THERAPEUTIC PATHOMORPHOSIS OF AUTOIMMUNE HEPATITIS IN CHILDREN

The purpose of the work was to study morphological features of autoimmune hepatitis in children before treatment and during immunosuppressive therapy. Methods: At the Center of Pediatric Hepatology of Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova NAMS of Ukraine during the period 2015-2017 42 children with autoimmune hepatitis were examined. Examination of all children was in accordance with the protocol, liver elastography by the shear wave method of liver parenchyma and a puncture liver biopsy with a morphological and immunohistochemical study of the biopsy. The disease activity was estimated with the histological index of activity (IHA) of Knodell, the stage of the disease was rated semi-quantitatively on the histological index of multiple sclerosis (GIS) of METAVIR. Results: 71,0% (n = 30) children have an expressive fibrosis >F2 METAVIR, among them 77,0% were in group I, 62,5% were in group II. High activity (IGA > 12 points) was detected in 45,0% of the examined patients with AIH. In the group of children who did not receive immunosuppressive therapy at the time of the morphological examination the high activity of hepatitis was significantly higher in comparison with the group of children who received treatment at the time of the examination (p = 0,05). Conclusions: Autoimmune hepatitis in childhood is characterized by high-level inflammatory process in the liver with rapid progression to cirrhosis of the liver, with the development of complications. There were signs of liver cirrhosis following morphological examination in 45,0% of the examined children. The activity of the inflammatory process in the liver and the rate of fibrosis depends on the duration of the disease. Puncture biopsy should be performed before the start of immunosuppressive treatment, which will improve the effectiveness of the diagnosis and choose the right treatment tactics.