Peculiarities of physical and sexual development of girls with autoimmune hepatitis in puberty period
Keywordsgirls, puberty, autoimmune hepatitis, physical development, sexual development, menstrual disorders
Autoimmune hepatitis (AIH) is a rare immune-mediated chronic disease that, when inadequately treated, leads to progressive liver damage, which in turn leads to cirrhosis, liver failure, or death. Features of physical and sexual development of girls with AIH at puberty are little studied. The objective: to determine the characteristics of physical and sexual development of girls with autoimmune hepatitis in puberty period. Materials and methods. A comprehensive clinical and paraclinical examination of 66 adolescent girls of the group AIH with autoimmune hepatitis and 180 conditionally somatically healthy girls of the control group aged 12-17 years was performed. The examination included clinical and anamnestic data, anthropometry, biochemical examination of liver function, determination of serum autoantibodies, markers of viral hepatitis, ultrasound and elastography of the hepatobiliary system, liver biopsy followed by histological examination of biopsy, assessment. Results. Age-related changes in body length and body weight, chest circumference, waist and hips among girls with AIH were characterized by a significant lag at all stages of pubertal development. In patients with AIH, the onset of pubertal development was manifested by the development of mammary glands to the stage of Mal in 43.94% of girls, the previous appearance of puberty to thelarchein 34.85% of patients, and in 21.21% of patients noted simultaneous puberty and thelarche. Delayed development of sexual characteristics was manifested in 12-, 13- 14-, 15-, 16- and 17-year-old girls with AIH by a decrease in the score of sexual development in all age categories compared to the same indicator in the respective age control groups: respectively 3.21 ± 0.40 vs 4.94 ± 0.37 points, 3.46 ± 1.00 vs 7.91 ± 0.58, 7.03 ± 1.44 vs 11.08 ± 0.25, 7.80 ± 0, 65 vs 11.86, 10.65 ± 0.79 vs 11.98. In the examined girls with AIH during puberty, such disorders of menstrual function were noted as: primary amenorrhea in 7.58% of cases, secondary amenorrhea – in 6.06%, oligomenorrhea – in 27.27%, opsomenorrhea– in 27.27%, juvenile uterine bleeding – in 9.09%, dysmenorrhea – in 31.82%, a combination of various disorders – in 18.18%. Conclusions. The presence of antinuclear antibodies, antibodies to microsomes of the liver and kidneys type 1, antibodies to smooth muscle, disorders of enzymatic, protein-forming, antitoxic, cytolytic activity of the liver in girls with autoimmune hepatitis is accompanied during puberty by a high frequency of abnormalities. formation of inverted puberty, delayed sexual development and delayed onset of menarche for 10-11 months, frequent menstrual disorders.
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