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Колкіна В.Я. Клінічна ефективність препарату Ліверія IC у лікуванні хворих на хронічний панкреатит
14.08.2014, 18:14

Резюме
Колкіна В.Я. Клінічна ефективність препарату Ліверія IC у лікуванні хворих на хронічний панкреатит.
У статті наведені дані обстеження хворих на хронічний панкреатит. Показано, що введення в традиційну терапію хронічного панкреатиту препарату Ліверія IC сприяє зменшенню больового синдрому, диспептичних явищ, а також показників панкреатичної ізоамілази крові і сечі.
Ключові слова: хронічний панкреатит, Ліверія IC, біль, диспепсія, панкреатична ізоамілаза.

Резюме
Колкина В.Я. Клиническая эффективность препарата Ливерия IC в лечении больных хроническим панкреатитом.
В статье приводятся данные обследования пациентов хроническим панкреатитом. Показано, что введение в традиционную терапию хронического панкреатита препарата Ливерия IC способствует уменьшению болевого синдрома, диспептических явлений, а также показателей панкреатической изоамилазы крови и мочи.
Ключевые слова: хронический панкреатит, Ливерия IC, боль, диспепсия, панкреатическая изоамилаза.

Summary
Kolkina V.Ya. Сlinical efficacy of Liveria IC in treatment of patients with chronic pancreatitis.
The article presents the patients examination with chronic pancreatitis. It was demonstrated that including in traditional treatment of chronic pancreatitis Liveria IC leads to pain, dyspeptic syndrome reduction and decrease indexes of pancreatic isoamylase of blood and urine.
Key words: chronic pancreatitis, Liveria IC, pain, dyspepsia, pancreatic isoamylase.

Рецензент: д.мед.н., проф. Я.А. Соцька

УДК 616.37–002.–036.12+615.244.245

Донецкий национальный медицинский университет им. М. Горького

M. Gorky Donetsk National Medical University 

i12041964m@yandex.ru

Interest to problem of diagnosing and treatment of chronic pancreatitis is rise all over the world. Regular appear new possibilities to diagnosing and abilities to treatment of this disease. Practically all sources testify the increase spread of chronic pancreatitis in Ukraine, associated with rise alcohol consumption [4,8,9].

According to the WHO repots alcohol abuse can come out on top among the causes of death in the world. Shown that chronic alcohol consumption has been associated with 38-94% of cases of pancreatitis in the industrialized countries. In Europe and the United States more than 20% of men and 9% of women admitted to hospitals with various diseases of alcoholic etiology [1,3,5]. Particular interest to us is increasing the efficiency of the treatment of chronic pancreatitis [4,7,10]. The alcoholic nature of the disease, dominate not only in Ukraine but in Europe also [1,5]. Therefore, new approaches are needed to increase the effectiveness of the treatment of patients with this disease. Drug Liveria IC showed sufficient efficacy in the treatment of chronic hepatitis of various, mostly alcoholic, etiology of this disease. Due to the fact that the liver and pancreatic affection, especially of alcoholic origin, has some similar mechanisms of development, there is an interest to evaluate the efficacy of Liveria IC in patients with chronic pancreatitis [6]. Liveria IC (1 tablet includes 0, 5gr. of metadocsin) has antialcoholic, desintoxicated, antifibrostic, antioxidant, hepatoprotective, antidepressive, anxiolytic effect [6].

Aim of investigation: to study the effect of the drug Liveria IC on the dynamic of pain syndrome, dyspepsia and pancreatic isoamylase (p-isoamylase) in blood and urine in patients with chronic pancreatitis.

Materials and methods: we examine 67 patients with chronic pancreatitis. Among them, 45 (67.2%) patients had alcohol etiology of chronic pancreatitis. In main group include 32 patients with chronic pancreatitis who treated with traditional therapy of antisecretory, spazmolitic, enzyme therapy, whom had been added Liveria IC 1tablete 2 times per day 15-30 minutes before meals for three months. In the comparison group were included 35 patients with chronic pancreatitis who received only traditional therapy of chronic pancreatitis (enzyme preparations, spasmolitics, antisecretory drugs). A control group included 30 healthy people of comparable age and sex with the surveyed patients. In patients before and after treatment assessed the dynamics of c pain and dispeptic syndrome, as well as indicators for pancreatic isoamylase of blood and urine.

Severity of complains and painfulness of palpation we estimate with index of average severity of manifestation (ASM) [2]. We used semiquantitative scale:

0 score — there are no manifestations;

1 score — minimal manifestation;

2 scores — moderate manifestations;

3 scores — significant manifestation .

In view of the scale we calculate ASM of clinical manifestations by formula:

where ASM is the average severity of manifestations;

a — the number of patients with manifestation of symptoms with 1 score;

b — the number of patients with manifestation of symptoms with 2 scores;

c — the number of patients with manifestation of symptoms with 3 scores;

d — the number of patients with no symptoms.

Determination of p-izoamilase conducted at Vitalab Analyzer Flexor (Netherlands) using sets firm Lachema (Czech Republic).

Results and discussion. The main manifestation of all examined patients was abdominal pain. Mostly often the pain was localized in epigastric region and both hypochondrium aria — 23 (34.3%) patients. Pain in epigastric region and right hypochondrium in 14 (20.9%) patients, in the right hypochondrium only — 8 (11.9%) patients, epigastric region and left hypochondrium — 9 (13.5%) patients , only in epigastric region — 4 (5.9%) patients, only in the left hypochondrium — 9 (13.5%) patients.

