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GASTROENTEROLOGY
INVENTION
Patent of the Russian Federation RU2286773

METHOD FOR TREATMENT OF LIVER DISEASES

METHOD FOR TREATMENT OF LIVER DISEASES

The name of the inventor: Yermolov Sergey Yurievich (RU); Shabrov Alexander Vladimirovich (RU); Yermolova Tatiana Vyacheslavovna (RU); Kolesnikov Maxim Evgenievich
The name of the patent holder: State Educational Institution of Higher Professional Education St. Petersburg State Medical Academy. I.I. Mechnikov
Address for correspondence: 195067, St. Petersburg, Piskarevsky Ave, 47, VPO SPbGMA them. I.I. Мечникова, пав.1, the patent department
Date of commencement of the patent: 2004.07.19

The invention relates to medicine, in particular to hepatology, and is intended for the treatment of patients with liver diseases. To do this, L-ornithine-L-aspartate is injected intravenously every day, previously dissolving 10 g of this preparation in 400 ml of a solution of low molecular weight dextran, with a course of 7-10 days. This embodiment of the method provides effective treatment by improving the hemodynamics of the liver.

DESCRIPTION OF THE INVENTION

The invention relates to the field of medicine, in particular for the treatment of patients with liver diseases.

A method for treating patients with liver diseases is known by improving microcirculation of the liver with nitroglycerin. Nitroglycerin is a powerful venous and moderately active arterial vasodilator. This drug causes a decrease in intrahepatic resistance. Its use makes it possible to reduce the amount of bleeding from varicose veins and the frequency of esophageal tamponade. Nitroglycerin is administered intravenously 40 mg / min or transdermally.

When nitroglycerin is used, headache, hypotension, dizziness (Cestari R, Braga M, Missale G et al., Haemodynamic effect of triglycyl-lysine-vasopressin (glypressin) on intravascular oesophageal variceal pressure in patients with cirrhosis is possible. Hepatol, 1990; 10: 205. Millikan WJ, Warren WD, Henderson, JM et al., The Emory Prospective randomized trial: selective versus non-selective shunt to control variccal bleeding, Ten-year follow-up.Ann., Surgut 1985, 201: 712 ).

A method for treating patients with liver diseases is known by correcting the hemodynamics of the liver with the drug vasopressin. The mechanism of action of vasopressin is to reduce the diameter of the arterioles of the internal organs, which causes an increase in resistance to the blood flow in the intestine, which results in a decrease in pressure in the portal vein. Vasopressin is administered intravenously at a dose of 20 IU in 100 ml of a 5% solution of glucose.

The use of vasopressin causes a decrease in coronary vessels. During the infusion, colic pains in the abdomen may appear, accompanied by emptying of the intestine, face pimple. The use of vasopressin decreases arterial blood flow, which is undesirable in cirrhosis of the liver (Valla D, Girod Lee SS, et al., Lakt of vasopressin action on splanchnic hemodynamics during bleeding; conscious, portal hipertensive rats., Hepatology 1988; 8:10).

A method for treating patients with liver diseases with angiotensin converting enzyme inhibitors is known. It is known that patients with liver diseases have elevated levels of angiotensin converting enzyme ("Diseases of the respiratory organs", edited by MMIlkovic, Nordmed-izdat, 1998, 221 s). During the therapy with captopril, there was an improvement in central and regional hemodynamics closely related to the normalization of the parameters of the receptor regulation of blood circulation. The main pharmacodynamic effect is the reduction of vascular resistance and the improvement of regional hemodynamics due to arterio- and venodilation, without the development of tachycardia, which favorably affects liver function in its primary and secondary lesions (Nedogoda SV "Receptor mechanisms of pharmacodynamic effects of cardiovascular drugs in patients Hypertensive disease, heart failure and chronic liver diseases (Author's abstract of dissertational medicine) -Volgograd, 1995, 36 p.).

However, nausea and diarrhea were noted in patients with this drug. In biochemical studies, an increase in the level of transaminases and bilirubin concentration, leading to the development of hepatic insufficiency, has been revealed (Handbook VIDAL, 2000. Izd: ZAO AstraFarmServis, 1089 pp. "Medicines in Russia", 2003. Izd .: Radar-2003, p. 436).

A method for treating patients with liver diseases with somatostatin is known. Somatostatin reduces resistance in the arteries of internal organs and thereby reduces pressure in the portal vein. Intravenous infusion of the drug adversely affects blood circulation in the kidneys and water-salt metabolism in the tubules, therefore, with ascites, it is prescribed with caution. When using somatostatin, there may be feelings of discomfort in the abdominal cavity, nausea, bradycardia, a sensation of hot flushes to the face. Treatment with somatostatin is performed only in hospital settings under the control of blood sugar level (Gines A, Salmeron JM, Gines somatostatin on renal function in cirrhos, 1992: 103; 1868).

