Національний фармацевтичний університет Проблеми клініки, діагностики та терапії гепатитів Збірник праць науково практичної конференції Харків 2005

Вид материала

КЛИНИЧЕСКАЯ ЭФФЕКТИВНОСТЬ КАНДЕСАРТАНА В КОМПЛЕКСНОЙ ТЕРАПИИ ХРОНИЧЕСКОГО ПЕРСИСТИРУЮЩЕГО ГЕПАТИТА Шустваль Н.Ф. 259
ОЦЕНКА ФУНКЦИОНАЛЬНОГО СОСТОЯНИЯ ПЕЧЕНИ ПРИ ТЯЖЕЛОЙ МЕХАНИЧЕСКОЙ ТРАВМЕ Яблоков Е.Б., Кулиджанов А.Ю., Лосев В.М., Казначеева И.
Клинические особенности течения беременности при впервые выявленном гепатите С Яковлева Э. Б., Голоденко Ю.Н. 264

Подобный материал:

1 2 3 4 5 6 7 8 9 10 ... 115

КЛИНИЧЕСКАЯ ЭФФЕКТИВНОСТЬ КАНДЕСАРТАНА В КОМПЛЕКСНОЙ ТЕРАПИИ ХРОНИЧЕСКОГО ПЕРСИСТИРУЮЩЕГО ГЕПАТИТА

Шустваль Н.Ф. 259

ОСТРЫЙ МЕДИКАМЕНТОЗНЫЙ ГЕПАТИТ У БОЛЬНЫХ ТУБЕРКУЛЕЗОМ ЛЕГКИХ, ВЫЗВАННЫЙ ТУБЕРКУЛОСТАТИЧЕСКИМИ ПРЕПАРАТАМИ

Шустваль Н.Ф. 260

ОЦЕНКА ФУНКЦИОНАЛЬНОГО СОСТОЯНИЯ ПЕЧЕНИ ПРИ ТЯЖЕЛОЙ МЕХАНИЧЕСКОЙ ТРАВМЕ

Яблоков Е.Б., Кулиджанов А.Ю., Лосев В.М., Казначеева И.Г. 261

Профілактика післятрансфузійних гепатитів В та С в Харківській області

Яворський В.В., Федорова Т.Г., Лопатін П.М. 262

Клинические особенности течения беременности при впервые выявленном гепатите С

Яковлева Э. Б., Голоденко Ю.Н. 264

Aminotranferase activity under abdominal sepsis: impact on liver and multiple organ dysfunction syndrome

Sydorchuk R.I.¹, Fomin P.D.², Olsson S.Д.³, Sydorchuk L.P. ¹, Sydorchuk I.I. ¹, Knut R.P. ¹, Dykyy M.V. ¹

Bucovinian State Medical Academy¹, National State Medical university named after O,O, Bohomoletsm, Kyiv (Ukraine),² Hospital Дngelholm-Helsigborg (Sweden)³.

Background/aim: Abdominal sepsis (AS) is leading in terms of diagnostic, prophylactics, treatment complexity, and mortality amongst the most spread surgical diseases in elderly patients associated with digestive system. While the multiple organ dysfunction/failure syndrome (MODS), including hepatic insufficiency became even more significant in prognosis and treatment outcome, role of messenger/regulatory and metabolic changes under AS is growing. The aim of the study was to reveal changes of systemic aminotransferases activity under AS.

Methods: Alaninaminotransferase [KF 2.6.1.2] (ALT) and aspartataminotransferase [KF 2.6.1.1] (ALT) activity we assessed dynamically using Kone®-Ultra system (U/l) in 52 AS patients (aged 41.933.47). Systemic inflammatory response syndrome (SIRS) associated with abdominal infection was a major criterion for AS diagnosis (R.C. Bone, 1996). All patients were divided accordingly into SIRS-2 (2 SIRS symptoms) – 1 group, SIRS-3 (3 SIRS symptoms) – 2nd, and SIRS-4 (4 SIRS symptoms, heavy sepsis) – 3rd group. 17 patient without abdominal pathology formed control group.

Results/discussion: Correlative analysis showed the following: AST and ALT levels correlation in respective groups was 0.26 (control), 0.943 (1st group), -0.14 (2nd group) and 0.30 (3rd group). Correlation coefficients 0.64, -0.07 та –0.39 for ALT and –0.28, 0,80 та 0.17 – for AST characterized interrelations between different research groups.

Conclusion: There is no doubt concerning development of hepatic dysfunction under AS. Although clinically expressed dysfunction/insufficiency was relatively rare (only 21.15%), this study shows that hepatic cytolysis syndrome under AS develops much earlier than clinical signs or laboratory marks occur. Lower than in 1st group results found in 3rd group during several periods may be associated with stimulated proteolysis activity mimicking less significant liver injury.

Viral clearance, Lamivudine resistant mutants appearance and HBV reactivation in the patients with Chronic Hepatitis B in End-stage Renal Disease treated with Lamivudine

Telehin D.¹, Kondrat P.², Tychka I.², Abragamovych T.², Antonenko S.³, Lulchuk M.³, Kryzhanska M.¹, Kobryn T.¹, Hritsko R.¹

National Medical University of Lviv¹, Lviv Regional Hospital², Institute for the Research of the Epidemiology and Infections Diseases of Kyiv³

Background/aim: The fact of HBV-infection in patients with end-stage renal disease (ESRD) is common and ranges 20-30% in some eastern European countries. Schemes and effectiveness of treatment of chronic hepatitis B (CHB) in this cohort were not established. The aim of our study was to evaluate course of CHB at the patients with ESRD treated with Lamivudine in the hemodialysis department.

Methods: 55 patients with HBV-related chronic liver disease and ESRD were studied: 28 males, 15 females. Mean age - 41 years. Median ALT was 98 IU/L, all of them HBV-DNA+. 72% patients were with wild-type, 28% with mutant HBV (HBeAg-negative). High virulence HBV was characterized by high level virus circulation (21,5%). 37 patients have taken Lamivudine in creatinine clearance depending doses (10-50 mg/day) during 24 weeks. Serum HBV-DNA was detected using a PCR by “Amplisens HBV” (>1000 cp/ml). Lamivudine resistance was presumed by virological and biochemical worsening during treatment. HCV-, HDV-superinfection was excluded.

Results. At the end of treatment with Lamivudine 17 patients (46%) achieved HBV-DNA clearance. Decreasing of ALT was notified in 52%. HBeAg seroconversion took place in 19% of HBeAg-seropositive patients. Sustained virological response within 12 months after treatment was revealed in 13 patients (35%). In 4 patients (24% of responders) HBV reactivation was noted. Kidney transplantation was made in 12 patients with SVR. In this group 8 patients (66%) develop HBV reactivation within the first year after surgery. In 18 patients without Lamivudine therapy late chronic hepatitis B sequences were present: mild and average chronic liver disease – 28%, severe chronic liver disease and cirrhosis – 50%, fatal outcome in 22% of patients was due to chronic liver failure. In patients nonresponders and/or in those with HBV reactivation the late sequences rate was accordingly 55%, 45%, 0%.

Conclusions: Peculiarities of clinical course and treatment in immunocompromised patients with end-stage renal disease strictly depend on the fact of HBV virulence. In this cohort sustained virological response (6 month duration Lamivudine therapy course) is 35%. In 66% kidney recipients reactivation of chronic hepatitis B is experienced even if surgery was after HBV disappearance. Severe course and mortality rate in Lamivudine treated patients, including those without confirmed virologic response were more rear then in non treated patients.

Blog