ALGORITHM OF DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF CHRONIC DIFFUSE LIVER DISEASES (CHRONIC HEPATITIS AND LIVER CIRRHOSIS) IN DIFFICULT CLINICAL SITUATIONS, BASED ON DETERMINATION OF ENZYMATIC ACTIVITIES OF BLOOD SERUM

Background. The search for non-invasive criteria for differential diagnosis of chronic hepatitis and liver cirrhosis is one of the urgent tasks of hepatology. Aim. Development of an algorithm for the diagnosis and differential diagnosis of chronic diffuse liver diseases (chronic hepatitis and liver cirrhosis) in difficult clinical situations, namely in patients with questionable results of routine laboratory research. Materials and Methods. 55 patients were examined who had a characteristic clinical picture of chronic diffuse liver diseases, however, the levels of AST and ALT were close to normal values. Chronic hepatitis was confirmed in 14 patients (mean age 55.0±11.2 years), liver cirrhosis in 40 patients (mean age 55.0±9.9 years). The control group included 43 practically healthy individuals (mean age – 52.8±4.2 years). All patients underwent determination of the levels of hyaluronidase, elastase, trypsin-like and deoxyribonuclease serum activities, as well as levels of alpha-1-defensin and interleukin-13 in blood serum. Results. An algorithm for the differential diagnosis of chronic hepatitis and cirrhosis of the liver was developed, which makes it possible to identify liver disease with odds ratio of 988.0 [CI95%=31.3-31207.7]. Conclusion. The algorithm allows to optimize diagnostic measures in difficult clinical situations.