Treatment of severe and protracted course of acute viral hepatitis

 

(57) Abstract:

The invention relates to medicine, namely to infectious diseases, Hepatology and immunology, and for the treatment of acute viral hepatitis. This method includes the introduction of corticosteroids and cytostatics. Before treatment a glucocorticosteroid determine the level of lymphocytes in the blood of the patient and at the level of the relative amount of lymphocytes above 35% extra administered cytostatic. The daily dose of corticosteroids are distributed evenly during the day and enter before the end of the period of their action. As cytostatics used 6-mercaptopurine or azathioprine. The method allows to individualize the conduct of immunosuppressive therapy, increasing its effect. 5 C.p. f-crystals.

The invention relates to medicine, namely to infectious diseases, Hepatology and immunology.

The closest to the technical nature of the claimed is a method of treatment of severe and protracted course of acute viral hepatitis, including the use of corticosteroids for 15-20 mg orally or 30-60 mg IV 3 times a day to "age crisis", followed by a daily dose of hormones post the St. Petersburg 1996, S. 250 (prototype)).

The disadvantages of this method is that the treatment of severe or protracted course of acute viral hepatitis glucocorticosteroids is carried out without taking into account the mass of the body (patients differ significantly from each other in body weight and it cannot be ignored), and with too great an interval of time. The introduction of corticosteroids 3 times a day means that the interval between doses is 8 hours. It's too much, as it is known that the period of active steps and then removing the drug from the body is 4 hours (Makarov, C. K. Infectious diseases. Diagnosis, differential diagnosis, immunotherapy, Tver, 2001. - S. 39). That is, the patient will be without therapeutic effect of glucocorticosteroids 3 times a day for 4 hours, for a total of 12 hours or1/2part of the day, which greatly reduces the effectiveness of the treatment.

In the claimed invention solved the problem of increasing the effectiveness of treatment of severe or protracted course of acute viral hepatitis and obtaining a positive economic effect.

The technical result is to develop a new and more effective ways licentiate fact, in the treatment of severe and protracted course of acute viral hepatitis by administering glucorticosteroids and drugs, according to the invention before treatment glucocorticosteroids determine the level of lymphocytes in the peripheral blood and when it is above 35% extra administered cytostatic.

At the same time as the glucocorticosteroid use prednisolone.

In addition, treatment with prednisolone is the rate of 0.5-0.8 mg/kg of body weight per day of prednisolone;

The daily dose of prednisolone distribute evenly during the day and is administered every 3-4 hours.

At the same time as drugs used 6-mercaptopurine and azathioprine.

In addition, cytostatic 6-mercaptopurine or azathioprine is administered by 50-100 mg 3 times a day for 5-7 days.

New, previously unknown features of the claimed method of treatment of severe and protracted course of acute viral hepatitis are

1) introduction of cytostatics in the complex therapy of severe and protracted course of acute viral hepatitis;

2) treatment with prednisolone is produced per 1 kg of body weight;

3) treatment with prednisolone is carried out with the continuous distribution is as lymphocytes, above which the patient, parallel to the course of treatment with prednisolone, administered drugs 6-mercaptopurine or azathioprine;

5) developed and offered a course and dose cytostatica 6-mercaptopurine and azathioprine.

The method was developed on the basis of the results of treatment of 26 patients with severe and prolonged course of acute viral hepatitis. Clinical experience has shown that in case of exceeding the level of the relative content of lymphocytes in the 35% observed "malignant" disease with progression to hepatic precoma and to whom. Although it is known that drugs have immunosuppressive effect, we found that the combined use of glucocorticosteroids and cytostatica in this combination provides a synergistic therapeutic and economic impact, which is more rapid exit of the patient from the serious condition and in reduction of almost 2 times the cost of expensive drug prednisolone. All calculations in medical practice "strength" of corticosteroids (hydrocortisone, cortisone, prednisolone, methylprednisolone, dexamethasone, triamcinolone, and others) is considered to correlate with prednisolone. Moreover, the effectiveness of therapeutic action of prednisolone GIP hepatitis is carried out in the following sequence.

Before treatment laboratory by the patient determine the relative content of lymphocytes in the peripheral blood and with his digital values above 35% advanced, and parallel to the course of treatment with prednisolone enter cytostatica, for example, 6-mercaptopurine or azathioprine, 50-100 mg 3 times a day for 5-7 days.

