Khomyn H. Clinical and pathogenetic features of chronic pancreatitis in comorbidity with viral hepatitis C, optimization of approaches to complex treatment

The aim of the study was to establish the clinical-pathogenetic features of the comorbidity of chronic pancreatitis with chronic viral hepatitis C treated with antiviral agents, and to increase the effectiveness of protocol treatment by differential inclusion of hepatotrophic agents in order to correct established disorders based on a comprehensive assessment of the clinical course, functional state of the pancreas and liver, endotoxicosis, nutritional status, the gastroduodenal mucous membrane morphological state and quality of patients life. The features of the clinical course of CP in combination with concomitant HCV treated with antiviral drugs were established. The aggravation of the clinical course of CP and quality of life against the background of HCV even treated with antiviral agents was proven by higher indicators of the GSRS scales (total by 49.44 %, (p<0.05)), the SF-36 questionnaire – by a decrease in the total physical – by 14.9 % and the mental component – by 12.99 % (p<0.05). It was proposed to use the scale CAGE was used to assess the severity of CP in combination with HCV and it was established that in the group of patients with a CAGE value ≥2.0, there was a deepening of excretory pancreatic insufficiency, structural and biochemical changes of the liver and pancreas, and deterioration of nutritional status. The deterioration of the nutritional status in the comorbidity of CP and HCV was established in relation to those in CP: protein deficiency, anemia, proteinogram disorders, endotoxicosis, dyslipidemia, vitamin and macro- and microelement deficiency, immunodeficiency with deepening of secondary immune deficiency according to the relative suppressor variant with simultaneous non-specific activation of B -lymphocytes. It was established that the state of MM of the organs of the gastrointestinal tract of patients with a comorbid course of CP and HCV was reliably 2.76 times worse in terms of the total number of pathological signs than in isolated CP. The additional inclusion of Heparizin in the CP in combination with HCV treatment protocol was proposed and substantiated for higher efficiency in relation to GCT, better correction of clinical signs, improvement of the physical and mental components of the quality of life according to the SF-36 and the dynamics of the scales of the GSRS questionnaire (p<0.001); by correction of anemia to the normal state, by a more significant improvement in the functional and structural state of the liver and pancreas, lipid profile, vitamin and micro- and macroelement status, by higher effectiveness on cellular and humoral immunity (р<0.001). The higher effectiveness and expediency of a treatment program with the inclusion of a combination of hepatotrophic agents heparizin and methadoxin in the problem group of patients with CP and HCV with CAGE≥2.0 compared to those in the group of GCT+HZ with a higher level of elimination of clinical symptoms, improvement of the quality of life was proposed and proved for the first time. SF-36 (according to the physical and mental components by 55.5 % and 21.8 %, respectively), according to the positive dynamics of the parameters of the scales of the GSRS gastroenterological questionnaire (p<0.001), according to the improvement of the functional and structural state of the liver and pancreas, according to the higher dynamics of the parameters lipidogram, parameters of the exchange of micro- and microelements and vitamins, better correction of immunodeficiency, according to the safety of this complex due to the positive effect on the morphological state of the MM gastroduodenal organs (according to the higher dynamics of the number of points of pathological morphological signs compared to that under the influence of GCT (by 82.9 % versus 42.2 % (р<0.05).