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Kozlova A.V., Andreytseva O.I., Syutkin V.Ye., CHzhao A.V.
Features of transplantation of the liver at HCV-infection (The Review of the literature) The aim of the review. To present data on transplantation of the liver at liver cirrhoses of HCviral etiology.
Original positions. The survival rate of recipients after operative transplantation of liver (OLT) depends on many causes, both surgical, and not related to surgical intervention. The latter group of causes most frequently include infections, rapidly progressing on a background of medicamental immune suppressive therapy, in particular, hepatitis C virus infection of the liver graft in patients who underwent transplantation of the liver for liver cirrhosis (LC) of HÑVetiology (recurrent HÑVinfection).
Management approach of patients with diseases of the liver of HÑVetiology on pre and posttransplantation stages, way of improvement of results of operative treatment (increase of terms of «survival» of hepatic grafts and recipients) are actively discussed in the literature in the last 10–15 years.
According to the data of multicenter investigations, antiviral therapy (AVT) before transplantation of the liver is approved. In patients who have achieved sustained viral response (SVO) on AVT before liver transplantation, the risk of relapse of infection after intervention has been reduced. Combined AVT at chronic hepatitis C in graft results in achievement of SVO in 20% of cases. Prognostic factors of SVR included age, gender, initial level of RNA HCV, early viral response (EVR) in the first 3 months, virus genotype, type of immunosuppression, initial histological pattern, time, elapsed after OLT.
Conclusion: Actions, in particular, successful AVT before liver transplantation, reduce risk of infection relapse after operation. Combined AVT patients with recurrent hepatitis C of hepatic graft results in retardation or arrest of progression of fibrosis of the graft, prevention of cirrhosis development, and, therefore, to decrease of frequency of retransplantations of the liver and increase of survival rate of these of patients.
Golovenko O.V., Mikhaylova T.L.
Efficacy of alimentary fibers from plantain oval seeds coating (psyllium) in treatment of internal diseases (On the data of foreign studies) The aim of the review. To present modern data on chemical composition, mechanisms of action and therapeutic range of alimentary fibers from plantain oval seeds coating (psyllium).
Original positions. Alimentary fibers (AF) are components of plant cell wall polysaccharides, and also noncarbohydrate compounds resistant to enzymatic cleavage in the small intestine of humans. AF, obtained from seeds of plantain oval (including their shuck), are termed «psyllium». Three basic fractions of psyllium amounting respectively 30, 55 and 15% of dry mass of the product have been defined.
The fraction A, soluble in alkaline medium, is not fermented by bacteria and acts as the filler increasing volume of intestinal contents. Purging effect is thus caused by reciprocal enhancement of peristalsis of intestine.
Gel – forming the fraction B keeps a significant amount of fluid, forming gel which acts as enterosorbent, fixing molecules of sugars and cancerogenes, rendering hypoglycemic and antineoplastic action. This mucous component of feces besides functioning as lubricant, facilitates transit of fecal masses, and also acts as active drug, having direct and indirect effect on activity of various enzymes participating in lipid metabolism by change of ðÍ of intestinal contents.
The fraction C is represented by the mucous substance which has no ability, however to form gel. Increasing viscosity of gastric contents and delaying its evacuation, this component promotes decrease of appetite, that can explain hypolipidemic effect of preparation from plantain seeds. The fraction C is easily fermented, enhancing proliferation of bifido and lactobacilli. Moreover, products of microbial decomposing of this fraction include shortchain fatty acids (SCFA) – one of key metabolic resources of colonocytes. Psylliumstimulated increase of their concentration is related to antineoplastic and antiinflammatory effect of the diet containing seeds of plantain.
Conclusion. Heterogeneity of composition and chemical properties of psyllium explains diversification of areas of its clinical application. Interest to application of psyllium at various diseases remains high that is proven by appearance of new scientific works confirming efficacy of this agent in prophylaxis and treatment of many gastrointestinal diseases, malignant neoplasms, as well as diseases related to high level of glucose and lipids in blood.
Buyeverov A.O., Mayevskaya M.V.
Potentials and prospects of application Timosin-alpha at chronic viral hepatitis The aim of review. Evaluation of results of the scientific studies concerning mechanisms of action and clinical application of immunomodulating factor Timosina1 in treatment of patients with chronic hepatites B and C.
Original positions. Timosin a1 (Timosin a, thymalfasin, Zadaxin®) is acetylated 28aminoacidic polypeptide, that influences cells of immune system involved in antiviral response, and directly attacks the hepatocytes infected by virus. Immunomodulating effect of Timosina1 is represented by elevation of quantity of CD4, CD8lymphocytes and natural killer cells, and reduction of Th1 subtype immune response. Antiviral action includes the increase of expression of molecules of main histocompatibility complex of the 1st class at infected cells and direct suppression of virus replication. In series of studies it was shown, that combination of Timosina1 with interferona (IFNa), and Timosina1 with lamivudine in treatment of chronic hepatitis B is more effective in comparison to monotherapy by traditional antiviral drugs. Timosina1 effect is more apparent at the end of monitoring period after completion of treatment. According to original studies, the AsianPacific association for the study of the liver (APASL) included Timosina1 in the list of immunomodulating agents for treatment of chronic hepatitis B. Timosina1 is also effective within triple therapy at treatment of one of the most complex groups of patients with persistent infection of hepatitis C virus, not responding to combination of interferona and ribavirin.
Conclusion. Timosin a1 can be successfully applied within modes of combined treatment of patients with chronic viral hepatitis B (CHB) and chronic viral hepatitis C (CHC), deserving the further studying.
Buyeverov A.O., Bogomolov P.O., Dubinina N.V., Matsiyevich M.V., Ivashkin V.T.
Heptral® (ademetionine) in complex antiviral therapy of chronic hepatitis C (Preliminary results) The aim. To estimate the role of ademetionine (Heptral®) in increase of efficacy and improvement of tolerability of combined antiviral therapy of patients with chronic hepatitis C (CHC).
Methods. 80 patients were included in original investigation. The basic group received IFNa 2b 3 IU 3 times per week, ribavirin 800–1200 mg per day and ademetionine (Heptral®) 400 mg 3 times per day orally. Patients of comparison group received similar antiviral therapy without ademetionine. The patients infected by HCV of genotype 1, received treatment for 48 wks, those infected by genotypes 2 HCV and 3 HCV – for 24 wks. The period of monitoring of all patients after the termination of treatment was 24 wks. Questioning by the Hospital Anxiety and Depression scale (HADS) was carried out additionally.
Results. In patients, infected by HCV genotype 1, rapid virologic response (RVR) was obtained at 50% of patients within 4 wks of treatment, in both basic and comparison groups. Early virologic response (EVR) within 12 wks was revealed in 80 and 90% of patients of these groups respectively. At HCVinfection with non1st genotype RVR was observed at 80% in the group, receiving ademetionine and at 65% in comparison group, EVR – at 100 and 90% respectively (differences were statistically insignificant). At 76% of patients receiving ademetionine, by the 12th week of treatment depression was not found (in the group of comparison it was absent at 42% of the cases). Clinically significant depression by the 12th week was diagnosed only at 3% of patients while in group of comparison its frequency made 24% (ð<0,05).
Conclusions. Addition of oral ademetionine (Heptral) in daily dose of 1200 mg to complex treatment by IFNa 2b and ribavirin in patients with CHC causes high frequency of RVR and EVR achievement. Despite lacking of significant differences with comparison group, it is necessary to consider, that in group of the patients receiving ademetionine, it was characterized by a panel of factors complicating antiviral therapy. Depression on a background of ademetionine application in combination to antiviral agents developed significantly less often and was mild in comparison to patients received no ademetionine.
Pasechnikov V.D., Litvinenko I.L.
Improvement of treatment of exocrine pancreatic insufficiency by combination of enteric-coated pancreatin and proton pump inhibitor Aim of investigation. To evaluate the assumption of improvement of efficacy of substitution therapy of chronic pancreatitis by entericcoated enzymes in combination to proton pump inhibitor.
Methods. Exocrine pancreatic insufficiency was diagnosed by assessment of fecal elastase1 and level of fecal fat for 24 hours by acid steatocrit method. By results of clinical and laboratory studies efficacy of combined treatment by pancreatin minimicrospheres and omeprazole (Omez, Dr. Reddy’s) was analyzed.
Results. It was found, that prescription of pancreatin as entericcoated minimicrospheres efficiently compensates signs of exocrine insufficiency in part of patients and does not require additional prescription of omeprazole.
Conclusions. The combined therapy by pancreatin minimicrospheres and omeprazole (Omez) causes significant improvement and even normalization of fat digestion at the majority of patients with exocrine pancreatic insufficiency.
Bueverov A.O.
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