MODERN APPROACHES IN MANAGEMENT OF CHILDREN WITH CHRONIC HEPATITIS B IN REMISSION OF ACUTE LYMPHOBLASTIC LEUKEMIA.

The aim of the study is to assess the effectivity of the drug «Betargin» in complex management of patients with chronic hepatitis B (CHB) in remission of acute lymphoblastic leukemia (ALL). The research had shown the results of treatment of 41 children with CHB in remission of ALL aged from 3 to 17 years old, who were on dispensary observation in Vinnytsia Regional Children's Clinical Infectious Diseases Hospital during 2013-2017 years. Patients were devided into the following groups: the comparison group (group A), which included 18 children with CHB in remission of ALL, who received basis therapy; the main group (group B) which consisted of 23 patients with CHB in remission of ALL, who got betaine arginine complex («Betargin») in addition to basis therapy. The control group was formed out of 30 healthy children. Determination of effectivity of the proposed treatment regimen was performed by studying the indicators of cholestasis, cytolysis, hepatocellular insufficiency, and lipid metabolism. To assess the liver's fibrosis level and necroinflammatory activity we used the determination of the level of plasma osteopontin in the serum using the enzyme-linked immunosorbent assay (ELISA) method: Human Osteopontin Quantikine (RDD systems, Dos Too, Minneapolis, MS, USA). The verification of the diagnosis of CHB was based on the detection of specific markers of HBV-infection in blood using ELISA and PCR analysis. During our scientific research we established that using betaine arginine complex in management of CHB in remission of ALL led to considerable improvement of children's general condition, namely due to reducing (p<0,05) the incidence of asthenovegetative (8.6% against 33.3% in the comparison group), dyspeptic (13.1% against 38.8%) as well as pain syndromes (4.3% against 11%) and hepatomegaly (13.1% against 38.8%). The activity of ALT in the main group was in 1.6 times less (p<0,05) than in comparison group at the end of the course of treatment. «Betargin» has an antifibrotic effect which is confirmed by a decrease in the level of plasma osteopontin up to 104,92 ng/ml against 178,15 ng/ml in the comparison group (p<0,05).