Atorvastatin in Combination with Pegylated Interferon and Ribavirin Provided High Rate of Sustained Virological Response in Patients with Genotype 3 Hepatitis C Virus

BACKGROUND: Chronic hepatitis C virus infection represents a more frequent cause of liver cirrhosis and hepatocellular carcinoma. Statins, inhibit HCV replication in vitro, enhance the antiviral effect of the already known antiviral drugs and reduce their resistance. AIM: To determine the impact of additional therapy (treatment with Atorvastatin 20 mg) to the standard antiviral therapy (pegylated interferon alpha-peg-IFN α and ribavirin) on achieving sustained virological response (SVR). MATERIAL AND METHODS: In the study which is comparative, open-label, prospective-retrospective, 70 patients diagnosed with chronic hepatitis C virus infection who met criteria for treatment with standard antiviral therapy combined with anti-lipemic therapy (Atorvastatin 20 mg) were included. Patients in the study were divided into two groups: one group of 35 patients receiving combination therapy (Atorvastatin + peg-IFN α + Ribavirin) and another group of 35 patients received only standard antiviral therapy. Those parameters were followed in all patients: genotyping, quantification of the virus, histological assessment of liver inflammation and fibrosis degree (before starting treatment), the presence of steatosis, laboratory analysis: hematology, liver, lipid and carbohydrate status, insulin blood level (the calculation of HOMA-IR) and body mass index (BMI) calculation. The overall treatment of the patients depends from the virus genotype, thus, patients with genotype 1 and 4 received 48 weeks standard antiviral therapy, but patients with genotypes 2 and 3 received 24 weeks of antiviral therapy. SVR was considered an undetectable level of HCV RNA levels 24 weeks after completion of antiviral therapy. The results were statistically analysed, and all results for p < 0.05 were considered statistically significant. RESULTS: Combination therapy leads to a slightly higher percentage of SVR (85.71%) in patients with chronic hepatitis C versus standard therapy (74.29%), but in a group of patients with genotype 3 this rate of SVR amounting to 95.83%. Combination therapy leads to significant improvement of lipid and glucose status after treatment, and in terms of side effects, there was no appearance of serious adverse events that would be a reason for discontinuation of the therapy. CONCLUSION: Combination therapy Atorvastatin + pegylated interferon alpha + Ribavirin leads to high rate of SVR of 95.83% in patients with chronic hepatitis C, genotype 3. Statins can be used safely in patients with chronic hepatitis C

Aсоцијација на плазма Д-димерите со стадиумите на црнодробна цироза и нејзините компликации

