The method of treatment of chronic hepatitis


(57) Abstract:

The invention relates to medicine, in particular to Hepatology. Enter hepatoprotector vegetable Maxar dose of 60 to 120 mg 3 times a day for 20 to 40 days. This method allows to increase the effectiveness of treatment and increase the range of domestic hepatoprotectors.

The invention relates to medicine, specifically to methods of treatment of chronic hepatitis using the hepato-of vegetable origin.

Known methods of treatment of chronic hepatitis, including the use of such hepatoprotective funds, as Essentiale, kateryn, legalon (cars), LIV-52, IKE-phosphate, trooper (1), lohein. From vegetable geoproduction most commonly used for the treatment of chronic hepatitis are as follows: LIV-52, kateryn, zelibor. However, in some cases there is a questionable clinical efficacy of these drugs in the treatment of chronic hepatitis (both persistent and active moderate activity). Thus, the effect of Kateryna questionable in patients with chronic hepatitis in respect of hyperbilirubinemia, hepatomegaly, hemorrhagic syndrome. Cat among the drug has no influence on the antigenemia, even after prolonged courses of treatment (2). The negative aspect is the frequency of allergic reactions to receiving Kateryna, which is observed in 15-17% of cases (in the form of fever, rash, eosinophilia (1, 2).

LIV-52 is often a negative effect on cytolysis syndrome and mesenchymal inflammation, its effect on the synthetic function of the liver relative and impermanent (1,3). In the treatment of chronic hepatitis by siliborum also reported allergic reactions (4). In addition, in viral liver disease, low therapeutic efficacy of the above hepatoprotectors (1).

Also known for the preparation of Salsola Collina - lohein. However, its use is limited in patients with active hepatitis and cirrhosis, because it contains alcohol.

Closest to the proposed for the treatment of chronic hepatitis is a vegetable hepatoprotector Carsil (legalon, silymarin, silibinin), obtained from the seeds of the Thistle and is similar to the national drug celebra. The drug is called "Legalon" in Yugoslavia and called "Cars" in Bulgaria. It is a mixture of three flavolignans: silidianin, celebra and silychristin. It hepatotoxin the membranes of liver cells, he has also shared a supportive and stimulating effect on metabolism in the cell. The above mechanisms hepatoprotective clinically in the treatment of chronic persisting hepatitis (with CPH), and chronic active hepatitis of moderate grade (HAG) is manifested in the positive dynamics of subjective and objective symptoms: pain and heaviness in the right hypochondrium, reducing the size of the liver, laboratory normalization belkovosinteticescuu liver, concentrations of total bilirubin, decreased activity of aminotransferases, the values of Tomilova samples, the decrease in the content of malonic delgadita in the liver (MDA), which indicates the reduction of lipid peroxidation (LPO) (1, 3, 5, 6). Moreover, a more pronounced therapeutic effect is observed in the use of liquid dosage forms (flameon - suspension, legalon - syrup) (5, 7). However, along with the positive effect of Kars has a number of undesirable moments in its application. So, in short courses (1-2 weeks) it has little effect on the cytolysis syndrome and may enhance hyperbilirubinemia (8). This requires long courses of treatment, because only through 2-2,5 months achieved a "laboratory" remission (5). Croogo inflammation, protein synthetic function of the liver, as well as lack of action in cholestasis (3).

Problem solved this technical improvement is a more effective treatment with fewer complications and expanding Arsenal of domestic hepatoprotectors.

The problem is solved by a new method of treatment of chronic hepatitis, which consists in receiving the hepato-of vegetable origin for 30-40 minutes before a meal, and as this hepatoprotector use Maxar dose of 60-120 mg 3 times a day for 20-40 days.

Maxar - dry extract from the trunk wood make Amur. Is a powder dark brown color with a specific balsamic odor; insoluble in water; soluble in ethanol, ether. In the composition of the extract revealed genistein, piceatannol, high molecular weight polyphenols.

