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C chronic hepatitis and thyroid gland function


Author: Mukhtar Abdulelah Saeid Al-Shargabi
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2004
Scientific adviser: Vlada-Tatiana Dumbrava
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Zinaida Anestiadi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 15 September, 2004
Approved by NCAA on the 14 October, 2004

Abstract

Adobe PDF document0.32 Mb / in romanian

Thesis

CZU 616.36-002.2 + 616.441

Adobe PDF document 1.05 Mb / in romanian
111 pages


Keywords

chronic hepatitis, C viral chronic hepatitis, hyperthyroidism, hypothyroidism, euthyroidism, autoimmune thyroidism, cytolisis syndrome, cholestasis syndrome, immunoinflamatory syndrome, antiperoxidasis, antithyroglobaline antibodies, extrahepatic manifestation

Summary

107 patients with viral chronic hepatitis C (VCHC) from the Republic of Moldova and 50 patients suffering from VCHC from the Yemen Republic were examined. All the patients to comparative analysis of clinical symptoms, basic laboratory syndromes, which characterized the liver functional state, including the immune status under different functional conditions of thyroid gland (euthyroidism, hyperthyroidism, hypothyroidism, as well as in dependency on presence or absence of antibodies to peroxidase and thyroglobulin) were subjected . The presence of thyroidian dysfunction in 41-44 % of patients with VCHC was attested : hyperthyroidism – in 23-24 % and hypothyroidism – in 18-20% of cases. Hepatomegalism, splenomegalism, sleep disturbances, arthralgia, hemorrhagic vasculism were more frequent at patients suffering from VCHC accompanied with thyroidian dysfunction. The dependence of cytolysis and cholestasis syndromes expressivity upon the function of thyroid gland was more evident at patients from the Yemen Republic, in comparison with those from the Republic of Moldova. In such a way, in the group from Yemen, the ALAT and ASAT activity was higher in case of hyperthyroidism than in those of euthyroidism and hypothyroidism, while alkaline phosphatase, general and indirect bilirubin were at maximal levels during hypothyroidism. At VCHC patients from Moldova, the GGTP activity was higher in hyperthyroidism. The increase of IgA, IgM, IgG and CIC levels was attested in both Yemen and Moldavian patients groups, comparative with healthy people. The dependence of IgA and IgG levels upon the functional state of thyroid gland was identified. The disturbances of cell immunity in different groups were different. The increase of the total T lymphocytes number was characteristic for Moldavian patients, while in the case of persons suffering from VCHC from Yemen, especially at hyperthyroidism, this parameter was lower than in control group. The thyroid gland function influenced the level of t-sensible T lymphocytes (maximal in hypothyroidism) at patients from Moldova and the level of active T lymphocytes (decreased in hyperthyroidism), as well as that of t-resistant T lymphocytes (decreased in hypothyroidism and hyperthyroidism) at Yemen patients. The thyroglobulin antibodies (ATTG) were identified in 18% of Moldavian patients and 16% of patients from Yemen, and the thyroperoxidase antibodies (APO) – in 40% and 16% respectively. The dependence of the expressivity of basic syndromes of liver affectation upon the thyroperoxidasis antibodies was established. At APO+ patients from Moldova an evident increase of ALAT, LDH, direct bilirubin, AP and IgG levels was ascertained. In the Yemen group, in the case of APO+, the levels of total bilirubin and its fractions, IgA, IgM, IgG, and t-resistant T lymphocytes were higher than in the group of APO- patients. In clinical practice the investigation of thyroidian status of patients suffering from VCHC is necessary for the early diagnosis of autoimmune disturbances of thyroid gland aiming the differential tactics while administrating the antiviral treatment.