[Clinico-immunological variants of extremely severe course of hepatitis B]

Analysis of the results of comprehensive clinical and immunologic examinations of 29 patients with hepatitis B running a particularly severe course has helped single out 2 variants of the immunogenesis of this form of the disease. Contribution of hyperimmune and autoimmune mechanisms and a high degree of the determination of the immunopathologic process are the major features of the first variant. In the second variant the infectious process per se plays the major role due to the direct viral cytolysis of the hepatocytes and/or a higher infective dose. Dynamic monitoring of hepatitis B specific markers, of the T-lymphocyte reaction, of autoimmune process markers, together with immunologic screening help predict the possible development of various patterns of particularly severe course of the disease and thus give grounds for differentiated therapy.