The dissertation is devoted to the optimization of diagnosis and treatment of patients with chronic hepatitis C (CHC) by studying the relationships between the clinical course, trace element imbalance, the activity of the inflammatory process, the nature and expressiveness of morphological changes in the liver, and establishing predictors of their progression. Patients who participated in the study underwent a standard examination according to current clinical protocols. The levels of zinc, copper and selenium in blood serum, the levels of cytokines (IL-1β, IL-4, IL-6, TNF-α) and collagen IV were also determined. In the paper, for the first time, the frequency of violations of the trace element composition of the blood in patients with CHC was analyzed and it was established that in about a third of people, the zinc content in the blood serum is reduced with normal indicators of copper and selenium. It has been shown that a reduced zinc content is more often registered in patients with CHC, combined with non-alcoholic fatty liver disease, and more than half of patients with a reduced level of zinc in the blood serum have an increased body weight. As a result of the conducted research, scientific data on the clinical course of CHC in the presence of a reduced zinc level, which is characterized by a predominance of dermatological symptoms (acne, dryness and peeling of the skin, dandruff, hair loss, brittle nails) over typical ones, have been expanded. Scientific data on the relationship between the activity of the inflammatory process, the expressiveness of the morphological changes of the liver and the trace element composition of the blood have been clarified, and it has been shown that in patients with CHC, in the presence of a reduced level of zinc, a higher activity of the inflammatory process (according to the levels of aminotransferases) is more often registered, which correlates with a high content proinflammatory cytokines. Serum zinc was shown to be significantly lower in patients with a higher degree of liver fibrosis, and there was a negative correlation between zinc and collagen IV levels. In the paper, for the first time, substantiates the expediency of the simultaneous additional appointment of zinc sulfate as part of the complex treatment of patients with CHC in the condition of insufficient zinc in the serum, which leads to the disappearance of dermatological symptoms, a faster decrease in the activity of the inflammatory process, the normalization of cytokine dysfunction and a decrease in collagen IV levels. According to the results of the regression analysis, it was proved that the level of zinc in the blood serum is an independent predictor of liver fibrosis, which makes it possible to argue the feasibility of determining the level of zinc together with the level of collagen IV, as an additional marker of liver fibrosis progression.
Key words: chronic hepatitis C, zinc, non-invasive diagnostics, liver damage, liver fibrosis, liver steatosis, non-alcoholic fatty liver disease, inflammation, cytokines, antiviral therapy, body mass status.
