Singh S. Early diagnosis and liver fibrosis treatment in children with chronic viral hepatitis B in lymphoblastic leukemia remission

Taking into account the study purpose and the objectives, a comprehensive study was conducted on children with chronic hepatitis B in lymphoblastic leukemia remission. The main group of the study was 41 children with chronic viral hepatitis B in lymphoblastic leukemia remission. The average age of patients was 9.0 (7.0-14.0) years. Wild-type HBeAg (+) strain of the virus occurred in 97.5%. In 24 children (58.5%) hepatitis was in the immune active phase, 9 patients (22%) had an immune tolerant phase, 3 children (7.3%) - the immune phase control, in 5 (12.2%) - the phase of avoiding the immune response was diagnosed. Hemotransfusion was found to be the most frequent transmission factor in the implementation of the parenteral route in 38 (92,7%) patients. 32 patients (78.1%) with CHB in LBL remission had burdened premorbid background. All children with CHB in LBL remission were characterized by primary-chronic course without jaundice. The mosaic of clinical symptoms is associated with severe asthenic-vegetative syndrome, in particular increased fatigue (31.7%), dyspeptic syndrome in the form of appetite lack (58.5%), flatulence (34.1%), unstable chest (36.6%), pain syndrome in the right hypochondrium (26.8%), hepatomegaly (43.9%) (p<0.05). In patients of the main group the markers of cholestasis (general and direct bilirubin, alkaline phosphatase) were significantly higher compared to the control group. With the age of patients with CHB in LBL remission, all indicators of cholestasis, except for indirect bilirubin, tended to increase and were significantly higher than in the control group. On the basis of the ROC analysis, the boundary level of osteopontin 248.20 ng/ml was determined which can be used as a non-invasive liver fibrosis biomarker (≥ F1) in children with CHB in LBL remission (sensitivity 92%, specificity 68%, accuracy - 76%). In children with CHB in LBL remission in accordance with the goal, pathogenic therapy was improved by the use of arginine-betaine agent.