THE SIGNIFICANCE OF STUDY OF FETAL HEMOGLOBIN IN CHRONIC HEPATITISES AND LIVER CIRRHOSISES
T.R. KASYANOVA, B.N. LEVITAN, Y.A. KRIVENTSEV
Medical Academy, Astrakhan, RUSSIA
Fetal hemoglobin (HbF) is of special interest among all types of hemoglobin. It is proved that with the same partial pressure,HbF more actively absorbs oxygen and more readily gives carbon dioxide, than hemoglobin of an adult. Given the high sensitivity of HbFto oxygen, there appeared interest in studying its clinical and diagnostic value in diseases followedby tissue hypoxia, including in chronic hepatitises (CH) and liver cirrhosises (LC).
Materials and methods. HbFconcentration in blood was examined in 55 patients with CH and 146 - LC (106 men and 95 women aged between 30-66 years). 20 actually healthy donors were included into control group. A method of rocket electrophoresis in agar gelwas developed and patentedfor quantitative analysis of HbF. Pure HbFdrugs and monospecific antiserums to HbF, which were obtained independently and passed strict control of purity and specificity were used.
Results. Analysis of the average values of HbF in patients with CH, LC and their comparison with the results in the control group allowed to reveal the following changes: increase ofHbF concentration for more than 1.5% of total hemoglobin (Hb) in the blood of anadultman, which is the norm, was observed in 48 patients in CH and 140 - LC. In the analysis of HbF in percentage of Hb in patients with liver diseases there were found differences with a high degree of significance (p <0.001) as in the control group (1,53▒0,06), and between CH (2,5▒0 08) and CP (3,07▒0,07) groups. Concentration of total Hb was the lowest in LC - average of 119g\l. Significantincrease ofHbF, i.e. ≥ 3% was detected in patients with a high degree of activity, signs of portal hypertension, long duration of the disease. HbF level was significantly high in patients with edematous-ascitic syndrome (p = 0,01), and hypersplenism (p = 0,01).
Conclusion. Increase of HbF in CH and LC is explained by metabolic disorders associated with endotoxemia, as well as intrapulmonary anastomoses and vasodilations, which may lead to the development of hypoxic conditions. Increased level of HbFis connected with the fact that withgreater sensitivity to oxygen than Hb of an adult, it is better adjusted to stabilization of tissue gas exchange with chronic hypoxia. The study ofHbF opens new diagnostic possibilities in the experience of a physician-gastroenterologist.
METABOLIC AND VASCULAR EFFECTS OF GLUTARGIN AT NONALCOHOLIC STEATOHEPATITIS IN 2 GRADE PANCREATIC DIABETES PATIENTS
Bukovinsk State Medical University, Chernovtsy, UKRAINE
The research objective is to study effects of glutargin (ôZdorovyeö FC (Kharkov)) on functional state of liver, lipid spectrum of blood, functions of endothelium, glycemic profile and degree of insulin resistance (IR) , content of connective tissue (CT) components and proinflammatory cytokines in blood in the treatment dynamics of nonalcoholic steatohepatitis (NASH) and 2 grade pancreatic diabetes (PD) patients.
The research materials and methods: 120 patients with moderately active NASH developed against the background of 2 grade subcompensated PD of medium-scale severity and 30 healthy persons aged 37 to 63 have been examined. All the patients, in addition to dietary nutrition (╣ 5/9), biguanid grouped sugar-reducing medicine (siofore) received monotherapy in the form of 10 ml 40% glutargin solution intravenously by 200 ml 0.9% chloride sodium solution (10 days) following the transition to 750 mg glutargin tablets taken 3 times per a day (30 days).
Results: Due to antioxidantic, disintoxic, antihypoxic, vasodilatic (NO donator) features, the application of glutargin in the treatment dynamics (the glutamic acid and arginine salt), first of all, has positively affected the PD course and normalized the glycemic profile on the 5th day of treatment, normalized the glycated hemoglobin level due to its ability to reduce the peripheral IR of tissues (HOMA IR reduced 2.8 times (<0,05)), and improved the functional state of endothelium (NO deficiency elimination, reduction of the desquamative endotheliocyte quantity in blood (<0,05)); it also favored the normalization of the functional state of liver (reduction of the activity of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gama-glutamiltransferase, thymol test following the normalization on the 10th day (<0,05)), the lipid spectrum of blood (reduction of the content of cholesterol, triglycerides, low and very low dense lipoprotein cholesterol (<0,05)); inhibited the liver tissue fibrosing due to the depression of collagen and glycosaminoglycan synthesis by the Ito stellate cells (as a result of recovery of NO liberation, removal of hypoxia, reduction of the affect of ╚╦-1β, TNF-α, TGF-β1 proinflammatory cytokines and the I grade insulin-like growth factor stimulating fibrogenesis), activated the collagenoid activity of the blood plasma (activation of the matrix metalloproteinase-1 (MMP-1), reduced the activity of the MMP-1 tissue inhibitors) and increased the ST metabolite excretion (free oxiprolin) with urine.
Conclusion. The results have shown high efficiency and reasonability of the application of glutargin for treatment of the NASH patients against the 2 grade PD background.