 year ago. In March, 2003 during the complex physical examination of the patient by the infectiologist in Volgograd Polyclinic № 3 with the aim of diagnostics and treatment of hand neurodermatitis, antibodies to hepatitis B virus by the method of Polimerase Chain Reaction (PCR) were detected (HBV DNA « positive + »). Antibodies to hepatitis D virus by the method of Immune-Enzyme Analysis (IEA) were not found.
Objectively: dermal integuments are swarthy, sclera is of usual staining, the lower edge of the liver is along the right costal margin, the palpation is moderately painful. The spleen isn't palpable.
According to results of the abdominal cavity ultrasound investigation: the liver tissue is of usual echogenicity, has a small-grained structure, homogeneous. The anteroposterior size of right lobe of liver is 9,3, of left lobe of liver - 6,1, of caudate lobe of liver - 2,8. The spleen is of usual size.
Common blood analysis is: Er - 4,2´1012, Hb - 124 g/l, colour index - 0,86, Tr - 310´109, reticulocytes - 2 %, Le - 4,4´109, b -1, e - 2, band neutrophils - 4, s - 47, l - 30, m - 8. ESR - 4 mm/h. Blood clotting time - 3 min. Blood glucose - 4,2 mmol/l. Whole protein - 80 g/l, albumins - 54%, a1-globulins - 4 %, a2 - globulins - 10%, b-globulins - 14 %, g-globulins - 18 %, A/G coefficient -1,17.
Coagulogramma: plasma recalcification time - 113 sec., trombotest rate - V, prothrombin index - 90%, plasma fibrinogen - 2 g/l, fibrinogen B - neg.
Clinical urine analysis: light-yellow, transparent, reaction - acid, relative density - 1018, glucose - not detected, protein -not detected, Le - 2-3 within eyesight, Er - not detected, cylinders -not detected, blennuria - not detected.
Biochemical tests: MDA - 13,67 mkmol/l, DC - 1,2 u., Cat - 20,46 mkmol/ml/min, SOD - 2,0 conv.u/ml, GP - 1,2 mkmol/ml/min, SU - 0 u., SG -0 u., CPl - 23,6 mg%, NAG - 12,5 nmol/ml/min, total bilirubin - 16 mkmol/l, thymol test -3,0 u., ALT - 0,44 mkkat/l, AST - 0,12 mkkat/l.
To make the diagnosis of liver disease and its activity more exact, the complex investigation of the presence of hepatitis B and C viruses in the blood serum of the patient by the methods of Polimerase Chain Reaction (PCR) and Immune-Enzyme Analysis (IEA) were made. Were detected DNA of virus hepatitis B and HBs Ag, HBcor Ig G, HBe Ig G. Were not detected HBcor Ig M and HBe Ag. Antibodies to hepatitis C virus were not detected either.
The results of liver puncture biopsy: in the punctate mat hyaline hepatocytes are visualized. Moderate vacuolar and parenchymatous degeneration of hepatocytes is observed. Some separate hepatocytes nuclei has the form of sand-glass. In the lobules of liver can be seen clusters of segmentonuclear leukocytes. Some portal tracts are dilated owing to lymphomacrophagal infiltration.
Conclusion: clinical presentation of chronic viral hepatitis B of moderate degree of activity. According to clinical-laboratory and instrumental investigations was formed the diagnosis: «Chronic viral hepatitis B (without delta-agent), moderate degree of activity».
According to the scheme for the purpose of antiviral treatment the patient underwent the monotherapy course of 10 intravenous drip infusions of Natrii Hypochloriti into the cubital vein with the speed of 20 - 30 drips per minute in the dynamically increasing concentration of solution from 300 to 600 mg/l as 400 ml injections in a day. The patient underwent the procedures successfully.
At the end of the course of treatment the patient noted the disappearance of a feeling of heaviness and aching pains in the right hypochondrium, appetite and sleep improved, the efficiency of the patient increased. 1 and 3 months after the finishing of the course of treatment all above-named investigations were made once again. It was detected almost full normalization of LPO indices, liver-specific enzymes and standard liver tests, a significant increase of AOP enzymes: MDA - 8,54 mkmol/l, DC - 1,0 u., Cat -22,57 mkmol/ml/min, SOD -3,57 conv. u./ml, GP - 4,99 mkmol/ml/min, SU - 0 u., SG - 0 u., CPl - 36,3 mg%, NAG - 7,34 nmol/ml/min, total bilirubin - 10, 6 mkmol/l, thymol test -1,5 u., ALT - 0,2 mkkat/l, AST - 0,12 mkkat/l. HBV DNA was not detected by the method of PCR (HBV DNA « negative - »). Antibodies to hepatitis B virus detected by the method of IEA - without negative dynamics too. Such positive laboratory and virologic dynamics is being kept up to nowadays, for more than 7 years.