[Nonalcoholic steatohepatitis and biliary sludge in people with metabolic syndrome]. / Nealkogol'nyi steatogepatit i biliarnyi sladzh u lits s metabolicheskim sindromom.

AIM: To determine the incidence of biliary sludge (BS) and to evaluate the clinical efficacy of Chophytol in patients with nonalcoholic steatohepatitis (NASH) and BS in the presence of metabolic syndrome (MS). SUBJECTS AND METHODS: Clinical laboratory examination was made in 72 patients with NASH in the presence of MS. BS was identified in 52 (72.2%) examinees who were divided in two (study and control) groups. The efficacy of Chophytol of plant origin, prepared from the purified extract of fresh artichoke (Cynara scolymus) leaf juice, which was used at a dose of 3 tablets thrice daily for a month, was evaluated. RESULTS: The use of Chophytol was established to promote BS elimination in 87% of the patients. This ceased pain syndrome in 87% and dyspeptic manifestations in 65.2% and normalized the levels of lipids and the biochemical indicators of liver process activity. No adverse drug reactions were seen. CONCLUSION: Chophytol used in patients with HASH and BS may soon be possible to make general condition better, to alleviate the symptoms of diseases of the liver and biliary system, and to appreciably improve the biochemical indicators of blood and bile.

[COURSE OF BILIARY SLUDGE ON THE BACKGROUND NON-ALCOHOLIC FATTY LIVER DISEASE].

To date, the factors significantly reduces the tolerance of the liver against the development of NAFLD and GSD. At the stage of biliary sludge cholelithiasis is found in more than half of the patients suffering from NAFLD. BS violates jelchnokamennouu and releaxation activity of hepatocytes, thereby slowing the passage of bile through the intrahepatic and extrahepatic bile ducts that aggravate the course of NAFLD. The reasons for the formation of sludge is not completely understood. To date there are no accepted tactics of conducting and treatment of patients with HB in the background of NAFLD. In our work we demonstrate one possible way to tackle this important problem.

[CHANGES IN MICROBIOCENOSIS OF THE COLON IN PATIENTS WITH CHRONIC LIVER DISEASE AND LATENT HEPATIC ENCEPHALOPATHY].

Interest in the study of complications of liver disease, in particular latent hepatic encephalopathy, due to its wide distribution, difficulty in diagnosis, the lack of differentiated treatment approaches. The correlation dependence of the influence degree of dysbiosis in the development of latent hepatic encephalopathy contributes to the formation of multiple organ pathology, including associated with the violation of the intestinal microbiota in chronic liver disease, is a separate link in the pathogenesis of hepatic encephalopathy. Dysbiosis of the colon in patients with chronic dislivoniami the liver is the triggering factor in the development of latent hepatic encephalopathy, and its level directly correlated with the execution time of the tests of numbers and lines, the manifestation of asthenovegetative syndrome, intestinal dyspepsia, cytolysis, cholestasis, hepatocellular nedostatusnosti.

[NONALCOHOLIC FATTY LIVER DISEASE: DIAGNOSTIC, SYMPTOMS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

According to the World Health Organization, it is recorded steady growth of the number of chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD), in recent years. As an independent nosological entity, NAFLD is one of the risk factors for cardiovascular diseases, associated with abdominal-visceral obesity, peripheral insulin resistance (IR), and is regarded as the hepatic component of Metabolic syndrome (MS). Nowadays there are no generally accepted national standards for diagnosis and treatment of NAFLD for physicians, gen- eral practitioners, gastroenterologists in Russia. This was the essential reason in their development. The main reason of The guidelines development is the absence of generally accepted national standards for diagnosis and treatment of NAFLD for physicians, general practitioners, gastroenterologists in Russia. These guidelines are based on the global and local data of treatment experience of NAFLD, recently published in reviews, analytical studies in the literature. Guidelines are intended for physicians, general practitioners, gastroenterologists and contain the description of the preferred approaches to the provision of diagnostic, curative and preventive care of patients NAFLD. The quality of recommendations was grading according to the GRADE approach.

