Treatment of acute viral hepatitis in
The invention relates to medicine, in particular to the treatment of infectious diseases, and for the treatment of acute viral hepatitis Century For the treatment of this patient is prescribed on the background of basic therapy antiviral drug “Antigua” in a dose of 0.1 ml/kg body mass, which is injected intramuscularly once a day for three days. The method provides a reduction in terms of relief of symptoms of intoxication and duration of jaundice period, as well as relapse prevention and chronic disease. 7 table.
The invention relates to medicine, namely to infectious diseases and can be used for the treatment of acute viral hepatitis In icteric form.
There is a method of treatment of acute viral hepatitis In using normal donor immunoglobulin on the background of basic therapy (Use of human immunoglobulin” Report of the who expert Committee, M., “world health organization”, 1968, page 24).
Disadvantages: low efficiency, long duration of treatment.
The invention is directed to solution of the problem: reduction of term relief of symptoms of intoxication and runs therapy as the donor immunoglobulin antiviral drug “Antigua” in a dose of 0.1 ml/kg of body weight, which is injected intramuscularly once a day for three days.
Antiviral drug “Antigua” is a human immunoglobulin against hepatitis b for intramuscular content specific HBs antibodies at least 50 IU/ml in enzyme reactions in the Fund 42-0028-0037-00 (RF Patent No. 2144379 from 20.01.2000 year). The drug is used for prevention of viral hepatitis b, after an accidental infections in persons, when the level of HBs-antibody protective or unknown; and individuals whose vitality requires regular maintenance activities due to the risk of infection by hepatitis b virus, or those in whom vaccination is not possible.
Data about therapy of acute viral hepatitis In this drug in literature no.
The method is as follows: a patient receiving pathogenetic therapy (baseline), including diet table 5, the mode-bed or pruposely, detoxification remedies and vitamins, prescribed in the second to fifth day of hospitalization antiviral drug “Antigua” in a dose of 0.1 ml/kg body mass, which is injected intramuscularly once a day for three days.
GCIB No. 1 with a diagnosis of Viral hepatitis b (HBsAg+), icteric form, moderate, acute. Was admitted with complaints of loss of appetite, nausea, weakness, yellow skin, dark urine.
Medical history: the Sick with 10.07, when there was loss of appetite, weakness, urine has become dark in color. With 12.07 - nausea, pasty stools. With 14.07 - interesest sclera.
Epidemiological history: contact with infectious patients, the drug denies. In the last 6 months were often treated teeth. Was sick last only for a cold.
When admitted to hospital, a state of moderate severity. Clear consciousness. The skin, sclera and mucous icteric coloration. Itches, hemorrhage no. Heart sounds are clear, rhythmic. Pulse 84 in 1 minute. AD=100/70 mm RT. Art. vesicular Breath. Language moderately covered. The abdomen is not swollen, soft, painless. Liver elastic, about 2 cm below the edge of the costal arch on the right of the mid-clavicle line. Spleen not palpated. Choluria. Chair pasty, bright.
Biochemical analysis of blood from 17.07: bilirubin total 185 µmol/l is associated bilirubin - 138 µmol/l, sublimate sample - 78%, thymol test - unit 7, ALT to 18.6 mmol/l, PETIT - 76%. Found in the blood of HBsAg, anti-HBC Ig M
Conducted basic therapy: diet - table 5A, the mode pruposely, vitamins, detoxification (5% aq glucose 400 ml and R-R ringer 400 ml per day intravenously). Antiga appointed in a dose of 0.1 ml/kg 6 ml intramuscularly course of 3 days daily. Side effects and complications in the treatment of Antijapan was not.
On the second day of treatment, her condition improved, the complaints disappeared. Slightly decreased the intensity of jaundice. To 6 days of treatment Antigama was only subikterichnost sclera. To 8 days after initiation of therapy in liver size decreased, and by the 15th day normalized.
