Problems of Radiation Medicine and Radiobiology

E. O. Sarkisova¹, V. O. Sushko¹, A. A. Chumak¹, L. M. Ovsyannikova², O. V. Nosach¹,
S. M. Alyokhina¹, T. O. Shyiko¹

¹State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», 53 Yuriia Illienka St., Kyiv, 04050, Ukraine
²National Academy of Medical Sciences of Ukraine, 53 Yuriia Illienka St., Kyiv, 04050, Ukraine

RETROSPECTIVE ASSESSMENT OF CLINICAL-MORPHOLOGICAL CHANGES OF THE HEPATOBILIARY SYSTEM IN LIVER CIRRHOSIS OF THE CHORNOBYL NPP ACCIDENT CLEAN-UP WORKERS

Objective.to retrospectively characterize changes in the hepatobiliary system in liver cirrhosis (LC) in the clean-up workers of the Chornobyl NPP accident and to determine the factors of disease progression according to the expert materials of the Central Interagency Expert Commission on Establishing the Causal Relationship of the Diseases with the influence of factors of Chornobyl NPP accident.
Materials and methods. Based on the data of 60 cases of the Central Interagency Expert Committee on establishing the causal link of diseases with the impact of the Chornobyl NPP accident, the factors of development, concomitant pathology and indicators of the hepatobiliary system status in 49 deceased and 11 alive clean-up workers with LC were investigated.
Results. A retrospective study of the morphological changes of the hepatobiliary system in the clean-up workers with LC showed that the main pathologic anatomical diagnosis in 37.8 % of cases was small-nodal LC, in 8.9 % – micromacronodular, in 4.4 % – large-nodal, in 2.2 % – primary biliary LC, in the other 40 % of cases – LC with uncertain nodal structure, as well as 2 (4.4 %) cases of fatty liver and 1 case (2.2 %) of portal cirrhosis against the background of fatty liver. Pathomorphological changes were characterized by expressed growth of fibrous tissue with replacement of the liver parenchyma (fields of fibrosis), increase in size and impaired structure of the liver, thickening and tightening of its capsule, fibrotic changes in other organs – gastric mucosa, pancreas, spleen, lungs, heart. Histological examination revealed lobe structure abnormalities, false lobules, periportal fibrosis, lymphoid-lymphocytic infiltration, diffuse fatty small-sized and large-drop dystrophy, and hepatocyte atrophy. Common inflammatory processes and fibrotic changes of other organs and systems: cardiovascular, urinary, bronchopulmonary, stomach, pancreas and spleen made the course of the LC more severe. The most frequent were cardiovascular diseases, significantly more frequent among the deceased than alive patients: hypertension – 67.3 % and 45.5 %, p < 0.05, coronary heart disease – 57.1 % and 18 %, p < 0.05. In most cases, the cause of death in the clean-up workers with LC was hepatic and cellular failure (53.3 %), which together with hepatic-renal failure (17.8 %) made 71.1 %.
Conclusion. Changes in the hepatobiliary system of change in in the clean-up workers with LC were characterized by marked growth of fibrotic tissue with replacement of the parenchyma and impaired liver structure, fibrotic changes in other organs, diffuse fatty small and large droplet dystrophy and atrophy of hepatocytes. The severe course of the LC with the manifestation of the disease at the stage of decompensation was due to a vague clinical picture, lack of subjective symptoms of liver disease, slow, steadily progressing development, lack of or inadequate examination and treatment, a significant number of concomitant pathology of other organs and systems. The factors of the development of LC in the clean-up workers were the long course of chronic liver disease, numerous concomitant pathology, long stay in the accident zone, the effect of ionizing radiation, as well as the lack of dispensary supervision and adequate treatment.
Key words: cirrhosis, hepatobiliary system, clean-up workers of Chornobyl NPP accident, retrospective study.

Problems of Radiation Medicine and Radiobiology.
2019;24:465-479. doi: 10.33145/2304-8336-2019-24-465-479

full text

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