MORPHOLOGICAL CHANGES IN THE LIVER IN PATIENTS WITH OPIOID DEPENDENCE IN THE ABSENCE AND PRESENCE OF COMORBID CHRONIC HEPATITIS C

Aim. To determine the clinical significance of morphological features in assessing toxic or viral liver damage in patients with comorbid opioid dependence and chronic hepatitis C. Materials and methods. The study involved histological preparations of liver tissue from 48 patients with opioid dependence according to ICD-10 criteria (F 11.30). Among them, 18 patients had opioid dependence without chronic hepatitis C, aged 22 to 40 years (16 males and 2 females), and 30 patients had opioid dependence with chronic hepatitis C according to ICD-10 criteria (B18.2), aged 22 to 38 years (27 males and 3 females). Ultrathin liver tissue sections were examined using an EM-100 electron microscope at an accelerating voltage of 75 kV and a magnification of x12000. Results. In cases of high-progressive opioid dependence without chronic hepatitis C, significant features included the presence of large steatotic granules in the centrilobular and periportal zones, impaired lipid granule degradation processes, a significant increase in Kupffer cell activity, and the transformation of Ito cells into fibrocytes. Low histological activity of comorbid chronic hepatitis C is characterized by moderate lymphomonocytic infiltration in the portal tracts, increased lipid granule destruction in the centrilobular zone of liver lobules. In cases of moderate activity of comorbid chronic hepatitis C in drug-dependent patients, there is a significant increase in necrotic and apoptotic changes in hepatocytes of the portal and periportal zones, an increase in the number and density of lipid granules, and a significant increase in collagen deposits in the perisinusoidal space, periportal, and centrilobular zones of liver lobules. Conclusions. 1. In clinical practice, it is advisable to use morphological studies of the liver in patients with opioid dependence and chronic hepatitis C to verify significant profibrogenic factors: the progression of steatotic granule deposits in hepatocytes, impaired degradation processes, Kupffer cell activation, and Ito cell transformation into fibrocytes. 2. Morphological studies of the liver in patients with opioid dependence with and without comorbid chronic hepatitis C allow for an objective assessment of the predominance of toxic or viral liver damage in each patient and determine the priority in treatment.