AN INTEGRATED CLINICAL-ECHOGRAPHIC APPROACH TO CHRONIC VIRAL HEPATITIS IN CHILDREN

Chronic viral hepatitis (CVH) in children causes prolonged liver inflammation, structural and functional impairment, fibrosis development, and an increased risk of cirrhosis. Conventional clinical and laboratory methods do not always provide sufficient information for an objective assessment of pathological activity or the severity of parenchymal structural changes. Objective. To improve the diagnosis of chronic viral hepatitis in children through the application of modern ultrasound technologies in comprehensive patient examination. Materials and Methods. A retrospective study was conducted in 112 children aged 3–18 years with CVH, including 87 (77.7%) with HBV, 18 (16.1%) with HCV, and 7 (6.2%) with HDV. Diagnostic methods comprised clinical, biochemical, and serological assessments together with comprehensive ultrasound examinations, including high-frequency grayscale sonography, Doppler ultrasound, 3D/4D sonography, multislice B-mode ultrasonography of the liver, and elastography with fibrosis staging according to the METAVIR scale. The study was conducted in accordance with the principles of the Declaration of Helsinki (2013 revision) and was approved by the Local Ethics Committee of Tashkent State Medical University, with informed consent obtained from the legal representatives of all participants. Statistical analysis included correlation analysis, Student's t-test, and Fisher's F-test, with statistical significance set at p < 0.05; data were processed using SPSS Statistics version 26.0. This work was carried out as part of the Tashkent State Medical University research project "Development and Improvement of Non-Invasive Diagnostic Methods for Chronic Diffuse Liver Diseases in Children" (2021–2025). Results. The severity of liver structural changes correlated significantly with clinical and laboratory indicators of disease activity, the most informative markers being liver size, echostructure heterogeneity, blood flow parameters in the portal and hepatic vessels, and quantitative elastometry. This comprehensive approach enabled stratification of CVH activity into minimal, moderate, and severe categories and improved diagnostic accuracy. Conclusions. The integrated clinical-sonographic approach employing modern ultrasound technologies provides an informative, reproducible, and safe means of assessing CVH in children, while standardization of morphometric and hemodynamic criteria enhances diagnostic accuracy and optimizes treatment strategies.

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