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Колкина В.Я. Влияние препарата Ливерия IC на клинические и биохимические показатели у больных хроническим алкогольным гепатитом
27.05.2014, 12:26

Резюме
Колкина В.Я. Влияние препарата Ливерия IC на клинические и биохимические показатели у больных хроническим алкогольным гепатитом.
В статье представлены данные обследований больных хроническим алкогольным гепатитом после лечения. Установлено, что включение в комплексную терапию гепатопротектора Ливерия IC способствует уменьшению астенических явлений, болевого и диспептического синдромов, а также снижению показателей цитолиза и холестаза, улучшению антитоксической функции печени.
Ключевые слова: хронический алкогольный гепатит, Ливерия IC, функциональное состояние печени, гепатопротектор, клиника.

Резюме
Колкіна В.Я. Вплив засобу Ліверія IC на клінічні та біохімічні показники у хворих на хронічний алкогольний гепатит.
У статті представлені дані обстеження хворих на хронічний алкогольний гепатит після лікування. Встановлено, що включення до комплексного лікування хронічного алкогольного гепатиту засобу Ліверія IC сприяє зменшенню астенічного, больового та діспептичного синдромів, а також зниженню показників цитолізу та холестазу, покращенню дезінтоксикаційної функції печінки.
Ключові слова: хронічний алкогольний гепатит, Ліверія IC, функціональний стан печінки, гепатопротектори, клініка.

Summary
Kolkina V.Ya. Influence of Liveria IC on clinical and biochemical data in patients with chronic alcoholic hepatitis.
The article presents the patients examination with chronic alcoholic hepatitis after treatment. It was demonstrated that including in traditional treatment of chronic alcoholic hepatitis Liveria IC leads to reduction of asthenia, pain and dyspepsia and decrease indexes of cytolysis and cholestasis, improves detoxicated function of liver.
Key words: chronic alcoholic hepatitis, Liveria IC, functional status of liver. hepatoprotector, clinic.

Рецензент:  д.мед.н., проф. В.О. Тєрьошин

Донецкий национальный медицинский университет им. М. Горького

83003, Украина, г. Донецк, пр. Ильича 16

Donetsk National Medical University n. a. M. Gorky

 Illicha Av. 16, Donetsk, 83003, Ukraine

v.teryshin_lsmu@mail.ru

The аctuality of the problem of alcohol abuse is evident, as every year steadily increasing the number of individuals excessively drinking. It is well known, that alcoholism is a disease, which may contribute to the genetic, biological and physiological factors [1].

Alcoholic liver affection, not rarely, presented without clinical symptoms, in addition, patients not always recognize the abuse of alcohol, making it difficult to verify the diagnosis. According to the literature, only 11% of patients with proven by biopsy alcoholic liver affection have liver symptoms and 35% have complaints with the affection of the gastrointestinal tract [2, 6, 8].

Ethanol oxidation takes place mainly in the liver, where it is metabolized from 75-98% contained alcohol. Biological detoxification of alcohol is a complex biochemical process. Among the direct and indirect effects of ethanol in the liver: damaging effect of acetaldehyde, the detoxification function of the liver, impaired immune responses, strengthening collagenesis, stimulation of carcinogenesis [3, 6].

The interest to us is to asses influence of the drug Liveria IC (1 tablet includes 0,5gr. metadoksin) with antialcoholic, antioxidant, detoxicated, antifibrotic, hepatoprotective, antidepressive, anxiolytic effect on clinical and biochemical data of chronic alcoholic hepatitis [4, 7].

Aim of the research: to study the results of complex treatment with drug Livery IC of patients with chronic alcoholic hepatitis.

Materials and methods: we examine 62 patients with chronic alcoholic hepatitis with minimal to moderate biochemical activity. Comparison group consisted of 30 patients who received traditional hepatoperotective therapy with silimarin only. The main group included 32 patients who recieved except traditional treatment hepatoprotector Liveria IC 1tablete 2 times a day for 15-30 minutes before meals for three months.

We evaluated the dynamics of clinical manifestations (asthenic and pain syndromes, dispepsia) and biochemical indicators (AST, ALT, total and direct bilirubin, alkaline phosphatase, γ-glutamiltranspeptidase). Control group results were 30 practicaly healthy persons.

Severity of complains and painfulness of palpation we estimate with index of average severity of manifestation (ASM) [5]. 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:  (1)

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.

All biochemical studies conducted before and after treatment at Vitalab Analyzer Flexor (Netherlands). For the detection of ALT, AST, ALP, γ-glutamil-transpeptidase , total and direct bilirubin in blood used tests by Coultronics firm (France).

Results and discussion. Surveyed patients had complaints on pain, discomfort, heaviness in the right hypochondrium, which took place in 19 (59.4%) of patients of the main group and 18 (60.0%) patients in the comparison group. ASM of pain syndrome in the main group was 0.91, while the comparison group — 0.83.

