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Вакцинация против вируса гепатита В также защитит от вирусного гепатита D

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Республика Саха (Якутия) является наиболее эндемичным регионом по гепатиту D (дельта) вместе с республикой Тува. Именно в Якутии впервые в России начали исследовать гепатит D.

Известно, что особенностью вируса гепатита D является то, что он самостоятельно не может вызвать заболевание. Для этого он нуждается в вирусе-помощнике, в качестве которого вступает гепатит В, а именно его наружная оболочка, так называемый австралийский антиген (HBsAg). Не имея собственную оболочку узнаваемую печеночными клетками, вирус D (дельта) оборачивается австралийским антигеном вируса В и проникает в печеночную клетку, разрушая ее изнутри.

В последние годы зафиксировано снижение уровня вирусоносительства. Такая тенденция связана в первую очередь с активной вакцинацией населения. Однако, показатели заболеваемости хроническим гепатитом В все еще остаются высокими. Именно больные с хроническими формами гепатита В являются источниками инфекции для 90% заболевших острым гепатитом.

В Институте здоровья СВФУ с 2002 года проводятся исследования по выявлению больных и носителей вирусного гепатита в Якутии. Организованы экспедиционные выезды специальной медицинской бригады для выполнения исследований, в результате которых обследовано население 22 населенных пункта из 17 улусов республики, всего сделано 26 204 анализов.

По результатам исследования, распространение вирусного гепатита В среди населения Якутии можно считать умеренным, вирусного гепатита D – высоким, а заболеваемость гепатитом С выше в пять раз, чем по стране. Теперь подробнее о гепатите D.

В конце 80-ых годов, в период лечебной практики у местного населения стали выявлять антитела на вирус дельта у больных с хроническими заболеваниями печени и у больных циррозом печени. Учитывая большое количество выявленных заболевших, было решено более подробно изучить это заболевание. В то время информации о гепатите дельта не было. Так, на окраине страны впервые было начато изучение гепатита D.

Известно, что вирусом заражаются в результате попадания вируса гепатита в кровь человека. Это может произойти при переливании зараженной крови, во время обширных оперативных вмешательствах, перинатально (во время беременности от матери к плоду) или при родах (прохождение плода родовых путей). Часто заражаются наркоманы (при внутривенном введении наркотических средств многоразовыми шприцами) и молодые люди, ведущие беспорядочную незащищенную половую жизнь.

 

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Если заражение происходит уже на фоне имевшегося хронического гепатита В, то в кратчайший срок формируется цирроз печени с декомпенсацией всех печеночных функций. Исход в цирроз печени возникает почти в 70-80% случаев в течение 10-20 лет, у части больных (в 5-10% случаев) наблюдается быстропрогрессирующее течение с декомпенсацией печеночного процесса в течение нескольких лет после инфицирования.

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Больше всего зараженных хроническим гепатитом D выявлено среди молодых людей в возрасте до 30 лет (58,9% ). Удельный вес пациентов до 30 лет с острой дельта-инфекцией составляет 93,4%. При этом, заражение вирусом гепатита D быстро приводит к формированию хронического поражения печени с последующим переходом в цирроз. Отчетливо выражен рост удельного веса цирроза печени с увеличением возраста.

Факт, что вирус больше распространен у людей до 30 лет связан с активным образом жизни. Считается, что у них больше травматизма, следовательно медицинских манипуляций больше: операций, переливаний препаратов крови. Также может иметь значение наркомания внутривенным введением наркотических препаратов и беспорядочная половая жизнь.

Лечение в настоящее время обсуждается. Применяемые при лечении других гепатитов В, С противовирусные препараты оказались малоэффективными. Назначение очень высоких доз чревато возрастанием частоты серьезных побочных эффектов препарата. Рассматривается применение различных вариантов комбинированной противовирусной терапии. Идет поиск и разработка новых препаратов блокирующих репликацию (размножение) вируса. Профилактикой остается только вакцинация против вируса гепатита В (нет вируса В – не будет гепатита D) и введение здорового образа жизни (без наркотиков, алкоголя), упорядоченные, защищенные сексуальные отношения.

Оригинал статьи — здесь.

Более подробную информацию для людей, готовящихся к программному гемодиализу и пациентов на диализе можно посмотреть здесь.

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