[Dynamics of chronic active hepatitis with varying degrees of severity]

Clinico-morphological examinations (repeated laparoscopies, histological and electron microscopic examinations of liver biopsies) were performed in 30 patients with chronic active hepatitis (CAH), in 20 of them in the time course of the disease. In 25 patients the viral etiology of CAH was established, in 5 patients the etiology remained obscure. In most cases of CAH there was a correlation between the intensity of clinico-laboratory and morphological manifestations of the disease activity. The following morphological variants of the CAH course were distinguished: progression of CAH with transition into liver cirrhosis (LC); decreasing activity of CAH under the influence of treatment; transition of chronic persisting hepatitis into CAH. Prognostically the most unfavourable form is CAH with pontile necrosis which rapidly terminates with LC. In patients with CAH of high activity with septal necroses the prognosis is more favourable and positive time course of the disease is possible. Patients with CAH treated with immunosuppressive drugs exhibited a decrease in the size of hepatocytic necroses and cell infiltration with increased sclerosis of the portal and lobular stroma up to the development of LC in some of them. The electron microscopic examinations specified the mechanisms of interaction of lymphocytes with hepatic cells in relation to the severity of the pathological process.