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  • Title: RETROSPECTIVE ASSESSMENT OF CLINICAL-MORPHOLOGICAL CHANGES OF THE HEPATOBILIARY SYSTEM IN LIVER CIRRHOSIS OF THE CHORNOBYL NPP ACCIDENT CLEAN-UP WORKERS.
    Author: Sarkisova EO, Sushko VO, Chumak AA, Ovsyannikova LM, Nosach OV, Alyokhina SM, Shyiko TO.
    Journal: Probl Radiac Med Radiobiol; 2019 Dec; 24():465-479. PubMed ID: 31841488.
    Abstract:
    OBJECTIVE: to retrospectively characterize changes in the hepatobiliary system in liver cirrhosis (LC) in the clean-up workers of the Chornobyl NPP accident and to determine the factors of disease progression according to the expert materials of the Central Interagency Expert Commission on Establishing the Causal Relationship of the Diseases with the influence of factors of Chornobyl NPP accident. MATERIALS AND METHODS: Based on the data of 60 cases of the Central Interagency Expert Committee on establishing the causal link of diseases with the impact of the Chornobyl NPP accident, the factors of development, concomitant pathology and indicators of the hepatobiliary system status in 49 deceased and 11 alive clean-up workers with LC were investigated. RESULTS: A retrospective study of the morphological changes of the hepatobiliary system in the clean-up workers with LC showed that the main pathologic anatomical diagnosis in 37.8 % of cases was small-nodal LC, in 8.9 % - micromacronodular, in 4.4 % - large-nodal, in 2.2 % - primary biliary LC, in the other 40 % of cases - LC with uncer- tain nodal structure, as well as 2 (4.4 %) cases of fatty liver and 1 case (2.2 %) of portal cirrhosis against the back- ground of fatty liver. Pathomorphological changes were characterized by expressed growth of fibrous tissue with replacement of the liver parenchyma (fields of fibrosis), increase in size and impaired structure of the liver, thick- ening and tightening of its capsule, fibrotic changes in other organs - gastric mucosa, pancreas, spleen, lungs, heart. Histological examination revealed lobe structure abnormalities, false lobules, periportal fibrosis, lymphoid-lympho- cytic infiltration, diffuse fatty small-sized and large-drop dystrophy, and hepatocyte atrophy. Common inflammato- ry processes and fibrotic changes of other organs and systems: cardiovascular, urinary, bronchopulmonary, stomach, pancreas and spleen made the course of the LC more severe. The most frequent were cardiovascular diseases, signi- ficantly more frequent among the deceased than alive patients: hypertension - 67.3 % and 45.5 %, p < 0.05, coro- nary heart disease - 57.1 % and 18 %, p < 0.05. In most cases, the cause of death in the clean-up workers with LC was hepatic and cellular failure (53.3 %), which together with hepatic-renal failure (17.8 %) made 71.1 %. CONCLUSION: Changes in the hepatobiliary system of change in in the clean-up workers with LC were characterized by marked growth of fibrotic tissue with replacement of the parenchyma and impaired liver structure, fibrotic changes in other organs, diffuse fatty small and large droplet dystrophy and atrophy of hepatocytes. The severe course of the LC with the manifestation of the disease at the stage of decompensation was due to a vague clinical picture, lack of subjective symptoms of liver disease, slow, steadily progressing development, lack of or inadequate examination and treatment, a significant number of concomitant pathology of other organs and systems. The fac- tors of the development of LC in the clean-up workers were the long course of chronic liver disease, numerous con- comitant pathology, long