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20070917181329.0 |
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|9 (HR-ZaNSK)232758
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|9 (HR-ZaNSK)990406007
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|a (HR-ZaNSK)000232514
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|a 616.36-002-037
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|a Čolić-Cvrlje, Vesna
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| 245 |
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|a Evaluacija i prognoza kroničnog hepatitisa B ispitivanjem seroloških biljega hepatitisa B virusa suvremenim metodama :
|b doktorska disertacija /
|c Vesna Čolić-Cvrlje.
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| 260 |
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|a Zagreb :
|b V. Čolić-Cvrlje,
|c 1996
|e ([s. l. :
|f s. n.])
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| 300 |
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|a 82 lista :
|b ilustr., table, graf. prikazi ;
|c 30 cm.
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| 500 |
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|a Mentor: Svebor Čerlek; Komisija za ocjenu: Nijaz Hadžić, Mara Dominis, Vladimir Presečki, Ante Bilić, Svebor Čerlek; Komisija za obranu: Nijaz Hadžić, Mara Dominis, Vladimir Presečki, Ante Bilić, Svebor Čerlek; datum obrane: 16. 02.1998.
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|a Sveučilište u Zagrebu, Medicinski fakultet, Zagreb, 1996
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|a Bibliografija: str. 69-81
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|a Summary
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|a Sažetak: Obradili smo grupu od 219 bolesnika s kroničnom bolešću jetre dokazanom biopsijom. Bolesnike smo pratili tijekom pet godina, a podjelili smo ih u tri grupe: 52 bolesnika bili su nosioci virusa hepatitis B. 75 su imala pozitivne biljege za prebioljeli B hepatitis, ali bez HBsAg u serumu. U bolesnika s biljezima virusa hepatitisa B isključen je alkoholizam. Preostala skupina od 92 bolesnika nije imala nikakvih biljega za infekciju B virusom, ali je među njima bio 41 alkoholičar. Bolesnike smo pratili tijekom pet godina s ciljem da ustanovimo obilježja prirodnog tijeka oboljenja u naših bolesnika s kroničnim B hepatitisom i bolesnika bez infekcije virusom hepatitisa B. Bolesnike smo tijekom posljednje godine praćenja testirali na suvremene testove za HBV: Prisutnost i razinu HBV DNK u serumu, HBV DNK polimerazu, IgM anti HBc protutijela.
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| 520 |
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|a Serološko ispitivanje smo poduzeli s zadaćom da odredimo kriterije i prognostičke čimbenike u naših bolesnika neophodnih za uvođenje antiviralne terapije. Istraživanjem smo dokazali da virus hepatitis B u nas izaziva teška kronična oboljenja jetre: ciroza ima 46,15% bolesnika, kronični aktivni hepatitis 27%, a kronični perzistentni hepatitis 19,23% bolesnika. Međutim ovi naši bolesnici su unatoč uznapredovaloj bolesti jetre, a bez antiviralne terapije kroz više godina bili u dobrom kliničkom stanju, a smrtnost je bila u 5,7% slučajeva. U bolesnika s negativnim nalazom HBsAg, ali drugim biljezima B virusa nalazili su se bolesnici s uznapredovalim kroničnim hepatitisom : 48% s cirozom jetre, 22,67% s kroničnim aktivnim hepatitisom, od kojih je umrlo 8% ispitanika.
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| 520 |
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|a Teška oboljenja jetre razvili su i bolesnici bez biljega virusa hepatitis B: 51,08% cirozu jetre, 13,08% kronični aktivni hepatitis. U ovoj grupi alkoholičari su imali znatno teže bolesti jetre: cirozu u čak 78,04% bolesnika, a smrtnost u ovoj grupi iznosila je 6,52%. Nealkoholičari bez biljega B virusa imali su značajno najteža oboljenja jetre. U bolesnika s kroničnim B hepatitisom virus se replicirao u 44,3% slučajeva. Svi ovi bolesnici imali su histološki značajno teža oboljenja jetre: 60% cirozu, 21,17% kronični aktivni hepatitis prema grupi bolesnika u kojih se virus nije razmnožavao. Svi bolesnici HBsAg pozitivni s replikacijom HBV virusa imali su kriterije za primjenu antiviralne interferonske terapije.
