Treatment of acute viral hepatitis b

 

(57) Abstract:

The invention relates to medicine, infectious diseases and can be used for the treatment of acute viral hepatitis C. Patients with mild or moderate forms of acute viral hepatitis In addition to conventional therapy administered lamivudine oral 100-150 mg daily for 12 months. This invention prevents chronicity of the process and helps reduce side effects in patients with mild and moderate forms of acute viral hepatitis C.

The invention relates to medicine, namely infectious diseases, and can be used for the treatment of patients with acute viral hepatitis C.

Acute viral hepatitis b (UGA) is one of the most common infectious diseases and is characterized by the tendency to chronicity, the subsequent development of cirrhosis and liver cancer (Sorenson S. N. Viral hepatitis. - SPb.: thesis, 1998, S. 47, 155; Maier K. P. Hepatitis and consequences of hepatitis. - M.: GEOTAR Medicine, 1999, S. 23-65). According to the world Health Organization, worldwide, there are more than 350 million carriers of HBV viral infection, 60 million of them will die from the primary. the Engl./Ed. by H. W., Prasinoi, N. A. Mukhina. - M.: GEOTAR Medicine, 1999. - 864 C.). About 5% of the population of the Russian Federation infected with HBV. In Russia, the incidence of acute viral hepatitis b remains high and in 2000 amounted to 35.5 cases per 10 thousand population. However, the treatment system aimed at preventing adverse clinical course, not actually developed.

It is therefore important to develop an optimal treatment and to reduce the negative consequences of the state body.

Conducted research on the medical-scientific and patent literature identified various methods of treatment of acute viral hepatitis C.

In the author's certificate of the USSR 1680200 published in B. I. 36, 1991 , describes "a Method for the treatment of acute viral hepatitis b" by injecting patients with hepatitis moderate reaferona dose of 1x106ME two times a day intramuscularly for 7-10 days.

Author's certificate USSR 1697828 published in B. I. 46, 1991-protected "Method of treatment of acute viral hepatitis b" by introducing patients lacenterra within 5-14 days exchange rate dose 1,5x105-H5ED.

In the patent of the Russian Federation 2122425 published in B. I. 33, 1998, described "Spoken" a day for two days in a row and then every 48 h for two weeks, at the rate of 1500 mg.

RF patent for invention 2154478 published in B. I. 23, 2000 protected "Method of treatment of viral hepatitis b in children, providing for intramuscular administration to a patient of a 12.5% solution of cycloferon in a dose of 6 mg per kg of body weight of the patient on intermittent in the amount of 15 injections for the full course of treatment.

In the patent of the Russian Federation 2164160 published in B. I. 8, 2001, describes "a Method for the treatment of patients who have had acute hepatitis b during early convalescence period" by the combined effects of electromagnetic fields of super-high frequency and infrared laser irradiation on the area of projection of the liver of the patient, with alternating treatments a day, treatment 9-10 procedures.

RF patent for invention 2166961 published in B. I. 14, 2001, a protected Method of treatment of viral hepatitis In providing intramuscular patient recombinant yeast vaccine against hepatitis b in a volume of 1 ml of 1 time per month for three months with additional use of nucleinate sodium.

The disadvantage of the above methods is that they do not allow to reduce the frequency of transition of acute viral hepatitis In chronic zabolevaniya closest to the technical essence and selected as the prototype is described in the work of Sorenson S. N. Viral hepatitis. - SPb.: thesis, 1998, S. 97 a method of treating patients in the system, providing for the appointment of a sick preparations of interferon in a dose of 2-3 million IU/day (1 million ME=MU, MT - 1 Mega Units) intramuscularly or subcutaneously, the first 3 days daily, and then every other day for 4 weeks. In some cases, increase the dose to 5 million ME, and the duration of the cycle to 8 weeks.

However, application of this method in the treatment of patients with mild and moderate forms of the state body is often not possible to reliably reduce the frequency of formation of the chronic form of the disease. The disadvantage of the prototype is also a significant number of side effects, such as patients develop feverishly-intoxication syndrome, dyspepsia, depression, autoimmune disorders, radiation and other pathological conditions (Guide for the management of patients with chronic hepatitis C. - GlaxoWellcom, 2000, S. 5-6).

This method of treatment is almost contraindicated for persons with related conditions as autoimmune disease, severe diseases of the cardiovascular and respiratory systems and several others. The disadvantages should also be referred invasiveness of the method is the necessity of introduction of preparations of interferon Trogo viral hepatitis In chronic and reducing side effects in patients with mild and moderate forms of hepatitis C.

This objective is achieved in that a patient with mild and moderate forms of acute viral hepatitis b administered orally once daily lamivudine 100-150 mg for 6-12 months, until the appearance in the blood of the patient of antibodies to HbsAg.

The method is as follows.

After admission to hospital the patient produce a blood from a vein for biochemical tests (serum total bilirubin and its fractions, the activity of Alat, thymol turbidity test), study of markers of viral hepatitis and PCR for HBV DNA. Based on these results establish the diagnosis and determine the severity of the disease. In patients with mild or moderate forms of OECS in addition to the traditional basis (table 5 or 5A, bed or pruposely mode) and infusion therapy (saline, ringer's solution, gemodez intravenously in the presence of poor health and severe jaundice) prescribe lamivudine, which is administered to the patient orally 100-150 mg once daily. The patient is being treated in hospital until normalization of serum total bilirubin and significant reduction of the activity of Alat. After discharge from the hospital of infusion is within 6-12 months under the dynamic supervision of a doctor. Biochemical blood tests carried out after 1, 3, 6, 9 and 12 months after discharge from hospital, the definition of markers of viral hepatitis in 6, 9 and 12 months, respectively. With the appearance in the blood of antibodies to HbsAg ascertain the recovery of the patient and produce the abolition of the basic therapy and lamivudine.

