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Шупер В. А., Шупер С. В., Вагина Ю. И., Шевцова А.Н., Штыка Е.С. Клиническая эффективность альтернативной терапии хронического вирусного геп
02.08.2014, 17:35

 Резюме
Шупер В. А., Шупер С. В., Вагина Ю. И., Шевцова А.Н., Штыка Е.С. Клиническая эффективность альтернативной терапии хронического вирусного гепатита С (клинический случай).
В работе представлен краткий обзор современной литературы по диагностике и лечению хронического вирусного гепатита С. Описан клинический случай диагностики и альтернативной терапии с помощью препарата бициклол хронического вирусного гепатита С в терапевтическом отделении.
Ключевые слова: хронический вирусный гепатит С, диагностика, лечение, бициклол.
Резюме
Шупер В. О., Шупер С. В., Вагіна Ю. І., Шевцова А.М., Штика Е.С. Клінічна ефективність альтернативної терапії хронічного вірусного гепатиту С (клінічний випадок).
У роботі представлений короткий огляд сучасної літератури по діагностиці і лікуванню хронічного вірусного гепатиту С. Описаний клінічний випадок діагностики та альтернативної терапії за допомогою препарату біциклол хронічного вірусного гепатиту С у терапевтичному відділенні.
Ключові слова: хронічний вірусний гепатит С, діагностика, лікування, біциклол.
Summary
Shuper V. A., Shuper S. V., Vagina Yu. I., Shevtsova A.N., Shtika E.C. Clinical effectiveness of the alternative treatment of the chronic viral hepatitis C (the clinical case).
The brief review of modern literature on diagnostics and treatment of the chronic viral hepatitis C is presented in the work. The clinical case of diagnostics and alternative treatment with bicyclol of the chronic viral hepatitis C in a therapeutic department is described.
Key words: the chronic viral hepatitis C, diagnosis, treatment, bicyclol.

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.
Further research for the development of protocol of alternative treatments of patients with HCV with bicyclol is needed on the basement of evidence-based medicine.

Литература

  1. Боброва І.А. Біциклол – нестандартна терапія хронічних вірусних гепатитів / І.А. Боброва, В.І. Матяш, В.Б. Шевчук // Матеріали науково-практичної конференції з міжнародною участю "Хвороби печінки в практиці клініциста". – Харків, 2007. – С. 58.
  2. Денисова М.Ф. Опыт применения бициклола в лечении хронических вирусных гепатитов у детей / М.Ф. Денисова, Н.Н. Музыка // Сучасні інфекції. - 2010. - № 1. – С. 118-122.
  3. Зайцев И.А. Эффективность Бициклола у пациента с рецидивом хронического вирусного гепатита С после 48 недельной терапии интерфероном альфа 2а и рибавирином. Клиническое наблюдение / И.А. Зайцева // Сучасні інфекції. – 2006. – № 3-4 – С.89.
  4. Печенка А.М. Бициклол – альтернативная терапия хронического вирусного гепатита С / А.М. Печенка, Ю.А. Сухов, Л.М. // Consilium medicum. – 2009. - № 7. - С. 38-44.
  5. Рекомендации по лечению гепатита С (Согласительная конференция по лечению гепатита С. Париж, Франция, 23-27 февраля 2002) // Рос.журнал гастроэнтерол., гепатолог., колопроктол. – 2003. – Т.13, № 2. – С. 4-13.
  6. Скрыпник И.Н. Современные аспекты диагностики, лечения и профилактики вирусных гепатитов / И.Н. Скрыпник // Здоровье Украины. - 2008. - № 3 (11). – С. 2-3.
  7. Lui G.T. The anti-virus and hepatoprotective effect of Bicyclol and the mechanism of action / G.T. Lui // Chin. J. New Drugs. – 2001. – Vol. 10. – P. 325 – 327.
  8. Min Li. Inhibition of Fas/Fasl mRNA expression and TNF-α release in concanavalian A-induced liver in mice by bicyclol / Li Min, Liu Gerg // World J. Gastroenterol. – 2004. – Vol. 10. – P.1775-1779.
  9. Yao G.B. A randomized double-blind controlled trial of bicyclol treatment of hepatitis B / G.B. Yao, Y.Y. Ji, Q.H. Wang // Chin. J. New Drug Clin. Rem. – 2002. – Vol. 21. – P.457-462.
  10. Yao Y.B. Efficacy and safety of Bicyclol in treatment of 2200 chronic viral hepatitis / Y.B. Yao, D.Z. Xu, P. Yan // Chin. J. New Drug Clin. Rem. – 2005. – Vol. 24. – P.421-425.
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