ART OF MEDICINE 2017

 

EXQUISITE REACTIONS OF ERYTHROCYTES WITH CRYPTOGENIC HEPATITIS WITH EXPRESSED INTESTRAL CHOLESTASIS WITH COMPLICATED ENCEPHALOPATHY

 

S.L. Pоpеl, S.Z. Krasnоpоlsky, О.S. Chovhaniuk, I.V. Melnik

G.D. Mаrkiv, N.I. Baryla  L.M. Оstrоvskаya

              Ivano-Frankivsk, Ukraine

 

Abstract

Summary. In the artical presents the features of structural and biochemical reactions of hepatocytes and erythrocytes in combination with electroencephalographic studies in cryptogenic hepatitis.

The purpose – to study the structural and biochemical reactions of hepatocytes and erythrocytes in combination with electroencephalographic studies in cryptogenic hepatitis.

At the patient, at the age of 55 years with the diagnosis of cryptogenic hepatitis, electroencephalographic and laboratory examinations were performed with admission to inpatient treatment. Control data were obtained from the same patient 12 months after outpatient treatment.

The patient underwent liver biopsy followed by morphometric analysis of histological sections of 500 mononuclear hepatocytes stained with hematoxylin and eosin, in which the area of the profile of nuclei and cytoplasm, their ratio and the form factor of the hepatocyte and its nucleus were determined. Morpho-functional state of erythrocytes was assessed on smears of Romanaminsky-Giemsa stained according to morphometric parameters of the area, perimeter of the profile, the shape factor, and changes in the microrelief of erythrocytes were studied in a scanning electron microscope.

Biochemical indices of lipid peroxidation intensity were determined: primary and secondary lipoperoxidation products, antioxidant enzyme activity: superoxide dismutase, catalase and products of oxidative modification of proteins, as well as transferrin and ceruloplasmin.

In erythrocytes, the ratio of the activity of the antioxidant defense system was evaluated.

To assess the destructive processes in the liver cells, the activity of alanine transferase and aspartate transferase was determined.

Electroencephalographic examination was performed using the diagnostic complex DX-NT in the mode of bispectral analysis with determination of the map of the correlation matrix of dynamic spectra.

It has been established that cryptogenic hepatitis with signs of cholestasis is manifested by morphological changes in hepatocytes, which indicate a decrease in the functionally active area of the liver due to activation of apoptosis and indicates a pronounced membrane pathology associated with activation of lipid peroxidation processes and inhibition of the functional capacity of the antioxidant defense system. Deep violations of liver function are reflected in the state of the nerve centers of the brain, accompanied by the presence of characteristic electroencephalographic patterns that indicate the development of hepatic encephalopathy in cryptogenic hepatitis with severe intrahepatic cholestasis. It is shown that in the case of cryptogenic hepatitis, the area of erythrocytes decreases with a significant relative morphometric redistribution, as a result of which cells with an area from 35 to 55 μm2 prevail. The proposed integrated approach in the study of hepatocytes and erythrocytes in combination with the determination of the activity of lipid peroxidation processes, the functional ability of the body's antioxidant defense system and electroencephalographic parameters is a complement to diagnosis in the clinic and the appointment of a pathogenetically grounded therapy for cholestatic forms of chronic hepatitis.

Conclusion: Cryptogenic hepatitis with signs of cholestasis is manifested by morphological changes in hepatocytes, which is confirmed by morphometric indices, which indicate a decrease in the functionally active area of ​​the liver as a result of activation of apoptosis. Simultaneously with changes in hepatocytes, the reduction of the area and perimeter of erythrocytes and their deformation are determined, which indicates a pronounced membrane pathology in cryptogenic hepatitis associated with activation of lipid peroxidation processes and a decrease in the functional capacity of the antioxidant defense system. Combined structural and morphometric changes in hepatocytes and erythrocytes, against a background of a sharp increase in the level of CD95 + lymphocytes, indicate a systemic apoptosis of these cells in cryptogenic hepatitis. The proposed integrated approach in the study of hepatocytes and erythrocytes in combination with the determination of lipid peroxidation activity, the functional capacity of the antioxidant defense system and electroencephalographic parameters is a complement to diagnosis in the clinic and the appointment of a pathogenetically grounded therapy for cholestatic forms of chronic hepatitis.

 

Key words: cryptogenic hepatitis, cholestasis, electroencephalography, lipid peroxyd, antioxidant defense system.

 

Full text: PDF (Rus)

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