Maxar has a pronounced hepatoprotective effect intoxication by poisons that cause hepatitis (CCl4, allyl alcohol, D-galactosamine). The use of Maksura in experimental toxic hepatitis normalizes the disturbed histoarchitecture liver, reduces the number of necrotic hepatocytes, ostrand respiratory function of mitochondria; stabilizes the membrane of lysosomes and inhibits the release of necrogenic hydrolases, including phospholi-groove A; stimulates oxidation and conjugation of xenobiotics, glukuronirovanie bilirubin increases exeternal liver function, reduces HyperTerminal (transaminases, lactatedehydrogenase, alkaline phosphatase).

A distinctive feature of Maksura is a pronounced stimulating effect on the oppressed segment of the hepatotoxins antitoxic function of the liver and a significant choleretic effect.

Choleretic effect of Maxara, manifested in the increase in the rate of secretion of bile and content of bile acids, bilirubin and cholesterol, observed both in intact animals and in depression jelcheobrazovanie liver in the CCl4-hepatitis.

The method is as follows.

The initial step is the diagnosis of the forms of hepatitis and the degree of its activity through:

1. Study of the functional state of the liver (for determining the activity of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gammaglutamyltranspeptidase (GGT), total protein content of blood and its fractions, the value of thymol and sublimate samples, B-lipoproteins, cholestero bilirubin in the blood;

2. Definition of processes of lipid peroxidation the levels of malondialdehyde in serum;

3. Determination of markers of HBV (HBsAg, antins, HAV, HBeAg, antennae, HCV, sample);

4. Study the state of cellular and humoral immunity;

5. Blood circulation in the liver with tetrapolar rogatory;

6. Evaluation of the functional state of parenchymal liver cells using dynamic hepatobiliscintigraphy;

7. Percutaneous biopsy of the liver with the morphological analysis of biodata;

8. Ultrasound examination of the liver and spleen.

The above methods are carried out in the dynamics after a full course of treatment. The mode of application of Maksura selected on the basis of experimental and clinical observations (7).

1. The rate of application (3 times a day) is uniform for most hepatic and close to standard food regime patients.

2. Dose of 60-120 mg is therapeutic. Based on the results of animal studies with CCl4-hepatitis influence on the duration geksenalovy sleep and the degree of fatty hepatocytes isoeffective are dose 200 mg/K is spitoni recommended dose of maksura 0,06 - 0.12 g, i.e., 1 - 2 tablets 60 mg.

3. The expediency of application of Maksura 30-40 minutes before meals due to physiological preparing the digestive system for absorption is relatively small (60 mg) quantities of the drug and, therefore, the maximum efficiency of the suction and low probability of mixing with food, which may reduce therapeutic efficacy of the drug.

4. Treatment within 20-40 days are given on the basis of clinical observations for this category of patients.

5. In a clinical experiment, it was proved that the doses of 120 mg 3 times a day in case of severe cholestasis is more effective than the use of 60 mg of the drug 3 times a day.

Example 1.

Patient Smita B. N. 42, enrolled 5.10.96, with a diagnosis of chronic active hepatitis moderate degree of alcoholic origin. Anamnestically - ill for about 15 years, often abusing alcohol. Previously hepatoprotectors not treated. In 1995, after the regular use of alcohol there was a strong yellowness of the skin, dark urine (diagnosis OECS was filmed). Recent deterioration in about a week after the regular abuse of Alcoa is whether in the right hypochondrium, sweating, loss of appetite. Objectively expressed asthenia, interesest of sclera and skin, hepatomegaly with seal, moderately sensitive to palpation region of the liver (liver size on Karlovo 12,HH).

In the biochemical analysis was carried syndrome cytolysis (ALT - 1.6 µmol/LCH, AST - 1.2 µmol/LCH, total bilirubin - 56,5 µmol/l, direct and 49.2 mmol/L. the total protein Content was normal - 76 g/l, but showed dysproteinemia: albumin was 44%, gamma-globulin - 23,6%). Activation of peroxidation processes was reflected in the increase in the content of MDA level to 7.0 mmol/L. Serological markers of viral liver disease have not been identified. Dynamic hepatobiliscintigraphy showed an increase in liver size, moderate violation absorption and severely impaired excretory functions of the liver. The morphological examination of biopsy material - expressed liver dystrophy, sparse lymphocytic infiltration of portal fields with moderate their expansion by fibrosis. In the edge plate met small areas of necrosis of hepatocytes and diffuse intralobular lymphocytic infiltration.

