Ryabokon Y. Chronic hepatitis C with extrahepatic implications: clinical-pathogenetic role of neurohumoral and endothelial dysfunction, optimization of diagnostic and treatment

On the basis of complex research of autoimmune disorders (mixed cryoglobulins, rheumatoid factor, cardiolipin, antinuclear antibodies), endothelial function (reactive hyperemia of a humeral artery, endothelin-1, nitrites, L-arginine), parameters of neurohumoral regulation (heart rate variability) and quality of life (SF-36 questionnaire) depending on existence and degree of expression of extrahepatic implications, formations of the early virologic answer and additional appointment as ball chronic hepatitis C with the mixed cryoglobulinemia are given to basic pathogenetic therapy of a L-arginine of a hydrochloride theoretical generalization and the new solution of a scientific problem which consists in improvement of early diagnostics of extrahepatic implications of chronic hepatitis C and optimization of complex treatment. On the basis of clarification of a pathogenetic role of neurohumoral and endothelial dysfunction in development of extrahepatic implications the most informative parameters which are associated with emergence and advance of signs of a crioglobulinemia syndrome and accession of other extrahepatic implications thanks to what the mathematical model for their early diagnostics is framed are determined; definition of function of an endothelium for forecasting of risk of a clinical manifestation of a hemorrhagic crioglobulinemia vasculitis is proved; it is shown influence of formation of the early virologic response to dynamics of the mixed cryoglobulinemia and function of an endothelium; efficiency of complex pathogenetic treatment thanks to justification of additional purpose of a L-arginine by sick chronic hepatitis C with the mixed cryoglobulinemia is increased.