Method for treating steatohepatitis

FIELD: medicine, hepatology.

SUBSTANCE: at achieving alkaline phosphatase of 580 U and more one should introduce ursodesoxycholic acid at the dosage of 15-20 mg/kg and orlistate at the dosage of 90-100 mg twice or thrice daily for patients with steatohepatitis. According to normalization of clinical and biochemical values of blood analyses it is possible to conclude upon successfulness of therapy performed. The method provides clinic-laboratory remission of the disease.

EFFECT: higher efficiency of therapy.

3 ex

 

The invention relates to medicine and can be used in the treatment of steatohepatitis with pharmacological tools.

There is a method of treatment of chronic hepatitis, including the appointment of Essentiale, hagadone and cholestyramine adopted for similar [1].

There is a method of treatment of patients with Hbe Ag - negative chronic hepatitis b using medication lamivudine [2], adopted for the prototype.

However, monotherapy with lamivudine according to the method prototype the process is time consuming, requiring up to three years, and when steatohepatitis with pharmacological tools its effectiveness is limited.

The aim of the present invention is to improve the effectiveness of treatment of steatohepatitis with pharmacological tools in the reduction of treatment time.

The technical result is achieved that determine the level of alkaline phosphatase in serum and at reaching the level of alkaline phosphatase in 580 units and more as a medical drug used ursodesoxycholic acid in a dose of 15-20 mg/kg and orlistat dose of 90-100 mg 2-3 times a day.

The method is as follows.

On admission the patient find out the presence of complaints of loss of appetite, intolerance to fatty foods, fatigue, weakness. When researching pay attention to the manifestation of autonomic dysfunction sweating, labile pulse, unstable blood pressure. Can be the mark subikterichnost skin and sclera, a single spider veins, “liver” of the palm, gynecomastia, pseudoceramides status (puffy face, injection of the sclera), euphoric behavior, increase the parotid glands.

Clinical and biochemical analysis of blood; Hb 90g/l and less, uh - 3,3·1012/l, ESR> 12 mm/h, L and 9.8·103/l, platelets - 250·103/l, as at 45, and more ed, al al - 48 units or more; alkaline phosphatase - 580 units and more, gamma-glutamyltranspeptidase - 80 units or more, bilirubin - 1,4-2.5 mg/100 ml

Treatment according to the proposed method.

The patient is prescribed ursodeoxycholic acid at a dose of 15-20 mg/kg and orlistat dose of 90-100 mg 2-3 times within 21-28 days. Then carry out control tests: Hb 110-120 g/l, uh - 3,5·1012/l and more, ESR - 7-12 mm/h, L (7-9)·103/l, platelets (260-330)·103/l as al - 30-36 ed, al Al - 30-32 u; alkaline phosphatase - 290-320 units, gamma-glutamyltranspeptidase - 40-50 units, bilirubin - 1.0-1.2 mg/100 ml

Way of the following examples.

Example 1.

Patient, 32 years old, was admitted with a diagnosis of steatohepatitis, acute exacerbation. No complains.

The examination noted increased sweating, subikterichnost sclera, “liver” of the palm.

Clinical and biochemical analysis of blood; Hb 86 g/l or less, e - 3,0·1012/l, ESR - 12 mm/h, L - 10·103/l, platelets - 250·103 /l as al - 45 ed, al at - 45 units, alkaline phosphatase - 570 units, gamma-glutamyltranspeptidase - 82 units or more, bilirubin - 2.0 mg/100 ml

Treatment according to the proposed method, assigning ursodeoxycholic acid at a dose of 15 mg/kg and orlistat dose of 90 mg 2 times a day for 21 days.

Then carry out control tests: Hb 120 g/l, eh - 3,4·1012/l, ESR - 9 mm/h, L - 8·103/l, platelets - 260·103/l as al - 30 ed, al al - 32 units; alkaline phosphatase - 290 units, gamma-glutamyltranspeptidase - 40 u, bilirubin - 1.1 mg/100 ml

The patient was discharged in a state of clinical and laboratory remission.

Example 2.

Patient F., 43 years old, was admitted with complaints of fatty food intolerance, fatigue. In the study noted sweating, instability

blood pressure, subikterichnost skin and sclera, a single spider veins, pseudoceramides status.

Clinical and biochemical analysis of blood : Hb-80 g/l, uh - 2,8·1012/l, ESR - 15 mm/h, L is 12.5·103/l, platelets - 200·103/l as al - 64 ed, al at - 72 units, alkaline phosphatase - 620 units, gamma-glutamyltranspeptidase - 92 units, bilirubin - 3.0 mg/100 ml

Treatment according to the proposed method.

The patient is prescribed ursodeoxycholic acid at a dose of 20 mg/kg and orlistat dose of 100 mg 3 times a day for 28 days.

After provideno what about the treatment of complaints fatigue does not impose, sweating has decreased, blood pressure steadily in subsequent studies during the day, subikterichnost skin and sclera is not marked.

Then carry out control tests: Hb 110 g/l, eh - 3,3·1012/l, ESR - 10.5 mm/h, L - 8·103/l, platelets - 290·103/l as al - 36 ed, al al - 32 units; alkaline phosphatase - 320 units, gamma-glutamyltranspeptidase - 45 units, bilirubin 1.2 mg/100 ml

The patient was discharged in good condition.

Example 3.

Patient, 45 years old, complains on weakness, increased sweating, loss of appetite.

Objective examination mark lability pulse, unstable blood pressure, subikterichnost sclera, gynecomastia, sick several African.

Clinical and biochemical blood analysis: Hb 75 g/l, uh - 2,5·1012/l, ESR - 17 mm/h, L - 14·103/l, platelets - 230·103/l as al - 74 ed, al al - 82 units, alkaline phosphatase - 680 units, gamma-glutamyltranspeptidase - 92 units, bilirubin 3 mg/100 ml

Needle biopsy of the liver: there is a large and atomized steatosis, limfomonotsitoza lobular infiltration, Taurus, Mallory; portal tracts moderately expanded, sclerotic (fibrous).

Treatment according to the proposed method.

The patient is prescribed ursodeoxycholic acid at a dose of 18 mg/kg and orlistat dose of 95 mg 3 times Uchenie 26 days.

Then carry out control tests: Hb 115 g/l, eh - 3,4-1012/l, ESR - 12 mm/h, L - 9,5·103/l, platelets - 270·103/l as al -34 ed, al al - 32 units; alkaline phosphatase - 300 units, gamma-glutamyltranspeptidase - 46 units, bilirubin 1.2 mg/100 ml

Needle biopsy of the liver: there is atomized steatosis, portal tracts moderately expanded, sclerotic (fibrous).

The patient is put into a state of clinical remission. At discharge recommendations on diet and herbal medicine.

According to the claimed method were treated 19 patients with chronic steatohepatitis. All patients were discharged in remission and transferred to outpatient monitoring.

Sources of information

1. Diseases of the digestive system in children. ALEXANDER Mazurin. Moscow, 1989.

2. HADZIYANNIS S.J. et al. Hepatology, 2000, 32, p. 847-851.

A method of treatment of steatohepatitis by drug therapy, characterized in that determine the level of alkaline phosphatase in the serum and at the level of alkaline phosphatase 580 units and more as drugs used ursodesoxycholic acid in a dose of 15-20 mg/kg and orlistat dose of 90-100 mg 2-3 times per day.



 

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