IMPROVEMENT OF PATHOGENETIC THERAPY OF ASCITES DURING LIVER CIRRHOSIS BY MODULATION OF RENIN-ANGIOTENSIN SYSTEM

M.A. KURYSHEVA

City Clinical Hospital No 30, Nizhny Novgorod, RUSSIA

The aim of the work - to study effectiveness and safety of application of rennin-angiotensin system blockers - - ACE inhibitor of benazepril (lotensine) and ARA II eprosartan (Teveten) in patients with ascites during liver cirrhosis (LC) for the optimization of the therapy: intensification of effects of diuretics with the reduction of their side effect, reduction of portal hypertension, improvement of the forecast of patients.

Materials and methods. 60 patients aged between 28-65 years with LC of Class B according to Child-Pugh (etiology: viral - 14% alcoholic - 52%, NAJP - 8%, mixed genesis - 26%), in which changes of clinical and laboratory indicators were assessed, and comprehensive ultrasound assessment of regional blood flow vessels of the liver and spleen was conducted. Patients of the 1^st group (20 pers. - control group) received standard therapy of LC of class B, patients of the 2^nd group (20 people) in addition to standard therapy took benazepril 10 mg / day, patients of the 3^rd group (20 pers.) - eprosartan dosed 400 mg against the background of standard therapy of LC within a month of observation.

Results. It was determined that as compared to the control group the inclusion of blockers of the renin-angiotensin system into complex therapy of ascites (patients of the 2^nd and 3^rd groups) led to a more rapid clinical improvement of patients - the transition to the Class A LC (within average 5-8 days), without the development of electrolyte disturbances, due to the synergism of the effect with diuretics and reduction of portal hypertension. The changes were accompanied by improvement in regional blood flow of vessels of the liver and spleen: increase of linear velocity in the portal vein to 17,2 ± 3,5 cm/sec and in the splenic vein to 28±0,14 cm/s, reduction of cross-sectional area of portal ( 1,3 ± 0,2 cm2) and splenic (0,7 ± 0,1 cm2) veins and superior mesenteric artery (0,6 ± 0,12 cm 2); reduction of the volume velocity of blood (up to 1100 ± 150 ml/min in the portal vein and up 400 ± 15 ml / min in the splenic vein); disappearance of ascites.

Conclusions: Indication of ACEi and ARA II in patients with LC allows to improve the effectiveness and safety of treatment of ascites. Therefore, it is reasonable to include modulators of the renin-angiotensin system - ACE inhibitors or ARA II in the treatment of LC as a means of pathogenetic therapy of portal hypertension and its complications in the absence of counter-indications in patients (hypodynamic variant of hemodynamics).

MAIN TYPES OF STRUCTURAL ORGANIZATION OF BLOOD SERUM IN CHRONIC HEPATITISES AND LIVER CIRRHOSISES ACCORDING TO CRYSTALLOGRAPHIC STUDIES

B.N. LEVITAN, A.R. UMEROVA, D.M. ABJALILOVA, A.K. AYUPOVA

Medical Academy, Astrakhan, RUSSIA

Studies on the structure of biological fluids, formed during their transition into solid state in the process of crystallization allows to record changes occurring in the body, assess the nature and activity of the pathological process and control its course. The study of crystallographic structural features of blood serum (BS) opens new perspectives in the diagnosis of early stages of the disease, forecasting and outcome of the pathologic process.

Methods: 57 patients with chronic hepatitis (CH), 106 with liver cirrhosis (LC) and 20 healthy individuals were examined. The structural analysis of BS was performed by the method of wedge-dehydration (Shabalin V.N., Shatokhina S.N., 2001). BS drops that formed a thin film – facies on open surface after dehydration were studied by using a stereomicroscope MZ 12,5 «Leica», equipped with a “Pixera” camera.

