3 research outputs found
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 ΓΒ± 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 ΓΒ± + 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
AΡΠΎΡΠΈΡΠ°ΡΠΈΡΠ° Π½Π° ΠΏΠ»Π°Π·ΠΌΠ° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΡΠΎ ΡΡΠ°Π΄ΠΈΡΠΌΠΈΡΠ΅ Π½Π° ΡΡΠ½ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΠΈΡΠΎΠ·Π° ΠΈ Π½Π΅ΡΠ·ΠΈΠ½ΠΈΡΠ΅ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈ
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).Β 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). Pearsonβs 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.Β Π¦Π΅Π» Π½Π° ΡΡΡΠ΄ΠΈΡΠ°ΡΠ°: ΠΠ° ΡΠ΅ ΠΈΡΠΏΠΈΡΠ° Π½ΠΈΠ²ΠΎΡΠΎ Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ Π²ΠΎ ΠΏΠ»Π°Π·ΠΌΠ° Π²ΠΎ ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° ΡΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈΡΠ΅ ΡΠΊΠΎΡΠΎΠ²ΠΈ: Child-Pugh-Turcotte (CTP) ΠΈ Model for End-Stage Liver Disease (MELD) ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΡΡΠ½ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΠΈΡΠΎΠ·Π° ΡΠΎ ΡΠ°Π·Π»ΠΈΡΠ½Π° ΡΠ΅ΠΆΠΈΠ½Π°, ΠΊΠ°ΠΊΠΎ ΠΈ Π½ΠΈΠ²Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° ΡΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈ, Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ ΠΈ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΈ ΡΠΎ ΡΡΠ½ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΠΈΡΠΎΠ·Π°. ΠΠ°ΡΠ΅ΡΠΈΡΠ°Π»ΠΈ ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ:Β ΠΠΊΡΠΏΠ½ΠΎ 50 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΡΠΈΡΠΎΠ·Π° Π½Π° ΡΡΠ½ Π΄ΡΠΎΠ± Π±Π΅Π° ΠΏΠΎΠ΄Π΅Π»Π΅Π½ΠΈ Π²ΠΎ ΡΡΠΈ Π³ΡΡΠΏΠΈ ΡΠΏΠΎΡΠ΅Π΄ ΡΠ΅ΠΆΠΈΠ½Π°ΡΠ° Π½Π° ΡΠΈΡΠΎΠ·Π° Π½Π° ΡΡΠ½ΠΈΠΎΡ Π΄ΡΠΎΠ± Π²ΡΠ· ΠΎΡΠ½ΠΎΠ²Π° Π½Π° CTP Score (CTP-A, CTP-Π, CTP-C). ΠΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ Π±Π΅ΡΠ΅ ΠΎΠ΄ΡΠ΅Π΄Π΅Π½Π° Π²ΠΎ ΠΏΠ»Π°Π·ΠΌΠ° ΡΠΎ Π½Π°ΡΡΠΈΡΠΌ ΡΠΈΡΡΠ°Ρ ΠΊΠΎΡΠΈΡΡΠ΅ΡΡΠΈ Π³ΠΎ Siemens, BCSXP ΠΊΡΠ²Π½ΠΈΠΎΡ ΠΊΠΎΠ°Π³ΡΠ»ΠΎΠΌΠ΅ΡΠ°Ρ. Kruskal-Wallis ΡΠ΅ΡΡΠΎΡ Π±Π΅ΡΠ΅ ΠΊΠΎΡΠΈΡΡΠ΅Π½ Π·Π° Π΄Π° ΡΠ΅ ΡΠΏΠΎΡΠ΅Π΄Π°Ρ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ ΠΏΠΎΠΌΠ΅ΡΡ CTP Π³ΡΡΠΏΠΈΡΠ΅. Mann-Whitney