In the main group of the examined patients before treatment was dominated moderate abdominal pain —15 (46.9%) patients; the intensity of the pain was minimal at 9 (28.1%) patients, significant — 8 (25.0%) patients. ASM of pain syndrome in the main group before the treatment was 1.97. In the comparison group the intensity of the pain was similar and determined 17 (48.6%), 9 (25.7%) and 9 (25.7%) of patients correspondently. The ASM of this syndrome in the comparison group was 2,0.

Before treatment dyspepsia disturb all examined patients. So, 12 (37.5%) patients of main group had intensive symptoms of dyspepsia, 9 (28.1%) — moderate, 11 (34.4%) — minimal dyspepsia. ASM of dyspeptic syndrome in this group amounted 2.03, in the comparison group the intensity of this syndrome was determined respectively by 14 (40.0%), 11 (31.4%) and 10 (28.6%) patients. ASM of dispeptic syndrome in the comparison group before the treatment amounted 2.11.

Dynamics of clinical manifestations in the treatment of patients with chronic pancreatitis was more pronounced in patients of main group. So, ASM of pain syndrome after treatment in the main group was 0.94, while the comparison group was 1.49, 1.59 times higher. The most effectiveness of the main variant of treatment concern the dyspeptic syndrome too. After the treatment the ASM of this syndrome in patients with primary group amounted to 0.97 and the comparison group is 1.46, so 1.51 times higher.

Dynamics of p-isoamilase in blood and urine were also more significant in the main group compared to the comparison group patients. Index of p-isoamilase of blood before treatment in main group patients was 1.94±0.12 mccat/l and after treatment was 0.95±0.04 mccat/l (p<0.05) and in the comparison group patients before treatment was1.39±0.08 mccat/l and after 0.35±0.07 mccat/l (p>0.05 ), in healthy persons was 0.85±0.14/l mccat. Level of p-isoamilase l in urine in patients of the main group before the treatment was 6.83±0.21 mccat/l after treatment was 4.02±0.29 mccat/l (p<0.05) and in the comparison group patients 6.72±0.28 mccat/l before treatment and 5.68±0.42 mccat/l (p>0.05 ) after, in healthy persons was 3.28±0.36 mccat/l.

Conclusion: including of drug Liveria IC in treatment of patients with chronic pancreatitis, especially of alcoholic etiology, leads to reduction of intesivity of pain, dyspepsia and positive dynamic of pancreatic isoamylase of blood and urine.

Perspectives of the studies are examining the influence of drug Liveria IC on structural changes and the functional state of the pancreas in patients with chronic pancreatitis.

Литература

  1. Алкогольная болезнь органов пищеварения: клинические очерки / Под ред. Н.Б. Губергриц, Н.В. Харченко. - Киев: Новый друк, 2009. – 180 с.
  2. Лапач С.Н. Основные принципы применения статистических методов в клинических испытаниях / С.Н. Лапач, А.В. Чубенко, П.Н. Бабич. - Киев: Морион, 2002. - 160 с.
  3. Маев И.В. Хронический панкреатит / И.В. Маев, А.Н. Казюлин, Ю.А. Кучерявый. - М.: Медицина, 2005. - 504 с.
  4. Ферментные препараты как основа лечения хронического панкреатита с внешнесекреторной недостаточностью: возможности применения и выбор в практике гастроэнтеролога / И.В. Маев, Е.В. Зайцева, Д.Т. Дичева, Д.Н. Андреев // Consilium Medicum. Гастроэнтерология. - 2013. - № 1. - С. 61-64.
  5. Аlcoholic pancreatitis: new insights into an old disease / L. Gullo, M. Migliory, M. A. Brunetti, M. Manca // Curr. Gastroenterol. Rep. - 2005. - Vol. 7, № 2. - P. 96–100.
  6. The beneficial effect of metadoxine (pyridoxine-pyrrolidone-carboxylate) in the treatment of fatty liver diseases / J. Feher, L. Vali, A. Blazovics, G. Lengyel // CEMED. - 2009. - Vol. 3, № 1. - P. 65–79.
  7. Clinical pancreatology for practicing gastroenterologists and surgeons / Ed. J.E. Dominguez-Munoz. - Oxford: A Blackwell Publ. Co., 2005. - 535 р.
  8. Determination of plasma trypsin-like activity in healthy subjects, patients with mild to moderate alcoholic chronic pancreatitis, and patients with nonjaundice pancreatic cancer / C.A. Hernandez, J.C. Nicolas, J. Fernandez, P. Pizarro // Dig. Dis. Sci. - 2005. - Vol. 50, № 11. - P. 2165–2169.
  9. Domínguez-Muñoz J.E. Latest advances in chronic pancreatitis / J.E. Domínguez-Muñoz // Gastroenterol. Hepatol. - 2013. - Vol. 36, Suppl. 2. - P. 86–89.
  10. A population-based study of severity in patients with acute on chronic pancreatitis / V.S. Akshintala, S.M. Hutfless, D. Yadav [et al.] // Pancreas. - 2013. - Vol. 42, № 8. - P. 1245–1250.
Категорія: 1 (121) | Додав: neyro | Теги: Pain, dyspepsia, pancreatic isoamylase, Liveria IC, chronic pancreatitis
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