stay in the accident zone, the effect of ionizing radiation, as well as the lack of dispensa- ry supervision and adequate treatment. Meta doslidzhennia: retrospektyvno okharakteryzuvaty zminy gepatobiliarnoï systemy pry tsyrozi pechinky (TsP) v uchasnykiv likvidatsiï naslidkiv avariï na ChAES (ULNA) ta vyznachyty chynnyky progresuvannia zakhvoriuvannia za materialamy ekspertnykh sprav Tsentral'noï mizhvidomchoï ekspertnoï komisiï po vstanovlenniu prychynnogo zv’iaz- ku zakhvoriuvan' iz vplyvom faktoriv avariï na ChAES.Materialy i metody. Za materialamy 60 sprav Tsentral'noï mizhvidomchoï ekspertnoï komisiï po vstanovlenniu pry- chynnogo zv’iazku zakhvoriuvan' z vplyvom faktoriv avariï na ChAES doslidzheni faktory rozvytku, suputnia patologiia ta pokaznyky stanu gepatobiliarnoï systemy v 49 pomerlykh vnaslidok TsP ta 11 khvorykh na TsP ULNA na ChAES. Rezul'taty. Retrospektyvne doslidzhennia morfologichnykh zmin gepatobiliarnoï systemy pry TsP v ULNA na ChAES pokazalo, shcho osnovnym patologoanatomichnym diagnozom v 37,8 % vypadkiv buv dribnovuzlovyy̆ TsP, v 8,9 % – mikromakronoduliarnyy̆, v 4,4 % – krupnovuzlovyy̆, v 2,2 % – pervynnyy̆ biliarnyy̆ TsP, v inshykh 40 % vypadkiv – TsP z nevyznachenoiu vuzlovoiu strukturoiu, a takozh 2 (4,4 %) vypadky zhyrovoï dystrofiï pechinky i vypadok (2,2 %) portal'nogo tsyrozu na tli zhyrovoï dystrofiï pechinky. Patomorfologichni zminy kharakteryzuvalysia vyrazhenym rozrostanniam fibroznoï tkanyny iz zamishchenniam parenkhimy pechinky (polia fibrozu), zbil'shenniam rozmiriv i po- rushenniam budovy pechinky, potovshchenniam ta ushchil'nenniam ïï kapsuly, fibroznymy zminamy v inshykh organakh – pidslyzovomu shari shlunka, pidshlunkoviy̆ zalozi, selezintsi, legeniakh, sertsi. Pry gistologichnomu doslidzhenni vyz- nachalys' porushennia struktury chastochok, khybni chastochky, peryportal'nyy̆ fibroz, limfoïdno-limfotsytarna infil'tratsiia, dyfuzna zhyrova dribno- ta krupnokrapel'na dystrofiia i atrofiia gepatotsytiv. Obtiazhuvaly perebig TsP rozpovsiudzheni zapal'ni protsesy ta fibrozni zminy inshykh organiv i system:sertsevo-sudynnoï, sechovydil'noï, bronkholegenevoï, shlunka, pidshlunkovoï zalozy ta selezinky. Nay̆bil'sh chastymy buly sertsevo-sudynni zakhvoriu- vannia, dostovirno chastishe sered pomerlykh: gipertonichna khvoroba – 67,3 % ta 45,5 %, p < 0,05, ishemichna khvoroba sertsia – 57,1 % i 18 %, p < 0,05. Prychynoiu smerti u razi TsP v ULNA v bil'shosti vypadkiv bula pechinkovo-klityn- na nedostatnist' (53,3 %), shcho razom z pechinkovo-nyrkovoiu nedostatnistiu (17,8 %) skladala 71,1 %. Vysnovok. Zminy gepatobiliarnoï systemy zminy pry TsP v ULNA kharakteryzuvalysia vyrazhenym rozrostanniam fibroznoï tkanyny iz zamishchenniam parenkhimy ta porushenniam budovy pechinky, fibroznymy zminamy v inshykh orga- nakh, dyfuznoiu zhyrovoiu dribno- ta krupnokrapel'nu dystrofiieiu i atrofiieiu gepatotsytiv. Tiazhkyy̆ perebig TsP z manifestatsiieiu zakhvoriuvannia na stadiï dekompensatsiï buv zumovlenyy̆ nevyraznoiu klinichnoiu kartynoiu, vidsutnistiu sub’iektyvnoï symptomatyky zakhvoriuvannia pechinky, povil'nym, neukhyl'no progresuiuchym rozvytkom, vidsutnistiu abo nedostatnistiu obstezhennia ta likuvannia, znachnoiu kil'kistiu suputn'oï patologiï inshykh organiv ta system. Faktoramy rozvytku TsP v ULNA na ChAES buly tryvalyy̆ perebig khronichnogo zakhvoriuvannia pechinky, chy- sel'na suputnia patologiia, znachnyy̆ termin perebuvannia v zoni avariï, diia ionizuiuchogo oprominennia, a takozh vidsutnist' dyspansernogo nagliadu i adekvatnogo likuvannia.
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