U ΡΠ΅ΡΡΠΎΡ Π±Π΅ΡΠ΅ Π½Π°ΠΏΡΠ°Π²Π΅Π½ Π·Π° Π΄Π° ΡΠ΅ ΠΎΠ΄ΡΠ΅Π΄ΠΈ ΡΠ°Π·Π»ΠΈΠΊΠ°ΡΠ° Π²ΠΎ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΏΠΎΠΌΠ΅ΡΡ Π³ΡΡΠΏΠΈΡΠ΅ ΡΠΎ ΡΠ°Π·Π»ΠΈΡΠ΅Π½ MELD ΡΠΊΠΎΡ, ΠΈ Π·Π° Π΄Π° ΡΠ΅ ΠΎΡΠ΅Π½ΠΈ ΡΠ°Π·Π»ΠΈΠΊΠ°ΡΠ° Π²ΠΎ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΠΏΡΠΈΡΡΡΡΠ²ΠΎ ΠΈΠ»ΠΈ ΠΎΡΡΡΡΡΠ²ΠΎ Π½Π° Π°ΡΡΠΈΡ ΠΈ ΡΠ°Π·Π»ΠΈΠΊΠ°ΡΠ° Π²ΠΎ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΊΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΠΎ ΠΈΠ»ΠΈ Π±Π΅Π· ΡΠΏΠΎΠ½ΡΠ°Π½ Π±Π°ΠΊΡΠ΅ΡΠΈΡΠΊΠΈ ΠΏΠ΅ΡΠΈΡΠΎΠ½ΠΈΡΠΈΡ (SBP). Pearson-ΠΎΠ²ΠΈΠΎΡ ΠΊΠΎΠ΅ΡΠΈΡΠΈΠ΅Π½Ρ Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° Π±Π΅ΡΠ΅ ΠΊΠΎΡΠΈΡΡΠ΅Π½ Π·Π° Π΄Π° ΡΠ΅ ΠΎΡΠ΅Π½ΠΈ ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ°ΡΠ° ΠΏΠΎΠΌΠ΅ΡΡ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ ΡΠΎ MELD ΡΠΊΠΎΡΠΎΡ ΠΈ ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ°ΡΠ° ΠΏΠΎΠΌΠ΅ΡΡ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ ΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ, ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ ΠΈ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΈ ΡΠΎ ΡΡΠ½ΠΎΠ΄ΡΠΎΠ±Π½Π° ΡΠΈΡΠΎΠ·Π°. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ: ΠΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΡΠ΅ Π·Π³ΠΎΠ»Π΅ΠΌΠΈ ΡΠΎ ΡΠ΅ΠΆΠΈΠ½Π°ΡΠ° Π½Π° Π±ΠΎΠ»Π΅ΡΡΠ° ΠΏΡΠΎΡΠ΅Π½Π΅ΡΠ° ΡΠΎ CTP ΠΈ MELDΡΠΊΠΎΡΠΎΡ ΡΠΎ ΡΡΠ°ΡΠΈΡΡΠΈΡΠΊΠΈ Π·Π½Π°ΡΠ°ΡΠ½Π° ΡΠ°Π·Π»ΠΈΠΊΠ° ΠΏΠΎΠΌΠ΅ΡΡ Π³ΡΡΠΏΠΈΡΠ΅ (p=,0000 ΠΈ p=,0001, ΡΠΎΠΎΠ΄Π²Π΅ΡΠ½ΠΎ). ΠΡΡΠΏΠ°ΡΠ° CTP-C ΠΏΠΎΠΊΠ°ΠΆΠ° Π½Π°ΡΠ²ΠΈΡΠΎΠΊΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ, ΠΏΠΎ ΡΡΠΎ ΡΠ»Π΅Π΄ΡΠ²Π°Π° Π³ΡΡΠΏΠΈΡΠ΅ Π ΠΈ Π. ΠΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ ΡΠΎ SBP ΠΈΠΌΠ°Π° Π·Π½Π°ΡΠΈΡΠ΅Π»Π½ΠΎ ΠΏΠΎΠ²ΠΈΡΠΎΠΊΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈ Π²ΠΎ ΡΠΏΠΎΡΠ΅Π΄Π±Π° ΡΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Π±Π΅Π· SBP (p= ,0006). ΠΠ΅ΡΠ΅ ΡΡΠ²ΡΠ΄Π΅Π½Π° Π·Π½Π°ΡΠΈΡΠ΅Π»Π½Π° ΠΏΠΎΠ·ΠΈΡΠΈΠ²Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° ΠΏΠΎΠΌΠ΅ΡΡ Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΈ CTP ΠΈ MELD ΡΠΊΠΎΡΠΎΡ (ΠΊΠΎΠ΅ΡΠΈΡΠΈΠ΅Π½Ρ Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° r= 0,74 ΠΈ r= 0,44, ΡΠΎΠΎΠ΄Π²Π΅ΡΠ½ΠΎ; p< ,001). ΠΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»Π½ΠΎ, ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΠΏΠΎΠΊΠ°ΠΆΠ°Π° Π΄Π΅ΠΊΠ° ΠΏΠΎΡΡΠΎΠΈ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΎΡΡ ΠΌΠ΅ΡΡ ΠΏΠ»Π°Π·ΠΌΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΡΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠΊΠΈΡΠ΅ ΠΈ Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ ΠΊΠΎΠΈ ΠΊΠ°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΠΈΡΠ°Π°Ρ ΠΏΡΠΎΠ³ΡΠ΅ΡΠΈΠ²Π½Π° Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡΠ° Π½Π° ΡΡΠ½ΠΈΠΎΡΠ΄ΡΠΎΠ±. ΠΠ΄ ΡΠΈΡΠ΅ ΠΈΡΠΏΠΈΡΡΠ²Π°Π½ΠΈ Π±ΠΈΠΎΡ
Π΅ΠΌΠΈΡΠΊΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΈ, Π½Π°ΡΠ²ΠΈΡΠΎΠΊΠ° ΡΡΠ°ΡΠΈΡΡΠΈΡΠΊΠΈ Π·Π½Π°ΡΠΈΡΠ΅Π»Π½Π° ΠΊΠΎΡΠ΅Π»Π°ΡΠΈΡΠ° Π±Π΅ΡΠ΅ ΡΡΠ²ΡΠ΄Π΅Π½Π° ΠΌΠ΅ΡΡ Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΈ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ°ΡΠ° Π½Π° ΡΠ΅ΡΡΠΌΡΠΊΠΈΡΠ΅ Π°Π»Π±ΡΠΌΠΈΠ½ΠΈ (r = - 0,65, p< 0,001). ΠΠ°ΠΊΠ»ΡΡΠΎΠΊ: ΠΠ»Π°Π·ΠΌΠ°ΡΡΠΊΠ°ΡΠ° ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ Π΅ ΡΠ΅ΡΠ½ΠΎ ΠΏΠΎΠ²ΡΠ·Π°Π½Π° ΡΠΎ ΡΡΠ΅ΠΏΠ΅Π½ΠΎΡ Π½Π° Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡΠ° Π½Π° ΡΡΠ½ΠΈΠΎΡΠ΄ΡΠΎΠ± ΠΈ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈΡΠ΅ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΈ ΡΠΎ ΡΠΈΡΠΎΠ·Π° Π½Π° ΡΡΠ½ Π΄ΡΠΎΠ±. ΠΠ°ΡΠΎΠ°, Π½ΠΈΠ²ΠΎΠ°ΡΠ° Π½Π° Π-Π΄ΠΈΠΌΠ΅ΡΠΈΡΠ΅ ΠΌΠΎΠΆΠ΅ Π΄Π° ΡΠ΅ ΠΊΠΎΡΠΈΡΡΠ°Ρ ΠΊΠ°ΠΊΠΎ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠΊΠΈ ΠΌΠ°ΡΠΊΠ΅Ρ Π·Π° ΡΡΡΠ°ΡΠΈΡΠΈΠΊΠ°ΡΠΈΡΠ° ΠΈ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»Π΅Π½ Π΄ΠΈΡΠ°Π³Π½ΠΎΡΡΠΈΡΠΊΠΈ ΠΌΠ°ΡΠΊΠ΅Ρ Π²ΠΎ ΠΊΠΎΠΌΠΏΠ»ΠΈΠΊΠ°ΡΠΈΠΈΡΠ΅ ΠΏΠΎΠ²ΡΠ·Π°Π½ΠΈ ΡΠΎ ΡΠΈΡΠΎΠ·Π° Π½Π° ΡΡΠ½ Π΄ΡΠΎΠ±
Assessing of anthropometric parameters in patients with Crohnβs disease in acute and remission phase
Patients with Crohnβs Disease are often underweight.The aim of this study was to compare the anthropometric measurements in patients (pts) with Crohnβs 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 Β± 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