METABOLIC CHANGES AND THERE INFLUENCE TO RESULTS OF ANTIVIRAL TREATMENT IN HCV PATIENTS

G. AGAYEVA, A. HIDAYATOV

Azerbaijan Medical University, Baku, AZERBAIJAN

Background and aims: In chronic hepatitis C, insulin resistance and type 2 diabetes mellitus are more often seen than in healthy controls or chronic hepatitis B patients. Since the hepatitis C virus (HCV) was identified, numerous epidemiological studies have reported a higher prevalence of type 2 diabetes mellitus (DM2) in subjects infected by HCV. The aim of the present study was to determine the relationship between insulin resistance (IR) or diabetes mellitus and SVR rates in patients with chronic hepatitis C.

Methods: Between 2003 and 2008 a total 680 adult patients (55 patients with carbohydrates disorders – insulin resistance or diabetes mellitus) with chronic hepatitis C and 248 patients with chronic hepatitis B were evaluated. Overweight was defined as BMI>25 kg/m2, and IR as HOMA> 2. Serum HCV RNA and genotype were determined for all patients. Fibrosis was evaluated using Metavir score.. Severe fibrosis was F3-F4.

Results: 82% of the patients were with genotype 1. Type 2 diabetes mellitus is more often seen in patients with CHC (8% vs 2% in patients with CHB). Severe fibrosis and cirrhosis (F3-F4) among patients with diabetes mellitus and high IR (HOMA-IR > 4) were appeared in 53% cases. SVR in patients with low IR (HOMA-IR< 4) was 63% (vs 9% in patients with high HOMA-IR>4). SVR among chronic hepatitis C patients with diabetes mellitus was 27%. Lowest SVR (18%) was appeared in patients with BMI>30 kg/m2. Most of chronic hepatitis C patients with diabetes mellitus had BMI>25 kg/m2 (85%).

Conclusions: Insulin resistance emerges as the most important host factors in the prediction of response in non-diabetic patients treated with peginterferon plus ribavirin. Management of IR should become part of the assessment of chronic hepatitis C patients. Diabetes mellitus is a predictor of treatment failure in HCV patients treated with pegylated interferon plus ribavirin, especially in group of the patients with BMI>30 kg/m2.

ANTIBIOTIC SUSCEPTIBILITY OF BILIARY TRACTS MICROFLORA IN PATIENTS WITH OBSTRUCTIVE JAUNDICE

R.M.AGAYEV, R.SH.GASIMOV, B.V.MUSAYEV, R.E.JAFARLI

Azerbaijan Medical University, Baku, AZERBAIJAN

Bacteriobilia is diagnosed in 80-98% of patients with obstructive jaundice and cholangitis, which shows the leading role of the microbial factor in the development of disease and postoperative septic complications. Lack of information on bacterial infections and characteristics of the clinical course of acute cholangitis, subject to the causative agent, complicates adequate antibiotic therapy, the principles of which so far have not been fully developed.

This work was based on the results of a comprehensive clinical examination and surgical treatment of 79 patients with obstructive jaundice. The patients were divided into a control (36) and main (43) groups. Conservative measures in the control group were based on generally accepted treatment regimens, using broad-spectrum antibiotics - cephalosporins, more often ceftriaxone. Antibiotic therapy in patients with the main group are held with the consideration of the results of antibiotic susceptibility microflora in control group patients.

Studies have shown that in almost all cases aerobic microflora seeding it was sensitive to amikacin (68 cases or 98,6 ± 1,44%), and in most cases (54; 78,3 ± 4,97%) to ofloxacin. In 32 or 46,4 ± 6% of patients with obstructive jaundice seeded from biliary microflora was sensitive to gentamicin, in 28 or 40,6 ± 5,91% of patients to ceftriaxone, 22 or 31,9 ± 5,61% of cases to chloramphenicol. In even lesser level isolated flora was sensitive to gatifloxacin (12 or 17,4 ± 4,56%) and furazolidone (8 or 11,6 ± 3,85%). Anaerobic microflora often (24 cases or 92,3 ± 5,23%) was susceptible to metronidazole and in many cases (15; 57,7 ± 9,69%) and to chloramphenicol and dioxidine (14 or 53,8 ± 9,78 %). In the a result of microbiological tests of antibiotic susceptibility of Helicobacter pylori it was found that the strongest antimicrobial effect on a colony of the pathogen was made by clarithromycin.

Proper and timely choice of an appropriate scheme of antibiotic therapy improves the efficiency of the conducted treatment, leads to early elimination of inflammation in the bile ducts, reduces the length of stay of patients in hospital and reduces the frequency of postoperative complications as compared with patients receiving conventional treatment.

Date: 2014-12-28; view: 917