The 3 (9.4%) patients of the main group and 3 (10.0%) patients of the comparison group had complaints on jaundice, which noticed or patients or their relatives.

Dyspepsia occurred in all examined patients. It was presented with belch, heartburn, nausea, abdominal distention, sense of bitterness in the mouth, etc. ASM of dyspepsia in the main group was 1.91 and in the group of comparison is 1.97.

Manifestations of the asthenic syndrome (weakness, fatigue, reduced efficiency, etc.) presented in all patients. The ASM of this syndrome in the main group was — 1.75, while the comparison group — 1.80

Pain syndrome (discomfort, heaviness, pain in the right hypochondrium, epigastric region) more distinctly decreasing in patients of main group. So, ASM of pain syndrome after treatment in the main group was 0.38, while the comparison group was 0.57, meaning 1.50 times higher. Despepsia after treatment was absent in 10 (31.3%) patients of the main group and 7 (23.3%) the comparison group patients and was minimal at 15 (46.9%) and 13 (43.3%), moderate in 7 (21.8%) and 8 (26.7%) patients correspondently, significant only in 2 (6.7%) of the comparison group patients. Thus, ASM of dyspepsia after treatment was 0.91 in the main group and in the comparison group is 1.09, or 1.20 times higher. Asthenic syndrome was more reduced in the course of treatment in the main group patients. This is evidenced by the fact that in the end of the treatment the ASM of this syndrome was 0.69 in the main group and in the comparison group — 1.03, so in 1.49 times higher.

After the treatment jaundice does not defined in one patient.

Table 1

Dynamics of functional liver tests in examined patients.

Indexes

Practically healthy

(n=30)

Main group

(n=32)

Comparison group

(n=30)

before treatment

after treatment

before treatment

after treatment

АLТ, u/l

23,6±1,4

65,2±3,5

39,1±2,4*/**

64,3±3,7

49,1±4,1*

АSТ, u/l

21,8±1,9

54,1±2,7

32,1±3,2*/**

52,6±3,8

44,3±3,7*

GGT, mcmol/l

36,3±2,6

94,2±4,8

59,6±3,1*/**

95,1±5,9

71,5±4,8*

ALP, mmol/l

167,1±8,4

403,9±9,1

305,7±12,2*/**

400,8±15,2

351,6±11,1*

Total bilirubin mcmol/l

24,2±1,1

33,7±2,8

18,9±2,0*/**

33,1±2,7

24,8±1,6*

Direct bilirubin

mcmol/l

5,9±0,3

7,8±0,8

3,5±0,7*

7,5±1,2

5,7±0,9

Notes: * — the difference between before and after treatment reliable; **— the difference between the main group and the comparison group reliable.

Dynamics of biochemical parameters related to activity of chronic hepatitis was reliable after treatment in patients of main group. In the comparison group also significantly improved biochemical parameters after treatment reliably except indicators of direct bilirubin. Comparative analysis of biochemical indicators of both groups found that levels of AST, ALT, alkaline phosphatase and total bilirubin after treatment were significantly lower in the patients of the main group. Also found that the rate of GGT more clearly decreased after main variant of treatment with using of the drug Livery IC that is characterize the improvement of detoxification liver function (Table 1).

Conclusion: using of drug Liveria IC in complex treatment of chronic alcoholic hepatitis lead to reduction of clinical manifestation (astenia, pain and dyspeptic syndrome), decrease biochemical indicators (markers of cytolysis and cholestasis), improves detoxification function of liver.

Perspectives for the studies are examining the effects of hepatoprotector Liveria IC on the synthetic function of the liver in patients with chronic alcoholic hepatitis.

Литература

  1. Алкогольная болезнь органов пищеварения: клинические очерки / Под ред. Н.Б. Губергриц, Н.В. Харченко. - Киев: Новый друк, 2009. - 180 с.
  2. Бабак О.Я. Цирроз печени и его осложнения / О.Я. Бабак, Е.В. Колесникова. - К. : Доктор-Медиа, 2011. - 576 с.
  3. Вирусные гепатиты в схемах, таблицах и рисунках / Б.А. Герасун, Р.Ю. Грицко, А.Б. Герасун [и др.]. - Львов: Кварт, 2012. - 122 с.
  4. Гепатопротекторы: от теории к практике / Н.Б. Губергриц, Г.Д. Фадеенко, Г.М. Лукашевич, П.Г. Фоменко. - Донецк : Лебедь, 2012. - 156 с.
  5. 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.
  6. Подымова С.Д. Болезни печени: руководство / С.Д. Подымова. - [4-е изд. ; перераб. и доп.]. - М. : Медицина, 2005. - 768 с.
  7. 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.
  8. Sherlock’s diseases of the liver and biliary system / Eds.: J.S. Dooley, A.S.F. Lok, A.K. Burroughs, E.J. Heathcote. - Oxford: Blackwell Publishing, 2011. - 771 p.
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