rospedРоссийский педиатрический журнал имени М.Я. СтуденикинаM.Ya. Studenikin Russian Pediatric JournalФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/1560-9561-2022-25-2-106-115etrkhkrosped-338Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSСочетание аутоиммунной гепатобилиарной патологии с воспалительными заболеваниями кишечника у детейAssociation of autoimmune hepatobiliary pathology with inflammatory bowel diseases in childrenhttps://orcid.org/0000-0003-0661-6976УсольцеваОльга ВладимировнаUsoltsevaOlga V.

Аспирант, врач-педиатр гастроэнтерологического отд-ния с ге-патологической группой ФГАУ «НМИЦ здоровья детей» Минздрава России.

e-mail: usoltseva.olga93@gmail.com

Post-graduate student, pediatrician of the gastroenterological department with the hepatological group of the National Research Center for Children’s Health of the Ministry of Health of Russia, Moscow, 119991, Russian Federation.

e-mail: usoltseva.olga93@gmail.com

usoltseva.olga93@gmail.comhttps://orcid.org/0000-0002-3697-4283СурковАндрей НиколаевичSurkovAndrey N.

Доктор мед. наук, проф., каф. факультетской педиатрии педиатрического факультета ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» Минздрава России.

e-mail: surkov@gastrockb.ru

surkov@gastrockb.ruhttps://orcid.org/0000-0003-4905-2373ПотаповАлександр СергеевичPotapovAlexander S.

Доктор мед. наук, проф., зав. гастроэнтерологическим отделением с гепатологической группой, гл. науч. сотр. лаб. новых технологий диагностики и лечения болезней детского возраста ФГАУ «НМИЦ здоровья детей» Минздрава России.

e-mail: apotap@mail.ru

apotap@mail.ruhttps://orcid.org/0000-0003-2881-4703МовсисянГоар БорисовнаMovsisyanGoar B.

Канд. мед. наук, врач-педиатр гастроэнтерологического отделения с гепатологической группой ФГАУ «НМИЦ здоровья детей» Минздрава России.

e-mail: gongurik@mail.ru

gongurik@mail.ruhttps://orcid.org/0000-0002-8750-9285ЧерниковВладислав ВладимировичChernikovVladislav V.

Канд. мед. наук, начальник методического аккредитационно-симуляционного центра ФГАУ «НМИЦ здоровья детей» Минздрава России.

e-mail: chernikov@nczd.ru

chernikov@nczd.ruФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава РоссииNational Medical Research Center for Children’s HealthФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииN.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation202229092023252106115Copyright © Усольцева О.В., Сурков А.Н., Потапов А.С., Мовсисян Г.Б., Черников В.В., 20232023Усольцева О.В., Сурков А.Н., Потапов А.С., Мовсисян Г.Б., Черников В.В.Usoltseva O.V., Surkov A.N., Potapov A.S., Movsisyan G.B., Chernikov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rosped.ru/jour/article/view/338Введение

Введение. Гепатобилиарная патология (ГБП) выявляется у 30% пациентов с воспалительными заболеваниями кишечника (ВЗК), однако особенности её течения у детей изучены недостаточно.

Цель

Цель: изучить особенности течения аутоиммунных форм ГБП у детей с ВЗК.

Материалы и методы

Материалы и методы. Проведено комплексное клиническое, лабораторное и инструментальное обследование 84 детей с аутоиммунными формами ГБП в сочетании с ВЗК (ГБП+ВЗК), составивших основную группу, и 79 больных с изолирован-ными формами ВЗК (группа сравнения).

Результаты

Результаты. Частота аутоиммунной ГБП у детей с ВЗК составила 10,2%. В 64,3% случаев диагностирован первичный склеро-зирующий холангит (ПСХ), который в основном сочетался с язвенным колитом. Частота аутоиммунного гепатита (АИГ) — 8,3%. Наиболее частым сочетанием являлось АИГ+ПСХ (15,5%). Дебют заболевания проявлялся диареей, абдоминальным болевым синдромом, синдромами цитолиза и холестаза, гемоколитом. При ГБП+ВЗК отмечалось повышение сывороточных концентраций аланин- и аспартатаминотрансферазы, общего белка, γ-глутамилтрансферазы, щелочной фосфатазы, прямого билирубина и IgG. Примерно с одинаковой частотой при ПСХ выявлены антитела к сахаромицетам — 80% и антитела к цито-плазме нейтрофилов — 75%. При АИГ антинуклеарные антитела и антитела к микросомам печени и почек обнаруживали в 100% случаев. При ГБП+ВЗК в равной степени были выявлены умеренный фиброз и цирроз (по 28,6%), отсутствие фиброза (20,6%), умеренный фиброз (15,9%), слабый фиброз (6,3%). Цирроз печени в 55,6% случаев являлся исходом течения ПСХ, в 16,7% — АИГ, в 27,8% был связан с течением синдрома перекреста.

