Головна » Файли » 2013 » 5 (119) |
02.08.2014, 17:35 | |
Резюме Рецензент: д.мед.н., проф. В.О. Тєрьошин УДК 616.36-002-036.12-022-08 ГУ «Луганский государственный медицинский университет» State Establishment "Lugansk State Medical University" Луганская городская многопрофильная больница № 1 Lugansk City Hospital № 1 shooper@inbox.ru, sergej-shuper@yandex.ua The data of the estimated non-governmental organizations show than about 3.5 million Ukrainians are infected with hepatitis in Ukraine. WHO Expert Research (2009-2010) show that there are about 180 million people have chronic viral hepatitis C infection and 350 thousand die each year as a result of liver damage by hepatitis C virus ( HCV). Chronic hepatitis B (HB) affects about 400 million people and annually 500-700 thousand people die from this infection. Morbidity and mortality increases progressively and will double by 2015-2020. WHO estimated that 57 % of cases of cirrhosis of the liver and 78 % of cases of primary liver cancer are caused by hepatitis B or C. Treatment of chronic viral hepatitis C is an extremely difficult task. As the basic therapy a- recombinant interferon in combination with the antiviral drug ribavirin is currently used. However, not all patients can receive such therapy due different reasons. Alternative treatment option was offered for these patients - the original drug "Bicyclol" (Beijing Union Pharmaceutical Factory, China). One of the main properties of the bicyclol is suppression of production of tumor necrosis factor (TNF a) together with antiviral and hepatoprotective effect. The earliest and most indicative criteria of bicyclol efficacy are the normalization of transaminases (ALT, AST) with a confirmed period of "after-effect". Moreover, bicyclol has specific antiviral effect and markers of viral replication decreasing or disappearing. Bicyclol was developed and approved for use recently, but has already received a positive evaluation of the effectiveness as an alternative treatment of viral hepatitis and therapy of chronic hepatitis of different etiology. In the therapeutic department patient A., 64 years old, was admitted with a preliminary diagnosis IHD. Diffuse cardiosclerosis. Atrial fibrillation, a constant tachysystolic form. Arterial Hypertension II st. (LVH), 2 st., risk IV. CHF IIA, FC III. Cardiac liver cirrhosis, active phase, the degree of activity III, ascites. The patient was admitted to the department with complaints of expressed general weakness, increased abdomen, swelling of the lower extremities, yellowness of the skin and visible mucous membrane, shortness of breath on slight exertion, discoloration of stool and dark urine. At the time of admission, these symptoms were reported during the week. From medical history it was revealed that the patient for 15 years suffers of the atrial fibrillation, in 2008 he was operated – implantation of the artificial pacemaker. In objective examination jaundice and increased abdomen were found. Hard breathing, moist finely wheezing in the lower parts of lungs were revealed, respiratory rate was 24 per min. Heart sounds were muffled, arrhythmic, heart rate = PS = 98 min, BP 160\90 mm Hg. Abdomen was tense, painful in epigastric region and right upper quadrant, the liver was under the costal arch at 5 cm, dull percussion sounds were in lower-lateral abdomen. Lower extremities were swollen to the knees, skin there was pigmented. Examinations in the hospital revealed hyperbilirubinemia - 320 mkmol\l, (unconjugated - 220.5 mmol/l), ALT - 5.64 mmol/l, AST - 1.88 mmol/L, urea - 5.8 mmol\l , creatinine - 80 mmol\l, total protein - 58 g\l , albumin - 26 g\l, PTT - 43 ", PTI - 49 % , fibrinogen - 7.19 g/l. Markers of hepatitis - HbsAg - neg. , Anti -HCV - 102,9, PCR hepatitis C virus - positive. Ultrasound examination: hepatomegaly, diffuse liver changes, chronic acalculous cholecystitis, chronic pancreatitis, fluid in the abdominal cavity - a small amount, portal vein is not expanded. X-ray - left-sided pleural effusion, pulmonary fibrosis, congestion in the pulmonary circulation, left ventricular hypertrophy. As a result of the diagnostics clinical diagnosis was exhibited: Chronic hepatitis associated with hepatitis C virus, the active phase, the high degree of activity, ascites. IHD. Diffuse cardiosclerosis. Atrial fibrillation, a constant tachysystolic form. Arterial Hypertension II st. (LVH), 2 st., risk IV. CHF IIA, FC III. The patient was treated in a hospital (reosorbilakt, atoxil, furosemid, veroshpiron, concor, noliprel, warfarin, dufalak, Hepa-Merz). For the treatment of chronic hepatitis C bicyclol 50 mg 3 t/d was prescribed together with glutargin, cycloferon. 3 weeks after hospitalization clinical condition of the patient improved and jaundice disappeared, decreased dyspnea and edema of legs, increased tolerance to the physical load. Blood biochemical parameters showed a significant decrease in ALT and AST in 3 times from baseline values at admission, total bilirubin decreased in 5 times (63.8 mmol/l). Ultrasonic examination revealed the absence of fluid in the abdominal cavity. The patient was discharged with improvement and recommendations to continue receiving of the bicyclol 25 mg 3 t/d under the dynamic control of liver function and viral load. In 3 weeks after discharge from the hospital the patient's condition was satisfactory, parameters of ALT and AST, alkaline phosphatase, GGT were within the normal range, total bilirubin - 30.7 mmol\l, PCR HCV - negative. Treatment with bicyclol had no side effects, tolerability was satisfactory. This was confirmed by normal values of CBC and blood creatinine levels, which were within the physiological range after treatment. Thus, bicyclol therapy may be recommended for patients with chronic hepatitis C. It should be noted that the literature contains information about more prolonged use of the drug in the treatment of chronic hepatitis C - up to 9 months. Литература
| |
Переглядів: 853 | Завантажень: 0 | |
Всього коментарів: 0 | |