[AUTOIMMUNE LIVER DISEASES: CLINICAL FEATURES, DIAGNOSIS, TREATMENT. GUIDELINES WERE APPROVED BY THE XV GASTROENTEROLOGICAL SCIENTIFIC SOCIETY OF RUSSIA IN 2015].

The group of liver autoimmune diseases (LAD) includes autoimmune hepatitis (AIH), Primary biliary cirrhosis (PBC) and Primary sclerosing cholangitis (PSC) The guidelines on clinical diagnosis and management of patients based on a review and analysis of recent publications on this topic in the global and domestic literature and on the authors'experience in treating patients with autoimmune liver disease.

[Tactics for the correction of intestinal microbiocenotic disorders in the combination therapy of patients with chronic liver diseases].

AIM: To evaluate the efficacy of the symbiotic Linex used in the combination therapy of liver cirrhosis (LC). SUBJECTS AND METHODS: Seventy-four patients with LC, including 44 who received additionally the symbiotic Linex and 30 who had conventional therapy, were examined. All the patients underwent clinical and biochemical blood tests, abdominal ultrasonography, fecal test for bacteria, gas chromatography-mass spectrometry of the blood composition of microbial markers, number connecting test, and quality-of-life assessment (SF-36). RESULTS: The symbiotic-treated patients showed a significant improvement in biochemical parameters (decreases in transaminase activities, bilirubin levels, hepatic protein-synthetic function--there were elevations in the concentrations of total protein from 74.0 +/- 0.50 to 78.1 +/- 0.80 g/l (p < 0.05) and albumin from 30.6 +/- 1.7 to 35.5 +/- 1.6 g/l (p < 0.05). There were also increases in the count of bifidobacteria from 8.7 +/- 0.1 to 9.1 +/- 0.1 Ig CFU/g (p < 0.05), lactobacilli from 5.0 +/- 0.2 to 5.2 +/- 0.2 Ig CFU/g (p < 0.05) and in the total count of Escherichia coli from 7.6 +/- 0.3 to 7.9 +/- 0.3 Ig CFU/g (p < 0.05); a tendency for normalization of microbial markers was revealed by mass spectrometry; the manifestations of hepatic encephalopathy were alleviated (the number connecting test showed a reduction from 51.0 +/- 3.58 to 29.7 +/- 4.10 sec (p < 0.05)), and the quality of life improved. CONCLUSION: By normalizing enteric microbiocenosis, the symbiotic Linex positively affects the course and prognosis of LC and it is both a symptomatic and pathogenetic agent for the treatment of patients.

[New aspects of pharmacological effects of ursodeoxycholic acid].

The paper reviews the use of hepatoprotective agents in chronic liver diseases (CLD) and biliary disorders. A variety of clinical studies have shown the beneficial effect of ursodeoxycholic acid (UDCA) in liver disease worldwide. Besides the well-known mechanisms of action of UDCA we could show its prebiotic effect. Several studies have demonstrated that UDCA serves as a potential therapeutic agent for a number non-hepatobiliary disorders including cardiovascular disease, immune disorders, organ transplantation and other.

[Approaches to the treatment of patients with climacteric disorders complicated with menopausal metabolic syndrome with cholestasis].

RESEARCH OBJECTIVE: Development of the individual comprehensive program of follow treatment of patients with climacteric disorders complicated MMS (menopausal metabolic syndrome) with cholestasis; on the basis of application of low-dose hormone replacement therapy in combination with ursodeoxycholic acid, to improve the quality of life. MATERIALS AND METHODS: We observed 101 woman with climacteric syndrome, obesity and cholestasis; conducted a comprehensive clinical and laboratory examination, ultrasound of the hepatobiliary system, measurement modified menopausal index (MMI), the measurement of the quality of life on questionnaire SF-36 before treatment and after 6 and 12 months. THE RESULTS: Positive and statistically significant changes in lipid spectrum, the activity of transaminases, bilirubin and its fractions, improvement of MMI and quality of life, the indices of coagulation remained virtually unchanged. CONCLUSION: Low-dose hormone replacement therapies in combination with ursodeoxycholic acid are highly effective drugs for the treatment of menopausal syndrome, which normalize lipid profile of patients and the performance of the hepatobiliary system.

