Клинико-цитохимическая характеристика вирусного гепатита а и в у детей на фоне железодефицитной анемии
Southern region of Kazakhstan is hyperendemic due to viral hepatitis morbidity and especially due to viral hepatitis A (96,3%), with the continuity and intensification of the epidemic process. In viral hepatitis B at children there is a tendency to morbidity decrease due to mass vaccination of infants. Mainly children (87,2%) with dominance of the age group from 0 to 7 years (64,5%) and a seasonal peak of incidence in November-December are involved into the epidemic process of the viral hepatitis A. In viral hepatitis A a social contact way of infection transmission (from 48,8% to 74,4% in different years) was revealed, a high proportion of transmission by water also remains (17,7%-33,9%), and in recent years ways of transmission by food were more prevalent (in 2006 – 24,6%, in 2007 – 23,3%). In most cases ways of viral hepatitis B transmission are not known (60,4%), which sets up a potential threat to infection spread among the population.
The frequency of iron deficiency anemia at patients with viral hepatitis was 53,9%, due to severity of anemia: a moderate degree at 75,6%, a marked degree at 18,6% and severe anemia at 5,8% of the children, as a rule, a severe degree of anemia was observed at most patients with viral hepatitis B.
The clinical picture of viral hepatitis A at children on the iron deficiency anemia background was generally heavier (frequency is 1,7 times more) than those without anemia, which was confirmed by calculating the Kulbah’s criteria (IK=0,146) and such symptoms as fever elongated more than 3 days (frequency is 1,7 times more), a repeated rise of body temperature (frequency is 2 times more) because of joining intercurrent infections, more marked intoxication (from 30,3% vs 4,2%), dyspeptic syndrome kept longer (at 54,1% vs 16,7%), elongation of jaundice more than 15 days, nearly at half patients (47,7%) with iron deficiency anemia against 21,3% without it, splenomegaly occurred more often (at 13,1% vs 2,1%), prolonged course (1,0% vs 0%).
The clinical picture of viral hepatitis B infection at children on the iron deficiency anemia background was characterized by more severe course than without anemia (34,3% vs 10,1%), it was confirmed by calculation of the Kulbah’s criteria (IK=1,28) and the following data: intoxication was strongly marked at half of patients (49, 3%), than without anemia (8,1%), prolonged (4,1% vs 0%) and chronic courses of the disease (6,9% vs 1,1%) were more often observed.
Study of the enzymatic activity of alkaline phosphatase and succinatedehydrogenase of the blood cells, made by the method of computer morphodensitometry in viral hepatitis A and concomitant iron deficiency anemia, showed presence of significant cytochemical changes in the viral hepatitis which reliably and informatively were confirmed by quantitative data: the reduction of the average and the integral optical density of the alkaline phosphatase granules of neutrophils (decrease to 1,4 and 2,3 times in comparison with the control group) and integral optical density of succinatedehydrogenase lymphocytes (decreased up to 1,7 times in comparison with the control group).
The influence of iron deficiency anemia on the course of viral hepatitis A and viral hepatitis B was negative and it was confirmed by comparing the clinical picture of viral hepatitis with iron deficiency anemia and without it, calculation of the Kulbah’s criteria and conducting morphodensitometrical researches, on this basis practical advice and tactics for treatment of such patients, aimed at enhancing protective immune mechanisms have been worked out.