Zakharchuk U. Clinical and pathogenetic substantiation of methods of optimization of complex rehabilitation of patients with chronic pancreatitis with concomitant diabetes mellitus

The object of study: chronic pancreatitis with concomitant diabetes mellitus. The purpose of the research: to increase the efficiency of diagnosis, treatment and rehabilitation of patients with chronic pancreatitis with concomitant diabetes mellitus, on the basis of established clinical and pathogenetic characteristics of the course, disorders of the secretory and inсretory functions of the pancreas and their pharmacological and non-pharmacological correction. Methods: clinical and anamnestic; anthropometric - body mass index (BMI), the amount of shoulder muscles (WMD), the thickness of fat skin folds on the triceps; biochemical - glycosylated hemoglobin (HbA1c), blood glucose, plasma proteolytic activity (PPA), kallikrein (KK), prekallikrein (PKK), inhibitor proteinase (IP), macroglobulin (MG), kinase-II activity, average molecule (SMP254 and SMP280), circulating immune complexes (CIC); enzyme immunoassay - fecal elastase-1; instrumental - ultrasound (USG); sociological; statistical. Scientific novelty of the results: it was identified the peculiarities of clinical manifestations and expressiveness of secretory and incretory insufficiencies of the pancreas in the course of the comorbid flow of CP with DM, the interconnections between them and the influence on the severity of CP are revealed. For the first time have been developed new methods for predicting the progression of secretory pancreatic insufficiency in patients with CP with diabetes, taking into account the age of patients, duration of CP and DM, quantitative significance of ultrasound criteria and criteria of coprogram expressed in balls, and blood glucose level. We managed to establish the pathogenetic features of trophic disorders, protein metabolism in the form of depletion of visceral and somatic protein pools, violations in lipid homeostasis. The pathogenetic role of the unbalance of the kallikrein-kinin system and endotoxicosis, interactions between them is established. For the first time there were proposed complex programs of pharmacological and non-pharmacological correction of the revealed disorders with the usage of lipoic acid and the course of the multi-colored multi-metallic application of Lyapko applicators during the treatment and rehabilitation.