[Fatty liver in elderly patients with atherosclerotic coronary artery disease (according to autopsy data)].

In article it is a question of morphological research of fragments of tissue of a liver at 143 elderly and old patients with atherosclerosis of the coronary arteries which have died on offices of the S-Petersburg hospital for veterans of wars in 2006-2010. Average age of the died patients was defined in the range from 61 till 98 years and made 82.3 ± 1.3 years. It is established that at geriatric patients with atherosclerotic defeat of coronary arteries fatty regeneration of a liver was observed in 25.9 ± 7.3%; more than at 2\3 geriatric patients with atherosclerosis of coronary arteries it was noted cteatogpatit with the minimum degree of the activity, thus specified degree of activity came to light at the surveyed patients with fatty regeneration of a liver (77.8 ± 8.0% against 60.7 ± 6.1% in group without fatty regeneration of a liver) more often. Cardiovascular diseases caused death of patients with atherosclerosis of coronary arteries and fatty regeneration of a liver, than in group of patients without a fatty degeneration of a liver (91.7 ± 4.8% of cases and 73.8 ± 4.9% of cases respectively) more often. Patients of senile age with atherosclerosis of coronary arteries and fatty regeneration of a liver died because of cardiovascular diseases, than their contemporaries in group without fatty regeneration of a liver (89.7 ± 6.1% and 71.3 ± 5.7% respectively) more often.

[Pathogenetic therapy of metabolic syndrome at the stage of visceral lesions].

Insulin resistance and oxidative stress play an important role in the pathogenetic mechanism of non-alcoholic fatty liver disease. Hepatoprotective therapy that blocks the second phase of pathogenesis (oxidative stress) is a promising modality for the treatment of non-alcoholic steatohepatitis (NACH). An alternative approach is the use of medicines recovering the mitochondrial membrane, lipid bi-layer of the plasma membrane, oxidative phosphorilation, and cellular metabolism. In this context, succinic acid-based remaxol showing antioxidative, antihypoxic and cytoprotective activities can be regarded as a promising metabolic hepatoprotector for the treatment of non-alcoholic fatty liver disease. The present original study demonstrated the clinical efficacy of remaxol in pathogenetic therapy of NACH in patients with metabolic syndrome. Its introduction in the combined treatment of NACH increased functional capacity of the liver by decreasing the severity of cytolysis, cholestasis, hepatomegalia, and steatosis (ultrasonic study), improved lipid metabolism, reduced cholesterol level, triglyceridemia, and atherogenic index. Remaxol exerted nephroprotective action in patients with diabetic nephropathy at stage 1 of chronic renal insufficiency (increased glomerular filtration rate and decreased blood creatinine level). The study demonstrated the advantage of medications with antihypoxic properties over traditional therapy of NACH.

[Alcoholic hepatitis].

The aim of the study was to evaluate Kholit efficiency in complex treatment of alcoholic hepatitis. 72 patients with proved chronic alcoholic hepatitis were examined. 37 of them underwent complex treatment including Kholit. Kholit in complex treatment of patients with chronic alcoholic hepatitis was shown to promote improvement of the general patient's state, disappearance of objective signs of the disease, normalization of laboratory and instrumental data.

[Metabolic correctors based on succinic acid as pathogenic therapy in chronic virus hepatitis].

Chronic viral hepatitides (CVH) run with long-term activation of the system of mononuclear phagocytes associated with hyperproduction of active oxygen forms. This can be considered as risk factors of antioxidant insufficiency which determines the course of the disease. Now, antioxidant, cytoprotective medicines are more and more actively used in hepatology. The results are reviewed of many Russian clinical trials of efficacy of metabolic correctors based on siccine acid (reamberin, remaxol) as pathogenetic treatment in CVH. Metabolic correctors in combined treatment of CVH improve basic clinico-laboratory indices, raise efficacy of basic therapy, correct insufficiency of antioxidant defense. The results of the studies confirm advantage of antihypoxic medication over standard infusion therapy for treatment of CVH patients.