In dynamics to a 30 day treatment Maxaron at a dose of 120 mg was found icesnow on Karlovo was HH see Positive dynamics was observed in the functional state of the liver in the form of normalization following biochemical parameters: a decrease in the activity of AST to 0.2 µmol/LCH, ALT to 0.6 µmol/LCH, total bilirubin up to 21.0 μmol/l, direct bilirubin, disappearance of dysproteinemia - albumin was 56.3 per cent, gamma-globulin and 12.4%. Decreased and lipid peroxidation: the MDA level decreased to 4.5 mmol/L. Held in the dynamics of needle biopsy of the liver showed a significant decrease in lymphocytic infiltration of portal tracts within the segments, also about the disappearance of necrosis at the edge of the plate.

Example 2.

Patient Merzlyakov, A. C., 37 years was admitted to the hospital 8.10.97, with a diagnosis of chronic active hepatitis moderate degree of viral etiology. History in 1978, the operation concerning a knife penetrating injury to the abdomen, blood transfusion. Since 1995 suffer from opiate addiction. In July 1997 in the blood accidentally discovered antibodies to viral hepatitis C. At the time of admission the patient was bothered by severe weakness, fatigue, insomnia, increased body temperature up to subfebrile figures, arthralgia, loss of appetite, nausea. Obyavu - 12,HH cm), pain in the region of the liver palpation. Laboratory blood: AST - 1.8 µmol/LCH, ALT - up to 3.6 µmol/LCH, total bilirubin to 29.0 mmol/l, direct to 2.4 mmol/l, and reduced level of PTI to 76% expressed dysproteinemia (albumin - 50%, gamma-globulins - 29%). There was a significant activation of peroxidation processes (the MDA level was increased to 8.1 mmol/l). Of markers of viral hepatitis have been identified antibodies to hepatitis C. According to the dynamic hepatobiliscintigraphy observed marked violation of absorptive and excretory functions of the liver. In the biopsy of the liver tissue is dense lymphocytic infiltration of portal tracts, moderate growth of connective tissue in them. Were expressed step necrosis of hepatocytes. The slices were also visible necrotic hepatocytes with dense lymphocytic infiltration around.

After a course of treatment Maxaron at a dose of 60 mg there was a positive dynamics of subjective symptoms in the form of reduced weakness, poor appetite, disappearance of arthralgia and nausea. Objectively normalization of skin color, reducing the size of the liver (Karlovo h,5h9 cm). In the biochemical analysis - reduction of cytolysis syndrome (cnmmal/l and 2.0 mmol/l, respectively), reducing dysproteinemia (albumin 56%, gamma-globulins 23%), as well as a significant reduction of peroxidation processes (the MDA level decreased to 4.8 µmol/l), which together were talking about a substantial reduction in activity process improvement belkovosinteticescuu liver function.

Example 3.

Patient Avdeev M, W, 23, was admitted for treatment 10.09.97, with a diagnosis of chronic persistent hepatitis viral etiology. History of acute viral hepatitis in 1992, 1993 and 1994 were used parenteral drugs. Previously hepatoprotectors not treated. Consume alcohol rarely.

At the time of admission complained of a feeling of heaviness in the right hypochondrium, belching, fatigue. Objective research has revealed the presence of moderate hepatomegaly (liver size on Karlovo HH,5 cm), as well as potoato-elastic consistence edge of the liver palpation. In the biochemical analysis of blood, there was an increase in the activity of AST and ALT to 0.8 and 1.0 µmol/LCH respectively, a small activation of peroxidation processes (the MDA level increased to 5,73 µmol/l). Dynamic hepatobiliscintigraphy found a violation of the absorptive function of the liver parenchyma mild and moderate snir> After 20 days of treatment with Maxaron at a dose of 60 mg there was complete normalization of activity of aminotransferases (AST-0.1 µmol/LCH and ALT-0.4 µmol/LCH) and MDA level in serum (4.0 μmol/l), and a noticeable improvement of the absorptive and excretory functions of the liver according to the dynamic hepatobiliary.

