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Reyzis A.R., Borzakova S.N., Aksenova V.A.
Up-to-date problems of drug-induced lesions of liver at tuberculosis The aim of review. To generalize literature data and to carry out analysis of state-of the-art for drug-induced lesions of the liver at chemotherapy of patients with tuberculosis.
Original positions. Increase of morbidity due to tuberculosis in the country, increase of multiple drug resistance of micobacteria tuberculosis, that require simultaneous application of several potentially hepatotoxic agents, make drug-induced liver lesions (DILL) at chemotherapy an important interdisciplinary problem demanding attention of gastroenterologists-hepatologists as well. One of leading and common pathogenic mechanisms for DILL of various drugs is apoptosis. The preparation of ursodeoxycholic acid (UDCA) Ursosan has antiapoptotic effect that can be a basis of its favorable effect at DILL on a background of antituberculous treatment.
Conclusion. Ursosan (UDCA) is a perspective drug for prophylaxis and treatment of DILL at chemotherapy of patients with tuberculosis. It has antiapoptotic action, besides known anticholestatic, hepatoprotector and immunomodulating effects.
Kuznetsova A.V.
Hormonal status parameters in patients with chronic hepatitis C Aim of investigation. To compare results of studying of thyroid hormones and insulin concentration at patients with chronic hepatitis C, to determine effect of narcotic use severity, HIV coinfection, genotype and viral load of HCV, stage of fibrosis of hepatic parenchyma on specified scores.
Material and methods. Overall study included 241 patients with chronic HCV-infection, that were distributed as follows: 1st group (79 patients – users of parenteral narcotics infected by HCV; 2nd group (75) – patients with non-narcotic way of HCV infection; 3rd group (87) – HIV coinfection). In 31,6% of patients clinical manifestations of thyroid gland lesion (mainly – diffuse hypertrophy) were found, in 14,5% – diabetes mellitus of the 2nd type has been revealed. Investigation of thyroid status was carried out by standard procedure with application of specific commercial test-systems of LLC «Vector-Best», Novosibirsk; concentration of insulin was determined by immunoenzyme assay with application of commercial diagnostic tests of Joint-Stock Company «BioKhimMak» by standard algorithm prior to onset of specific antiviral therapy of chronic hepatitis C.
Results. In patients with chronic HCV-infection high rate of deflections of thyroid hormones and insulin concentration (39,8 and 44,1% respectively) was found, that exceeded frequency of overt clinical forms. The most essential differences between main and control groups have been registered for the level of antibodies to TPO (p<0,05) and insulin concentration (p<0,001). The stage of HIV-infection, genotype and HCV viral load had no significant effect on investigated scores. On the contrary, significant changes of thyroid hormones (p<0,05) and concentration of insulin on a background of narcotic drugs use and in relation to stage of hepatic fibrosis respectively was found.
Conclusions. The revealed patterns of hormonal status, probably, were caused by pathological processes which were caused not only directly by hepatitis virus C, but also have been related to narcotic drugs usage. HIV coinfection renders no additional essential effect on studied scores of hormonal status.
Loginov A.F.
Choice of proton pump inhibitor for prophylaxis and treatments of NSAID-induced lesions of the stomach (Review of the literature) The aim of review. To present up-to-date data on features of the mechanism of acid-inhibiting effect and pharmacodynamics of pantoprazole.
Original positions. In the review data of randomized studies on severity and duration of stomach acid production decrease, pattern and stages drug-to-drug and metabolic effects on cytochrome Ð450 system are given. It is proposed to use pantoprazole as a drug of the first line in treatment of NSAIDs-induced lesions of upper regions of gastro-intestinal tract.
Korochkina O.V., Geyvandova N.I., Ratnikova, L.I., Morozov V.G.,. Kashuba Yu.A, Haydarova L.M., Grechuscheva N.N., Yagoda A.V., Koroy, P.V., Bertram L.I.,. Mikhaylova Ye.A, Topornina, L.M., Permitina
Efficacy and safety of "Altevir"(r) at treatment of patients with chronic hepatitis C Aim of investigation. To estimate efficacy and safety of the drug «Altevir»® (interferon alpha-2b) in complex treatment of chronic hepatitis C (CHC).
Material and methods. Overall 79 adult patients with CHC were included in the open clinical multicenter study (phase IV), that underwent complex treatment by Altevir® 3 million MU 3 times per week along with ribavirin. Duration of treatment was 24 and 48 wks according to genotype of the virus. For evaluation of treatment efficacy patients were separated into groups with high and normal aminotransferases activity. Analysis was carried out by the number of patients who have achieved rapid viral response (RVR), sustained viral response (SVR). Safety profile of Altevir® application was estimated in relation to virus genotype and duration of treatment.
Results. In group of patients with CHC with high activity of aminotransferases SVR has been achieved in 25% of patients with genotype 1b and in 86,7% of cases in patients with genotype 2 and 3à. In group with normal activity of aminotransferases SVR has been achieved in 53% of patients with genotype 1b, in 88,9% of cases – in patients with genotype 2 and 3à. The pattern and frequency of the registered side effects corresponded to the previously published data, all side effects were easily eliminated.
Conclusion. «Altevir»® is an efficient drug for complex treatment of CHC first of all for patients with genotypes 2 and 3à both with normal, and elevated activity of aminotransferases, as well as for those with virus genotype 1b with normal activity of these enzymes in the case of RVR achievement.
Lapina T.L.
Safety of proton pump inhibitors Original positions. The spectrum of undesirable effects of PPI is widely discussed in scientific literature, and according to results of many broad-scale studies, little differs from undesirable effects of H2-histamine receptor blockers and placebo. Drug interaction with vitamin K antagonists, benzodiazepines and phenytoin is the most significant. Interaction at the level of cytochrome P450 isoenzyme 2C19 with clopidogrel, that result in decrease of antithrombotic effect of the latter, was demonstrated. Intake of PPI can be related to increase of risk of osteoporosis and community-acquired pneumonia, however mechanisms and clinical significance of these data require further studying.
Conclusion. High efficacy of PPI makes this class of pharmaceuticals one of the most widespread. Available data on the drug interaction, based on significant clinical experience and results of scientific studies, allow to predict, with high degree of reliability, risk of undesirable effects for each specific case.
Khlynov I.B., Chikunova M.V., Lisovskaya T.V.
Efficacy and safety of nutritional support in hepatic encephalopathy Aim of investigation. To study efficacy and safety of enteral nutritional support at patients with nutritional failure on a background of liver cirrhosis of Child–Pugh class B.
Methods. Overall 118 LC patients of Child–Pugh class B were investigated. Along with treatment involving nutritional support methods trophological status of patients was evaluated by following methods: anthropometric and laboratory with assessment of concentration of total protein, albumin, activity of cholinesterase in blood. The number connection psychometric test was applied to study severity of clinical course of hepatic encephalopathy with subsequent evaluation on Raton scale.
Results. At prospective randomized study it was revealed, that the patients receiving nutritional support, show significant increase of concentration of serum albumin from 32,6±2,7 to 36,4±2,68 g/l (ð<0,05). On a background of enteric nutrition significant improvement in number connection test from 99,9±20,1 to 76,4±13,5 was marked as well, that was not observed in control group.
Conclusion. Nutritional support in patients with LC of Child–Pugh class B with nutritional failure and hepatic encephalopathy is safe and effective.
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