Выводы

Выводы. Различные формы аутоиммунной ГБП встречаются в 10,2% случаев, чаще ассоциированы с язвенным колитом, представлены ПСХ и АИГ, у лиц мужского пола, в дебюте клинически представлены диареей, абдоминальным болевым син-дромом, синдромами цитолиза и холестаза, гемоколитом.

Участие авторов

Участие авторов:Усольцева О.В., Сурков А.Н., Мовсисян Г.Б. — концепция и дизайн исследования;Усольцева О.В., Мовсисян Г.Б., Черников В.В. — сбор и обработка материала, статистическая обработка, написание текста;Сурков А.Н., Мовсисян Г.Б. — редактирование.Все соавторы — утверждение окончательного варианта статьи, ответственность за це-лостность всех частей статьи.

Информированное согласие

Информированное согласие: от родителей пациентов получено письменное добровольное информированное согласие на участие в исследовании.

Финансирование

Финансирование. Исследование не имело финансовой поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 05

Поступила 05.04.2022Принята к печати 26.04.2022Опубликована 07.05.2022

Introduction

Introduction. Hepatobiliary pathology (HBP) occurs in approximately 30% of patients with inflammatory bowel disease (IBD). However, the features of its course in the pediatric cohort of patients remain insufficiently studied.

Purpose

Purpose: to study the features of the course of autoimmune forms of HBD in children with IBD.

Materials and methods

Materials and methods. A comprehensive clinical, laboratory and instrumental examination was carried out in 84 children with autoimmune forms of HBP in combination with IBD (HBP+IBD), which made up the main group, and 79 patients with isolated forms of IBD included in the comparison group.

Results

Results. The prevalence of autoimmune HBP in IBD children was 10.2%. Primary sclerosing cholangitis (PSC) was diagnosed in 64.3% of cases, which was mainly associated with ulcerative colitis. The incidence of autoimmune hepatitis (AIH) was 8.3%. In the structure of the overlap syndrome, the most frequent combination was AIH+PSC (15.5%). The debut of the disease was manifested by diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, haemicolitis. With HBP+IBD, there was an increase in serum concentrations of alanine (ALT) and aspartate aminotransferases (AST), total protein, γ-glutamyl transferase (GGT), alkaline phosphatase, direct bilirubin and IgG. Approximately with the same frequency in PSC, antibodies to saccharomycetes (ASCA) — 80% and antibodies to the cytoplasm of neutrophils (ANCA) — 75% were detected. In AIH, antinuclear antibodies (ANA) and antibodies to liver and kidney microsomes (anti-LKM1) were detected in 100%. HBP-IBD equally (28.6%) revealed moderate fibrosis and cirrhosis, no fibrosis in 20.6%, moderate fibrosis in 15.9% of cases, mild fibrosis in 6,3%. Cirrhosis of the liver in 55.6% of cases was the outcome of the course of PSC, in 16.7% — AIH, in 27.8% was associated with the course of the overlap syndrome.

Conclusion

Conclusion. Various forms of autoimmune HBP occur in 10.2% of cases, are more often associated with UC, are represented by PSC and AIH, occur in males, at the onset signs are clinically presented by diarrhea, abdominal pain syndrome, cytolysis and cholestasis syndromes, and haemicolitis.

Contribution

Contribution:Usoltseva O.V., Surkov A.N., Movsisyan G.B. — research concept and design of the study;Usoltseva O.V., Movsisyan G.B., Chernikov V.V. — collection and treatment of materials, statistical processing, text writing;Surkov A.N., Movsisyan G.B. — editing.Аll co-authors — аpproval of the final version of the article, responsibility for the integrity of all parts of the article.

Informed consent

Informed consent: informed consent was received from the patients` parents for the participation of a study.

Acknowledgment

Acknowledgment. The study had no sponsorship.

Conflict of interest

Conflict of interest. The authors declare no conflict of interest.

Received

Received: April 05, 2022Accepted: April 26, 2022Published: May 07, 2022

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The authors declare that there are no conflicts of interest present.