The proposed method for the treatment of acute viral hepatitis b was tested in 4-m Department of infectious BSMP - 1. N. A. Semashko, Rostov-on-don on 33 patients with mild (~ 27,3%) and moderate (~72,7%) forms of acute viral hepatitis C. the patients ' Age averaged 27-31 year, the number of women ~39.4 percent. All patients were treated according to the proposed method in the hospital within approximately 17.7 per day. The duration of treatment according to the claimed method after hospital discharge was determined individually for 6-12 months depending on the time of appearance in the blood of antibodies to HbsAg.

Further observation of the patients confirmed the high degree of efficiency of treatment of patients with acute viral hepatitis In mild and moderate forms according to the proposed method. The development of chronic hepatitis was observed in less than 3% of patients. Any side effects at all 33 b is AMI from clinical practice.

Example 1. Sick.. 32 years (I. B. 816), and entered in 4 infectious diseases unit BSMP-1. N. A. Semashko, Rostov-on-don on the 9th day of illness with complaints of moderate weakness, loss of appetite, the presence of dark urine and jaundice color of the sclera.

From the first day of illness was noted General weakness, lack of appetite and nausea. On the 8th day of the disease appeared dark urine and yellowness of sclera. For 3.5 months before the beginning of the disease the patient was conducted appendectomy.

When receiving a satisfactory condition. The sclera and the skin slightly icteric. The liver was moderately enlarged, appears from under the edge of the costal arch on srednechrochnoy line 2-2,5 cm, soft, elastic, painless. Urine dark.

Upon further examination revealed the following results:

1. Biochemical blood test: total bilirubin - 67 Ámol/l (related to 45 Ámol/l); Alt - 3.5 mmol/L. H.; thymol turbidity test - 6 ed,;

2. Marker diagnostics: detected HBsAg and anti-HBc-IgM;

3. PCR diagnosis: detected HBV DNA (+++). The data obtained allowed to establish the diagnosis of acute viral hepatitis In a mild form. Since in this disease a chronic infectious process is th therapy) lamivudine oral 100 mg daily, once.

After 15 days of treatment, the patient was fully extinguished jaundice, and she was discharged to outpatient aftercare. The level of total bilirubin was 18.5 Ámol/l, i.e., normalized; the activity of Alat was a few high - 2.2 mmol/L. p.m. Continued to take lamivudine, and after 6 months in the serum of the patient revealed antibodies to HBsAg, which was seen as a sign of recovery was the reason for discontinuation of the drug. During the entire course of treatment, the patient has not reported any side effects, including intoxication, fever, leukopenia, diarrhea and depressive disorders. The control needle biopsy of the liver symptoms of chronic hepatitis b not found.

Example 2. Patient K., aged 27 (I. B. 1040) received ua 8-day sickness. From the first days of the disease was worried about fatigue, loss of appetite, pain in the elbow and shoulder joints. In the evenings, registered a moderate increase of temperature to 38.0oS. 4th day of illness darkened urine, even 2 days later appeared jaundice.

Previously, diseases of the liver were noted. Epidemic history could not be detected.

When entering article is znachitelnaya hepatomegaly, with the consistency of the liver was soft and supple. Urine dark brown.

Upon further examination revealed the following results:

1. Biochemical blood test: total bilirubin - 115 Ámol/l (associated - 90 Ámol/l); Alt - 4.1 mmol/L. H.; thymol turbidity test - 8 units;

2. Marker diagnostics: detected HBsAg, HBeAg and anti-HBc-IgM;

3. PCR diagnosis: detected HBV DNA (++++).

These clinical and laboratory data made it possible to diagnose in a patient with acute viral hepatitis b occurring in moderate form.

Because this form of disease is characterized by a rather high risk of developing chronic hepatitis, the patient developed by us for the scheme from the first days of hospital stay in addition to the baseline and infusion therapy was appointed lamivudine oral 150 mg daily dose.

After 10 days of treatment the patient's health began to improve, even after 8 days completely extinguished jaundice, and he was discharged from the hospital to outpatient aftercare. The level of General bilirubin amounted to 22.2 mmol/l, i.e., became normal. The activity of Alat remained slightly increased to 1.9 mmol/L. including our recomendated. The last we saw as a sign of recovery of the patient, which was the basis for the drug. Throughout the course of lamivudine treatment the patient has no side effects. The control needle biopsy of the liver symptoms of chronic hepatitis b not found.

Thus, compared with the prototype of the proposed solution allows to reduce the number of cases of transition of acute viral hepatitis In chronic and virtually eliminate side effects in patients with mild and moderate forms of acute viral hepatitis C.

Treatment of acute viral hepatitis b, providing for conventional therapy, characterized in that patients with mild or moderate forms of acute hepatitis In addition to impose lamivudine oral 100-150 mg daily for 12 months.

 

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FIELD: veterinary science.

SUBSTANCE: a sow should be twice injected with oxytocin and, additionally, intramuscularly about 2-4 h after afterbirth detachment one should introduce clathroprostin at the dosage of 1 ml. The innovation suggested is very efficient in preventing metritis-mastitis-agalactia and endometritis in sows, as well.

EFFECT: higher efficiency of prophylaxis.

1 ex, 1 tbl

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