Thus, the above clinical observations suggest that the application of the proposed method of treatment of chronic hepatitis by hepaprotection vegetable origin Maxaron received positive clinical effect. Moreover, the proposed method of treatment has yielded positive results in different clinical course of chronic hepatitis (HUT moderate and with CPH) and different etiological factors (alcoholic, viral, toxic) and relatively short (30 days), compared to Kars, the treatment time. The clinical efficacy of the drug was expressed in the complete disappearance or reduction of dyspeptic symptom complex, astheno-vegetative syndrome, normalization of liver size, activity reduction process was stopped or decreased syndrome cytolysis and cholestasis), improving belkovosinteticescuu liver, and. An important property of the proposed method of treatment and is an antioxidant effect, as evidenced by the decreased activity of the processes of the FLOOR, which was manifested in the decrease in MDA level in serum.

Any side effects during treatment were not identified.


1. Yakovenko, E. P., rough S. I., Grigoriev, P. J., and others the Effectiveness of therapy in patients with chronic hepatitis with hepatic // abstracts of the final scientific and practical conference "problems of clinical medicine Ministry of Health of the RSFSR M., 1989, S. 228-231.

2. Semendyaeva M. E., Eremeev, E. L., Cedrac A. A. and other Kutergin in the treatment of chronic liver diseases // Soviet medicine.- 1986, No. 9, S. 47-50.

3. Grigoriev, P. J., Yakovenko, E. J. Diagnosis and treatment of chronic hepatitis and cirrhosis of the liver // Soviet medicine. 1985, No. 12, S. 61-67.

4. Bondarenko, I. P., kharlampieva C. A., Sklarevska Century. And. Akapost in the treatment of patients with chronic liver disease //Actual problems of Hepatology: Sat. articles. - Kharkov. Publishing house of the Kharkov medical Institute. 1989, S. 48-50.

5. Patiashvili L. M., Khymenko P. L., deacons I., the Experience of using a new dosage form of the drug Kars for chronic, the. 35-38.

6. Loginov A. S., Radbill O. S., Alekseev, C. F. Pharmacotherapy in clinical gastroenterology // VNIMI. Survey information. Medicine and healthcare. A series of "Therapy", M, 1981, No. 3, S. 3 - 12.

7. Chuchalin B. C. Heptadienyl the drug from Salsola Collina. Dis.Kida.the honey. Sciences. Tomsk, 1989, 168 S.

8. Blinkov I. L., Chemokine O. C. clinical Experience with hepatoprotective tools legalon // Symposium "Clinical value of the drug is legal". M., 1981, S. 113-123.

9. Vlasova, T. C. Hepatoprotective and choleretic properties of polyphenolic complex maackii Amur. Dis.Kida.the honey.Sciences. Tomsk, 1991, 135 S.

The method of treatment of chronic hepatitis, which are involved in the reception of hepato-of vegetable origin for 30 to 40 minutes before a meal, characterized in that the take Mascara dose of 60 to 120 mg 3 times a day for 20 - 40 days.


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SUBSTANCE: invention relates to the field in development of an agent of vegetable origin used for improvement of the functional state and prophylaxis of organic alterations in cardiovascular system, in particular, atherosclerosis. The biologically active supplement used for prophylaxis of cardiovascular diseases, in particular, atherosclerosis comprises clover dry extract, haw-thorn flowers powder, ascorbic and nicotinic acids, and accessory substances taken in the definite ratio. The biologically active supplement is made in the form of tablet or capsule. No adverse responses observed in intake of the supplement. The blood cholesterol level was reduced to the normal value in 68% of patients and reducing morbidity with acute respiratory-viral infections has been noticed. In patients with ischemic heart disease with cholesterolemia the improvement of the state is noted on the background of conventional therapy: the moderate reducing the arterial pressure value in its elevation, improved in the state of health, enhanced working capacity, reduced retrosternal pains, ear noise, vertigo, headache.

EFFECT: valuable medicinal properties of supplement.

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