Aim of the study: To investigate plasma D-dimer levels in correlation with Child-Pugh-Turcotte (CTP) and Model for End-Stage Liver Disease (MELD) scores in patients with liver cirrhosis (LC) of different severity, as well as the correlation with LC-associated clinical, biochemical parameters and complications. Material and methods: Fifty patients with LC were divided in three groups according to LC severity using the CTP Score (CTP-A, CTP-B, CTP-C).  The levels of D-dimer were measured in sodium-citrate plasma on Siemens, BCS XP Blood Coagulometer. Kruskal-Wallis test was used to compare D-dimer levels between the groups. Mann-Whitney U test was used to evaluate the difference of D-dimer levels in groups with different MELD score, and to evaluate the difference in D-dimer levels in patients with presence or absence of ascites and the difference of D-dimer levels in patients with or without spontaneous bacterial peritonitis (SBP). Pearson’s coefficient of correlation was used to evaluate the correlation between D-dimer levels with MELD score and the correlation between D-dimer levels and the concentration of LC-associated biochemical, clinical parameters and complications. Results: D-dimer levels increased with severity of the disease as assessed with CTP and MELD scores, with a statistically significant difference between the groups (p=.0000 and p=.0001, respectively). Group CTP-C demonstrated the highest D-dimer levels, followed by groups B and A. Patients with SBP had significantly higher levels of D-dimers than patients without SBP (p=.0006). A significant positive correlation between D-dimers and CTP and MELD score was detected (r= 0.74 and r=0.44, respectively; p<.001). A correlation between D-dimer levels and several biochemical parameters characterizing progressive liver dysfunction was observed. From all investigated biochemical parameters, the highest significant correlation was detected between D-dimer levels and the concentration of serum albumin (r= -0.65, p<.001). Conclusions: Plasma D-dimer levels are tightly correlated with the degree of liver dysfunction and LC-associated complications. Therefore, D-dimer levels could be utilized as a prognostic stratification marker and adjunctive diagnostic marker in LC-associated complications. Цел на студијата: Да се испита нивото на Д-димери во плазма во корелација со клиничките скорови: Child-Pugh-Turcotte (CTP) и Model for End-Stage Liver Disease (MELD) кај пациенти со црнодробна цироза со различна тежина, како и нивна корелација со клинички, биохемиски параметри и компликации поврзани со црнодробна цироза. Материјали и методи:  Вкупно 50 пациенти со цироза на црн дроб беа поделени во три групи според тежината на цироза на црниот дроб врз основа на CTP Score (CTP-A, CTP-Б, CTP-C). Концентрацијата на Д-димерите беше одредена во плазма со натриум цитрат користејќи го Siemens, BCSXP крвниот коагулометар. Kruskal-Wallis тестот беше користен за да се споредат нивоата на Д-димери помеѓу CTP групите. Mann-Whitney U тестот беше направен за да се одреди разликата во нивоата на Д-димерите помеѓу групите со различен MELD скор, и за да се оцени разликата во нивоата на Д-димерите кај пациенти со присуство или отсуство на асцит и разликата во нивоата на Д-димерите кај пациенти со или без спонтан бактериски перитонитис (SBP). Pearson-овиот коефициент на корелација беше користен за да се оцени корелацијата помеѓу нивоата на Д-димери со MELD скорот и корелацијата помеѓу нивоата на Д-димери и концентрацијата на биохемиски, клинички параметри и компликации поврзани со црнодробна цироза. Резултати: Концентрацијата на Д-димерите се зголеми со тежината на болеста проценета со CTP и MELDскорот со статистички значајна разлика помеѓу групите (p=,0000 и p=,0001, соодветно). Групата CTP-C покажа највисока концентрација на Д-димери, по што следуваа групите Б и А. Пациентите со SBP имаа значително повисока концентрација на Д-димери во споредба со пациентите без SBP (p= ,0006). Беше утврдена значителна позитивна корелација помеѓу Д-димерите и CTP и MELD скорот (коефициент на корелација r= 0,74 и r= 0,44, соодветно; p< ,001). Дополнително, резултатите покажаа дека постои поврзаност меѓу плазма концентрацијата на Д-димерите со клиничките и биохемиски параметри кои карактеризираат прогресивна дисфункција на црниотдроб. Од сите испитувани биохемиски параметри, највисока статистички значителна корелација беше утврдена меѓу нивоата на Д-димерите и концентрацијата на серумските албумини (r = - 0,65, p< 0,001). Заклучок: Плазматската концентрација на Д-димерите е тесно поврзана со степенот на дисфункција на црниотдроб и компликациите поврзани со цироза на црн дроб. Затоа, нивоата на Д-димерите може да се користат како прогностички маркер за стратификација и дополнителен дијагностички маркер во компликациите поврзани со цироза на црн дроб

Assessing of anthropometric parameters in patients with Crohn’s disease in acute and remission phase

Patients with Crohn’s Disease are often underweight.The aim of this study was to compare the anthropometric measurements in patients (pts) with Crohn’s disease in remission and active phases. Disease activity was assessed according to the Crohn Disease Activity Index (CDAI). 78 pts were observed (38m;40f),mean age 41,2 ± 13,06. 22 (28,2%) and 56 (71,8%) pts were in an active and remission phase, respectively. Anthropometric measures included body height, body weight, mid arm circumference and triceps skinfold thickness to identify body mass index (BMI), mid arm muscle area (MAMA) and mid arm fat area (MAFA), respectively. The mean values of MAMA and MAFA in pts in active phases were significantly lower than those in a remmision phases (p<0,05). Muscle and fat mass depletion in active phases in compare with the remission phases in female pts was found, but only muscle depletion in male pts was observed . No difference was found in BMI in the remmision and active phases. Muscle mass is very important indicator of the disease activity in both sexes