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What causes chronic hepatitis?
Last reviewed: 19.10.2021
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Most often, the formation of chronic hepatitis is etiologically associated with hepatitis viruses.
- Chronic hepatitis is caused by viruses, mainly transmitted parenterally:
- hepatitis C virus (HCV) in children with chronic hepatitis is detected in 30-50% of cases;
- hepatitis B virus (HBV) - in 15-20% of cases, as a rule, simultaneously with the delta virus (HDV);
- viruses of hepatitis F, G - less than 1% of cases;
- viruses of cytomegaly, herpes, rubella, enteroviruses, Epstein-Barr virus - very rare, mainly in young children.
Chronic hepatitis can be a consequence of toxic damage to the liver:
- chemical substances (benzene derivatives, chlororganic compounds, heavy metal salts);
- drugs (isoniazid, sulfonamides, preparations of valproic acid and carbamazepine, phenytoin, androgenic hormones, methyldopa, acetaminophen, salicylates, hydralazine, nitrofurans, cytostatics).
Perhaps the emergence of chronic hepatitis against bacterial and parasitic diseases (septic endocarditis, brucellosis, tuberculosis, amebiasis, opisthorchiasis, infectious mononucleosis).
Pathogenesis of chronic hepatitis
The leading moments of chronic hepatitis are:
- persistence in the body of a virus with insufficient ability of the organism to eliminate the virus from the liver;
- development of immunopathological aggressive process in the liver.
The features of the immune response are largely determined by genetic factors. This is evidenced by the presence among patients of a significant number of persons with histocompatibility antigens HLA-B8, DRw3 and A1.
In the liver as chronic hepatitis develops:
- progressing destruction of the parenchyma with death of hepatocytes, inflammatory and immunopathological changes in the mesenchyme,
- decreased blood flow and microcirculation disorder;
- violation of the function of intact hepatocytes;
- cholestasis.
Classification of chronic hepatitis (Los Angeles, 1994)
|
The form |
Activity |
Stage |
Phase |
|
Chronic viral hepatitis (B, delta, C, G, F) Autoimmune hepatitis Chronic toxic or drug-induced hepatitis |
The minimum (> ALT up to 3 times) Moderate (> ALT up to 10 times) Expressive (> ALT more than 10 times) Inactive hepatitis |
Slightly expressed Moderate fibrosis with portoportal septa Strong fibrosis with portocentral septa Violation of the lobule structure Formation of |
With viral HG Integration replication |