[Reamberin for pathogenetic therapy of acute and chronic viral diseases of the liver].

The study including 427 patients with acute and chronic viral hepatitis was designed to assess results of clinical and laboratory diagnostics of hepatic problems and the state of thiosulfide antioxidative system. It was shown that infusion of succinate-containing preparation reamberin (400 ml/day for 10 days) took less time to eliminate clinical manifestation of the disease (dispeptic and asthenovegetative syndromes) than conventional therapy. Simultaneously the levels of biochemical markers of hepatic cytolysis and cholestasis significantly decreased while serum antioxidative potential recovered. The normal size of the liver was achieved 3.4 times more frequently than in control. No side effects or adverse reactions other than listed in the instruction for use of reamberin occurred. The preparation had to be withdrawn only in one patient.

[Hepatoprotective activity of remaxol in patients with chronic hepatic disorders].

This milticentre randomized clinical study of the efficiency of remaxol infusion solution (hepatoprotective medicine for chronic liver dysfunction) included 494 patients with chronic hepatitis B and C. 294 of them staying in 7 clinics were given remaxol and 200 ones received placebo. Randomization was achieved by the envelope method. A detailed description of clinical and laboratory characteristics of the diseases is presented. Effects of remaxol vs placebo on the functional activity of affected liver are discussed. Results of laboratory and clinical analysis indicate that mechanism of remaxol action is based on hepatoprotective, antioxidative, and anticholestatic activities of the drug.

[Efficiency of using cycloferon as part of combined therapy for chronic hepatitis C (a review of multicenter clinical trials)].

The results of a study of the efficiency of treatment in patients with chronic hepatitis C conducted in a complex of multicenter clinical trials of the impact of various antiviral therapy regimens including the interferon genesis inductor cycloferon are reviewed. Four hundred and seventy-eight patients with hepatitis C virus infection were followed up. The study has demonstrated that the incorporation of cycloferon into the standard treatment regimen, which is manifested by the effect of drug synergism, by producing antiviral, immunomodulating, and antifibrotic effects, is a promising pharmacotherapy for chronic hepatitis C. This treatment is economically sound, reduces the incidence and degree of adverse reactions and increases the quality of life in the patients.

[The effectiveness of antibiotics in typical and atypical pneumonias depending on combination with glucocorticosteroids].

Sixty-seven cases of prolonged pneumonia were analyzed. The study found that in cases with a typical onset the efficacy of antibiotics with predominantly bactericidal activity was much higher when they were administered in combination with glucocorticosteroids (GCS); bacteriostatic preparations were not used in such cases. In prolonged pneumonia with an atypical onset the efficacy of mainly bacteriostatic antibiotics was significantly higher than that of bactericidal ones, but the efficacy of both did not increase when they were combined with GCS. The use of GCS in addition to antibiotics shortens the time to pneumonia resolution in cases with both typical and atypical onset, regardless the character of antibacterial therapy.

[Psychosomatic aspects of therapy in patients with ischemic heart disease of behavioral type A]. / Psikhosomaticheskie aspekty lecheniia bol'nykh IBS s povedencheskim tipom A.

Forty-five patients aged 34 to 67 years who had coronary heart disease (CHD) were examined. Anaprilin was given in a dose of up to 120 mg daily. Concurrently with positive changes in the anginal syndrome there were improved sleep, decreases in hot temper, irritability, anxiety, phobic manifestations, hypochondrical trends, and neurotic asthenization, increased working and social orientation. During anaprilin therapy, cardialgias reduced or disappeared, the incidence of arrhythmia decreased. There was a reduction in the personality profile in the scales "neurotic triad" and "psychoasthenia", significantly diminished reactive anxiety, and a decrease in the blood levels of aldosterone, cortisol, triiodothyronine, and thyroxine. Thus, supplementation of anapriline to the combined therapy for patients with CHD of behavioral type A (BTA) positive affected the clinical course of the disease. Hormonal disorders in BTA CHA may be eliminated by anaprilin. Configuration of the personality profile was leveled in patients with CHA of "coronary" type.