Example 1. Patient Agayev A., 29 years old, medical history, 1423, was treated in the infectious diseases Department, Tver about severe course of viral hepatitis C. Severe condition was manifested in the form of intoxication symptoms (nausea, vomiting), intense jaundice of the skin and a significant improvement in biochemical tests (total bilirubin - 427 μmol/l, sublimate sample - 1.2 ml, prothrombin index 54%, the activity of alanine aminotransferase (Alt) was 8.8 mmol/h-l). Been a large basic therapy (detoxification, diet and vitamin therapy, Kars, Essentiale and other drugs), but without the desired effect. Within six months the patient remained intoxication, bright yellowish coloration of the skin, high levels of bilirubin, aminotransferases and low values of prothrombin index. When surveyed in the blood, the number of limpets costeroids prednisolone calculation of 0.7 mg/kg of body weight per day every 4 hours and cytostatic azathioprine 50 mg 3 times daily rate 5 days. After 5 days of treatment was able to reduce the level of bilirubin up to 167 µmol/l, the activity of alanine aminotransferase to 1.2 mmol/h-l and increasing values of prothrombin index to the norm (82%). The disease was transferred from severe to moderate, that is normal. Subsequently came the fast positive-side dynamics of clinical and laboratory findings, and the patient was discharged after recovery.

Example 2. Patient Sergeev S. N., 38 years old, medical history, 1211, was treated in the infectious diseases Department, Tver about a protracted course of viral hepatitis In (hyperferritinemia lasted more than 3 months (Alat - 1.7 mmol/h-l), remained elevated bilirubin (78 µmol/l). Received conventional basic therapy. When surveyed in blood lymphocyte count was 38%, which was higher than 35% and was the indication for drugs. He was appointed prednisolone 0.5 mg/kg of body weight a day every 4 hours and cytostatic 6-mercaptopurine 50 mg 3 times a day course of 7 days. After 7 days of treatment for the first time managed to achieve normalization of activity of aminotransferases and bilirubin level in the blood, meaning she recovered.

Example 3. Sick of Hreno the surveillance of viral hepatitis A. Conducted basic therapy (detoxification therapy, diet, vitamins b and C, Essentiale), but without effect. When going to a place and examination the patient was found to have a pronounced yellowness of the skin, significant changes in the functional liver samples, in particular prothrombin index (the leading test for assessment of the severity) was 45%. There was a threat of development precoma and coma. Considering the fact that in the analysis of blood lymphocyte count was 42%, which was higher than 35% and was the indication for drugs, was appointed glucocorticosteroid prednisolone calculation of 0.8 mg/kg of body weight per day every 4 hours and cytostatic mercaptopurine 50 mg 3 times a day course of 7 days. After 2 days of treatment indicators prothrombin index increased significantly, and after 5 days from the start of treatment was normalized. After 7 days of starting treatment intoxication disappeared, yellowness of the skin significantly decreased the level of bilirubin in the blood decreased in 2 times, transaminases returned to near normal. The disease was transferred from severe to moderate, that is normal. Later came the fastest growth from klineline. The rational timing of corticosteroids and additional co-administration of cytostatics give comprehensive high therapeutic effect, which in turn allows to obtain a high economic effect as reducing treatment time, i.e. reduce the number of days of disability, and reduce to 2 times the consumption of expensive patients drug prednisolone. The method available for use in the practice of a wide range of infectious diseases. Can significantly reduce the material cost of treating severe or prolonged course of viral hepatitis.

1. Treatment of severe and protracted course of acute viral hepatitis, including the use of corticosteroids and cytotoxic agents, characterized in that before beginning treatment with glucocorticosteroids determine the level of lymphocytes in the blood of the patient and at the level of the relative amount of lymphocytes above 35% is administered cytostatic, and the daily dose of corticosteroids are distributed evenly during the day and enter before the end of the period of its action.

2. Treatment of severe and protracted course of acute viral hepatitis on p. 1, characterized in that h is s acute viral hepatitis in p. 1, characterized in that as cytostatic use azathioprine.

4. Treatment of severe and protracted course of acute viral hepatitis on p. 1, characterized in that the drugs azathioprine and 6-mercaptopurine administered in a dose of 50-100 mg 3 times a day for 5-7 days.

5. Treatment of severe and protracted course of acute viral hepatitis on p. 1, characterized in that as glucocorticosteroid use prednisolone at the rate of 0.5-0.8 mg/kg of body weight per day.

6. Treatment of severe and protracted course of acute viral hepatitis on p. 1, wherein the daily dose of prednisolone is administered every 3-4 hours

 

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