Biochemical parameters are shown in table 1
Indicators sublimate, thymol samples, PETIT normalized to 7 days of treatment.
Markers of HBV:
Discharged 21 days from the time of admission in a satisfactory condition. No complaints. Jaundice no. The size of the liver in the normal range.
The patient lies on the observation in the study of infectious diseases at the place of residence. Signs of chronic viral hepatitis In there.
Patient K., aged 30, was on treatment in the MUSES GCIB No. 1, Perm with 25.03.02 at 30.04.02. Diagnosis: Viral hepatitis b (HBsAg+), icteric form, moderate, acute.
Was admitted with complaints of weakness, malaise, nausea, loss of appetite, heaviness in the right hypochondrium, jaundice.
The history of the disease. Ill 22.03 appeared malaise, weakness. On the same day, decreased appetite, choluria, there was a feeling of heaviness in the right hypochondrium. 23.03 noticed jaundice and discoloration of the feces. The doctor turned 23.03 and on the same day hospitalized.
Epidamnus. Contact with infectious patients had not. Uses other people's combs, manicure sets.
Previously ill only epidemic Elitistic. Heart sounds are clear, rhythmic. Pulse 78 in 1 minute, satisfactory filling and voltage. AD=120/80 mm RT. Art. vesicular Breath. The abdomen is soft, sensitive in the right hypochondrium. Liver 3 cm below the edge of the costal arch on the right of the mid-clavicle line, moderately dense. The spleen is not enlarged. Choluria, ahole. Blood 26.06: total bilirubin 191 μmol/l, associated bilirubin - 160 µmol/l, ALT - 18.5 mmol/l, sublimate the sample is 54%, thymol 15 units, PETIT - 69%. Detected HBsAg, anti-HBC Ig M
Diagnosis: viral hepatitis b, icteric form, acute delivered on the basis of: the history of the disease (acute onset, predzheltushnogo period of one day), complaints (loss of appetite, heaviness in the right hypochondrium, jaundice, dark urine, light stool), objective data (yellowness of the skin, sclera, mucous membranes, liver enlargement, choluria and acholia), biochemical data (bilirubinemia with predominance of conjugated bilirubin, increased ALT and thymol turbidity tests, reducing sublimate samples and PETIT) and the presence of HBsAg and anti-HBC Ig M in the serum.
Was conducted basic therapy: diet 5A, mode pruposely, vitamins, detoxification therapy (5% glucose 400 ml ringer solution 400 ml intravenously per day, oilers 3 days. Side effects, complications during treatment was not.
On the second day of treatment Antigama decreased fatigue, improved appetite. On day 3 of treatment complaints disappeared, the condition is satisfactory. Decreased jaundice, feces returning to a normal color, brightened up the urine.
The dynamics of the size of the liver: on day 2 of treatment stands out from the edge of the rib arc 2 cm by 1. mediaclav. dextra, on day 6 of 1 cm to 10 days of treatment with Antigama the size of the liver returned to normal.
Biochemical parameters are shown in table 2.
To 14 days after beginning therapy normalized sublimate and thymol turbidity tests.
HBsAg has disappeared on day 3 of treatment, appeared anti-HBs. Anti-HBe identified from the beginning of therapy. Anti-HBC Ig M and G was determined from the moment of receipt. Anti-HBC Ig M gone 3 months after discharge.
Discharged on the 37th day of treatment in a hospital in a satisfactory condition. No complaints. Jaundice no. Liver, spleen not enlarged.
Was under medical supervision in KEYES during the year. Signs of chronicity of the process there. Charged with a dispensary registration.
The study included 97 adults with acute viral hepatitis b (the research Institute of the medical unit No. 1, Perm.
