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  • Title: Comparative characteristics of hepatoprotectors used for the treatment of non alcoholic steatohepatitis associated with herpesvirus infection in sufferers of the Chornobyl accident.
    Author: Gasanova OV, Sarkisova EO, Chumak AA, Ovsyannikova LM, Nosach OV, Alohina LM, Gasanov VA, Kryzhanivska VV.
    Journal: Probl Radiac Med Radiobiol; 2017 Dec; 22():339-352. PubMed ID: 29286519.
    Abstract:
    UNLABELLED: Objective of the study was to determine the effectiveness of various groups of hepatoprotectors in the treatment of patients with nonalcoholic steatohepatitis (NASH) sufferers of the accident at the Chornobyl NPP following the assessment of metabolic changes and control of persistent infections. MATERIALS AND METHODS: The study included 104 males with NASH, who were sufferers of the Chornobyl disaster and underwent examination and treatment in the conditions of the clinics of the National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine. Analysis of the course of the functional state of the liver before and after treatment with hepatoprotectors was carried out using laboratory methods of investiga tion. RESULTS: Hepatoprotectors of different groups used for the treatment of patients affected by the Chornobyl accident with NASH, differed in their effect on various chains in the pathogenesis of disease. Ursodeoxycholic acid (UDCA) drugs and preparations of holy thistle normalized the functional state of the liver and disorders of fat metabolism. Treatment with essential phospholipids eliminated cytolytic syndrome with a significant decrease in alanine amino transferase (p < 0.05), but increased alkaline phosphatase (p < 0.001), beta lipoproteins (p < 0.05), triglycerides (p < 0.05), the total cholesterol level remained elevated to (7.0 ± 0.8) mmol/L. Amino acid (AA) preparations normal ized the level of aminotransferases, eliminated the symptoms of cholestasis with a significant decrease in bilirubin (p < 0.001) and alkaline phosphatase (p < 0.001), positively influenced on fat and carbohydrate metabolism decreasing levels of beta lipoproteins (p < 0.05), triglycerides and glucose. Treatment with hepatoprotectors posi tively influenced on the state of antioxidant protection (AOP) - decreased before treatment in 56.5 % of patients, after treatment it reduced to 28.6 % (p < 0.05), the number of patients with elevated lipid peroxidation indices decreased from 39.1 % to 21.4 %. Titres of antibodies to persistent herpes virus infections, elevated before treat ment, under the influence of hepatoprotectors did not decrease to reference values. CONCLUSION: The most effective were drugs on the basis of AA, when applied they normalized the functional state of the, fat and carbohydrate metabolism, decreased lipoperoxidation and improved AOP state. Effect of drugs AA and UDCA on the level of antibodies to herpesvirus infection requires further study. Meta doslidzhennia: vyznachyty efektyvnist' riznykh grup gepatoprotektoriv pry likuvanni postrazhdalykh vnaslidok avariï na ChAES z nealkogol'nym steatogepatytom (NASG) za rezul'tatamy otsinky metabolichnykh zmin i supresiï persystuiuchykh infektsiy̆.Materialy ta metody. U doslidzhennia uviy̆shly 104 osoby, choloviky z NASG, iaki postrazhdaly vnaslidok Chorno byl's'koï katastrofy i perebuvaly na obstezhenni ta likuvanni v umovakh kliniky DU «Natsional'nyy̆ naukovyy̆ tsentr radiatsiy̆noï medytsyny NAMN Ukraïny». Analiz perebigu funktsional'nogo stanu pechinky do ta pislia liku vannia gepatoprotektoramy provodyvsia za dopomogoiu laboratornykh metodiv doslidzhennia.Rezul'taty. Pry likuvanni postrazhdalykh vnaslidok avariï na ChAES z NASG gepatoprotektory riznykh grup maly vidminnosti za vplyvom na rizni lanky patogenezu zakhvoriuvannia. Preparaty ursodezoksykholevoï kysloty (UDKhK) i preparaty roztoropshi normalizuvaly funktsional'nyy̆ stan pechinky ta porushennia zhyrovogo obminu. Likuvan nia esentsial'nymy fosfolipidamy usuvalo tsytolitychnyy̆ syndrom z dostovirnym znyzhenniam kontsentratsiï v krovi alaninaminotransferazy (r < 0,05), ale pryzvodylo do pidvyshchennia vmistu luzhnoï fosfatazy (r < 0,001), beta lipoproteïdiv (r < 0,05) i tryglitserydiv (r < 0,05), zalyshavsia pidvyshchenym riven' zagal'nogo kholesterynu do (7,0 ± 0,8) mmol'/l. Preparaty aminokyslot (AK) normalizuvaly riven' aminotransferaz, usuvaly symptomy kholestazu z dostovirnym znyzhenniam kontsentratsiï bilirubinu (r < 0,001) ta luzhnoï fosfatazy (r < 0,001), pozy tyvno vplyvaly na zhyrovyy̆ i vuglevodnyy̆ obmin – znyzhuvalysia rivni beta lipoproteïdiv (r < 0,05), tryglitserydiv ta gliukozy. Likuvannia gepatoprotektoramy pozytyvno vplyvalo na stan antyoksydantnogo zakhystu (AOZ) – zny zhenyy̆ do likuvannia u 56,5 % khvorykh, pislia likuvannia zalyshyvsia takym u 28,6 % (r < 0,05), zmenshylas' kil'kist' khvorykh z pidvyshchenymy pokaznykamy perekysnogo okyslennia lipidiv z 39,1 % do 21,4 %. Tytry antytil do persys tuiuchykh gerpesvirusnykh infektsiy̆, pidvyshcheni do pochatku likuvannia, pid vplyvom gepatoprotektoriv ne znyzhuva lysia do referentnykh znachen'.Vysnovok. Nay̆bil'sh efektyvnymy vyiavylysia preparaty na osnovi AK, pry likuvanni iakymy normalizuvalysia funktsional'nyy̆ stan pechinky, zhyrovyy̆ i vuglevodnyy̆ obmin, vidbulosia znyzhennia protsesiv lipoperoksydatsiï ta pokrashchennia stanu AOZ. Vplyv preparativ AK ta UDKhK na riven' antytil do gerpesvirusnoï infektsiï potrebuie po dal'shogo vyvchennia.
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