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| 520 |
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|a Osjetljive serološke metode serumske HBV DNK i HBV DNK polimeraze pokazale su se najsigurnijima u određivanju kriterija i prognostičkih čimbenika za uvođenje antiviralne terapije. Monoklonalna RIA metoda za određivanje HBsAg u serumu nije se pokazala osjetljivijom od poliklonalne RIA metode u svakodnevnoj kliničkoj praksi. IgM anti HBc protutijela bila su prisutna u 42,30% bolesnika s kroničnim B hepatitisom uz povišene vrijednosti aminotransferaza, te ova protutjela možemo smatrati jednim od pokazatelja aktivnosti oboljenja. Petogodišnjimpraćenjem, naših bolesnika s kroničnom bolešću jetre pokazali smo da je virus hepatitisa B važan čimbenik u nas u zadobijanju bolesti jetre, ali da su isto tako alkoholizam i drugi do sada nepoznati čimbenici također značajni u etiologiji kronične bolesti jetre.
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|a Summary: In our study we have analyzed a group of 216 patients with histollogically proven chronic hepatitis. We have followed up them for 5 years. 52 of them were positive and carries of hepatitis B virus, 75 were negative for HBsAg but were positive for some other markers of HBV. 92 patients had not any marker for hepatitis B infection. Among them were 41 alcoholics. The purpose of assessing these group was to establish the nature history of chronic HB hepatitis in our patients. In the sera of the all our patients we have determinated and prospectively examined markers of viral replication: level of HBV DNA, HBV DNA polimerase and IgM anti HBc antibodies. The purpose serological testina was to determine criterias and predictive factors for responding to antiviral interferon therapy.
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| 520 |
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|a By our investigation we have proved that HBV causes very strong hepatitis diseases: cirrhosis in 46,15% cases, chronic active hepatitis in 27% cases, chronic persistent hepatitis in 19% cases. Despite of progresive hepatic diseases and without treatment with antiviral therapy throught these 5 years all of our patients wereclinically in good condition. At the end of investigation in these group have 5,7% of them. We have also proved for the first time that mutant HBV causes very strong hepatitic diseases in 26,08% cases. The HBsAg negative patients but with the other HBV markers positive also had very sever chronic hepatitis diseases: 48% cirrhosis, 22,67% chronic active hepatits. 8% in these group of patients have died within thereemonths after investigation. The patients without any marker for HBV had also very serious hepatic diseases: 51,08%
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| 520 |
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|a The patients without any marker for HBV had also very serious hepatic diseases: 51,08% cirhosis, 13,04% chronic active hepatitis. Alcoholics in these group had significantly progresive chronic hepatitis: cirrhosis in 78.04% cases and 6,52% of them had died after investigation. Nonalcoholics without any marker for HBV definitly had the most serious chronic hepatitis diseases. We established that 44,23% of HBV chronic hepatitis patients were positive for HBV DNA: 60% with cirrhosis, 21,7% with chronic active hepatits. All of them had criterias for antiviral (Interferon) therapy, but in the patients with cirrhosis represent a risk group for such therapy. The serological markers HBV DNA, HBV DNA polimerase were the most sensitive tests for determination the criterias and predicitive factors for respond to antiviral therapy.
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| 520 |
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|a The monoclonal antybody - based RIA assay for detecting HBsAg in serum of HBV hepatitis patients had the same value as the political RIA assay in every day clinical practice. IgM anti HBc antibodies were positive in 42,30% patients with HBV chronic hepatits which also had biochemical parameters AST, ALT two times higher than normal. These antibodies were uself in determing the activity of hepatic disease. The five years following up of our patients with chronic hepatic diseases resulted that HBV has a very important influence in development of chronic hepatitis as well as alcohol enjoying. The existance of the other etiologic factors which seem to be very obvious in reason of chronic liver diseases have to be serious reason for further investigations.
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| 650 |
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7 |
|a Hepatitis B
|x Prognoza
|2 nskps
|
| 700 |
1 |
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|a Čerlek, Svebor
|4 cns
|
| 700 |
1 |
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|a Hadžić, Nijaz
|4 oth
|
| 700 |
1 |
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|a Dominis, Mara
|4 oth
|
| 700 |
1 |
|
|a Presečki, Vladimir,
|c liječnik
|4 oth
|
| 700 |
1 |
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|a Bilić, Ante,
|c liječnik
|4 oth
|
| 981 |
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|p CRO
|r HRB1996
|
| 998 |
|
|
|n DCD
|c sbno9904
|c lbap9904
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| 852 |
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|j DCD-ZG-208/98
|
| 876 |
|
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|e DCD
|a 208/1998
|
| 886 |
0 |
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|2 unimarc
|b 07927nam0 2200409 450
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