All patients admitted to the hospital in icteric period of HBV, moderately grave condition with acute symptoms of intoxication. In accordance with the introduction of immunoglobulin (1-6 series) 59 patients were divided into 6 groups. The first group (2 -, 3-and 5-series) received the drug Antiga. The second group - group comparison (1, 4 and 6 series) received normal donor immunoglobulin. The drugs were injected intramuscularly in the gluteal region in the first 2-4 days of icteric period at a dose of 0.1 ml/kg of body weight daily for 3 days.
The control group consisted of 38 patients with HBV without treatment with immunoglobulins, receiving only basic, pathogenetic therapy.
The formation of groups was performed by random sampling.
When comparing the course of the disease in the patients treated with the drug Antiga, normal donor immunoglobulin and patients of the control group obtained the results given in table 3.
On the basis of the results of therapy, all patients treated with immunoglobulins were divided into 2 groups:
1 gr. patients who received the drug Antiga (series 2, 3 and 5) had a favorable acute illness without patients, received normal donor immunoglobulin (series 1, 4, 6), had an unfavorable course with exacerbations of HBV have 4 people, recurrence at 2 and Gilbert syndrome - 5.
In the control group as in group 2 experienced frequent exacerbations have 4 people, relapse - 2, Gilbert's syndrome - 3, and 1 patient had any progression of the disease and developed a chronic form.
Clinical criteria for the effectiveness of treatment outcomes were: the severity and duration of intoxication, jaundice, term normalization of the liver (table. 4).
Based on the data given in table 4 we can conclude that the best results were for the treatment of drug Antiga (series 2, 3, 5). Earlier disappeared weakness, decrease of appetite, nausea, jaundice, decreased liver.
These data differ significantly from the performance of patients who received normal donor immunoglobulin, and the parameters of the control group, where the intoxication symptoms, duration of jaundice period and hepatomegaly lasted more long-term.
Table 5 shows the timing of the improvement and normalization of pigment of liver function (bilirubin), and cytolysis (ALT).
x drug Antiga (series 2, 3, 5).
Dynamics of HBsAg are presented in table 6. Among patients receiving immunoglobulin (53), HBsAg during the observation period, ceased to be or title it fell sharply from 49 people (92%), with 11 of them (21%) saw a decrease of titer, and the rest of HBsAg has disappeared (71%). Not decreased the titer of HBsAg in 4 people (7%).
In the control group HBsAg ceased to be defined in most cases within 2 months from start of therapy (76%), a 13% titer remained constant without trend. When analyzing the results in the series was that HBsAg was not detected at an early time in the 2 and 3 series (1/3patients). The worst results were obtained at 1 and 4 of the series: 4 series HBsAg persisted during the monitoring period, the1/4patients, as in the first series none of the patients he has not disappeared at an early date.
The dynamics of anti-HBs are presented in table 7. It shows that the 51 surveyed who received the drug Antiga, during the period of monitoring anti-HBs not detected in 10 (20%) in the control group and in 8 (21%).
In the group of patients treated with the drug Antiga, anti-HBs appeared often within 1 month of observation (18 - 35%). In the control group it was observed less frequently: 4 people (10%). Often more is 1/2patients).
Thus, in the treatment of drug Antiga patients earlier than in the control group disappeared HBsAg and developed anti-HBs.
During clinical trials were conducted surveillance of patients in order to identify possible side effects of the drug Antiga. In any case, use of the drug allergic complications, reactions to the drug were not.
Thus, the application of the proposed method for the treatment of acute viral hepatitis b significantly reduces the duration of intoxication (weakness, decrease of appetite, nausea, jaundice, hepatomegaly, before going improvement and normalization of indices of functional liver samples (decrease bilirubinuria, ALT). Earlier HBsAg disappears and appear anti-HBs. In the patients treated with the drug Antiga, there were no complications of the disease (acute, recurrent, chronic).
Treatment of acute viral hepatitis b by introducing a donor immunoglobulin on the background of basic therapy, characterized in that as the donor immunoglobulin is used antiviral drug "Antigua" in a dose of 0.1 ml/kg body mass, which is injected within the
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