Thesis for the Doctor of Medical Sciences Degree by specialty 14.01.33 — Medical Rehabilitation, Physiotherapy and Balneology. — The Odesa National Medical University, Ministry of Health of Ukraine, Odesa, 2021.
The thesis solves an important and topical problem of modern hepatology, which concerns the optimization of treatment of patients with chronic viral hepatitis C (CHC) with concomitant non-alcoholic fatty liver disease (NAFLD). Based on a comprehensive examination of patients, it was proved that patients with CHC who have achieved a stable virological response are at risk because of
comorbid liver disease, which comes to the fore after the elimination of the virus and leads to further progression of fibrosis and liver cirrhosis. Based on the experimental study, the effect of a suspension of bentonite and mineral waters of different chemical composition on the functional and morphological state of the liver of rats with the model of experimental NAFLD was studied. It is established that under the influence of selected factors the detoxification and protein-forming functions of the liver, the state of lipid and carbohydrate metabolism improves against the background of reduced inflammatory processes in the liver. In patients with CHC with concomitant NAFLD, who had elimination of hepatitis C virus after the course of antiviral therapy, the effectiveness of the
next stage of therapy — the use of low-mineralized silicon hydrocarbonate sodium mineral water in double dosage, “dry” carbon dioxide baths, bentonite, which is confirmed by normalization of the indicators of cytolytic and cholestatic syndrome, restoration of lipid and carbohydrate metabolism, normalization of the profile of adipokines, a positive effect on fibrotic changes in liver tissue and liver steatosis, restoration of qualitative and quantitative composition of the intestinal microflora, improving the quality of life of patients. The positive effect of the use of ultrahigh-frequency therapy, vitafon therapy, low-mineralized silicon hydrocarbonate sodium mineral water in patients with CHC with concomitant NAFLD who received standard antiviral therapy (alpha-2b interferon and ribavirin) for prevention of side effects of a standard antiviral therapy, improvement and stabilization of the biochemical response, increasing the level of virological response and quality of life of patients. The expediency of using mineral water, ultrahigh-frequency therapy and vitafon therapy in patients with CHC during the period of receiving standard antiviral therapy (alpha-2b and ribavirin) to improve its tolerability, increase the number of virological response, preventing side effects of antiviral disease (flulike
syndrome, anemia, leukocytopenia, thrombocytopenia). Experimental studies on the NAFLD model in animals, clinical, laboratory
and instrumental studies have allowed to develop and propose treatment methods (mineral water in double dosage, “dry” carbon dioxide baths, bentonite) NAFLD, which remains in patients with CHC after virus elimination and can lead to further development of steatohepatitis and liver fibrosis.
Key words: chronic viral hepatitis C, non-alcoholic fatty liver disease, antiviral therapy, virological response, mineral water, ultra-high frequency therapy, vitafon therapy, “dry” carbonic baths, bentonite.