Results: Crystallographic studies of BC during CH and LC in comparison with healthy individuals allowed to identify 4 types of structural organization: I – partially radial, II - irradial, III - circulatory and IV - triradial. Type I had weak or mildly expressed deviations from the radially-ordered location of sectors, separations and concretions. In the type II pattern of facies differed for non-symmetry, the number of core elements was reduced, and their configuration varied. Feature of the type III was the presence of a large crack, located parallel to the edge of the facies between the peripheral and intermediate zones, formation of which was determined by a circular distribution of observed basic structures. Type IV is fundamentally differed from I - III type facies of BS, did not contain the main elements, the figure consisted of a network of small (triradial) fractures. In 73.7% of patients with CH and 87.7% - LC had BS facies with significant disorders at the systemic level, and if during LC the morphotype II was dominant, types I was recorded much less, and III, and IV types were encountered in a few cases, then in CH type I and III facies were often recorded (p <0.05).

Conclusion. Four main morphotypes of BS facies were distinguished and frequency of their occurrence in the CH and LC was determined. Crystallographic study of BS is one of the prospective non-invasive method of diagnostics of CH, LC and their complications.

CLINICAL AND LABORATORY- INSTRUMENTAL PARAMETERS OF PROGNOSIS OF CLINICAL COURSE OF CHRONIC CHOLECYSTITIS AND CHOLELITHIASIS

V.B. LIFSHITS, N.V. SUSHKOVA, V.G. SUBBOTINA, D.S. TIMOFEEV, E.A. SIMONOVA

Saratov State Medical University after V.I. Razumovsky, Saratov, RUSSIA

Gallbladder diseases - chronic cholecystitis (CC) and cholelithiasis (CL), are one of the actual problems of gastroenterology.

The aim - the study of clinical, sonographic, biochemical indices in chronic cholecystitis and cholelithiasis, the definition of the mutual relationship of criteria with the construction of mathematical models based on obtained data for prediction the clinical course of the disease.

Materials and methods: The contingent of examined persons included 98 patients (48 males and 50 females) in the average age of 50,0 ± 6,2 years. Patients were subdivided into 3 groups: the 1st - exacerbation of chronic cholecystitis (ECC), the 2nd - remission of chronic cholecystitis (RCC), the 3rd - CL. Clinical-anamnestic examination and ultrasonography (US) of gallbladder were carried out. Were determined serum levels of alkaline phosphatase (ALP) and concentration of lipids: total cholesterol (LDL), cholesterol of high density lipoprotein (HDL), triglycerides (TG) with the expectation of the content of cholesterol of low density lipoprotein, atherogenic coefficient (AC).

Results: Heredity was burdened in 62.0% of patients with CL and in 15.8%- with CC. Ultrasonographic deformation and flexure of gallbladder more frequently occurred in patients with CC than in those with CL ( 9.6% and 0% and 9.6% and 2.8% of cases respectively). In patients with ACC and CL, as compared with RCC the level of serum alkaline phosphatase (U / L) was substantially increased - 220,8 ± 19,7; 234,0 ± 25,8 and 132,0 ± 16,9, respectively (p <0,05). Analysis of the indices of lipid spectrum of blood serum (mmol / l) has shown an increase of triglycerides in CL as compared with ACC and RCC (1,8 ± 0,7; 1,3 ± 0,4; 1,3 ± 0,5respectively) and of AC (3,2 ± 0,9; 2,3 ± 0,7; 2,2 ± 0,6 respectively, p <0.05). In patients with RCC in comparison with a group of patients with CL the level of HDL-CL has increased in1.5 times (1,8 ± 0,5 mmol / l and 1,2 ± 0,3 mmol / l, p <0.05). Conclusions. The possibility to determine correlations between clinical-anamnestic, biochemical and sonographic criteria will allow us with the use of a method of discriminant analysis to construct mathematical models of prediction of the course of CC and CL for further optimization of therapeutic and preventive measures among these patients.

Date: 2014-12-28; view: 884