Known is a method for treating patients with liver disease with octreotidine. Octreotidine is a synthetic analogue of somatostatin, which shares the same 4 amino acids with it. This drug, in contrast to somatostatin, does not reduce the incidence of early recurrence of bleeding (Primignani M, Andreoni B, Carpinel Sclerotherapy plus octreotide versus sclerotheraf, prevention of early rebleeding from esophagea, randomized, double-blind, placebo-controlled r trial, Hepatology, 1995; 21: 1322 ).

A method for treating patients with liver diseases is known by reducing cardiac output by blocking B 1 -adrenoceptors of the myocardium. Partially, this effect is given by propranolol. Metoprolol and atenolol are cardioselective blockers that reduce pressure in the portal vein less efficiently than propranolol. The use of this group of drugs has a large number of contraindications. Absolute contraindications include: bronchial obstructive diseases, bradycardia, hypotension, violation of peripheral blood supply, etc., which limits the use of these drugs (Sherlock, J. Dooley, Liver and Biliary Diseases, Izd. Meditsina GEOTAR, 1999, 860 from.).

A method is known for treating patients with liver diseases by correcting hemodynamics with ketanserin. Ketanserin - inhibits the sensitivity of S 2 receptors in the vessels of the portal system. Ketanserin is a serotonin inhibitor that reduces pressure in the vein port system. The use of this drug is limited due to frequent side effects (Vorobioff J, Garcia-Tsao G, Gamen M, Picabea E. Long-term hemodynamic effects of ketanserin, a 5-hydrotrjptamine blocker, in portahypertenzie patients., Hepatology, 1989, 18; 9; ; 88).

A method for treating patients with liver diseases by correcting hemodynamics with verapamil is known. Verapamil - a blocker of calcium channels, reduces pressure in the portal vein and intrahepatic resistance due to the opsonic vascular resistance. Verapamil causes hypotension, is contraindicated in case of circulatory failure, with sinus node weakness (Moreau R. Lee S, Ha-dengue A et al., Hemodynamic effects of a clonidine-induccd decrease in sympathetic tone in patients with cirrhosis., Hepatology, 1987; 7: 149 Handbook VIDEAL, 1998. "Medicines in Russia", 1998, p.120).

As a prototype for the closest technical essence, we chose a method for treating patients with liver diseases by correcting the hemodynamics of the liver with a clonidine preparation. Clonidine is used as a course monotherapy. Its pharmacological effect is the reduction of vascular resistance and the improvement of regional hemodynamics in combination with a pronounced decrease in the heart rate and an increase in the shock index (Nedogoda SV "Receptor mechanisms for the realization of pharmacodynamic effects of cardiovascular drugs in patients with essential hypertension, heart failure and chronic liver disease." Doctor of Physical and Mathematical Sciences, Volgograd, 1995, 36 p.).

The drawbacks of the prototype include the need for regular measurement of blood pressure during the administration of the drug. Treatment with the drug should not be suddenly abolished. The presence of a sedative effect and the possibility of slowing down the reactivity significantly limits the widespread use of this drug in hepatology (MD Mashkovskii, "Medicinal products", part 1. M., Medicine, 1986, p.441).

The object of the invention is to develop a method for treating patients with liver diseases, which increases the effectiveness of therapy by improving hemodynamics of the liver.

The goal is achieved by administering intravenous drip L-ornithine-L-aspartate daily, 10 g of this preparation in 400 ml of low molecular weight dextran solution, the course of treatment for 7-15 days.

The method is carried out in the following way: after conducting clinical and laboratory and psychometric studies, the porto-hepatic hemodynamics is evaluated by the method of polyhepatography (Radchenko VG, Ermolov S.Yu., ALDobkes et al. "Polyhepatography", manual for doctors St. Petersburg " NEO, 60 s), followed by a course of intravenous drip daily L-ornithine-L-aspartate for 7-15 days, previously dissolving 10 g of the drug in 400 ml of low molecular weight dextran (Rheopolyglucin), and this therapy is performed against the background Basic treatment, including polyenzymes, vitamins, infusion therapy with 5% glucose solution, etc.

Currently, L-ornithine-L-aspartate is used only in the treatment of liver diseases accompanied by the development of hepatic encephalopathy. Numerous studies have shown that the drug contributes to a decrease in the concentration of ammonia due to the enhancement of urea synthesis (by 80%) and the enhancement of glutamine synthesis (Gebhardt R, Beckers G., Gaunits F., Haupt W., Jonitza D., Klein S., Scheja L Treatment of cirrhotic rats with L-ornithin-aspartate enhances urea synthesis and lowers serum ammonia levels J.Phamacol.Exp.Ther., 1997; 283: 1-6; Kircheis G, Nilius R., Held C., et al. Therapeutic efficacy of L-ornithin-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: Results of a placebo-controlled double-blind study Hepatology, 1997; 25: 1351-60; Rees CJ, Oppong K., Mardin HAL, Hudson M., Record CO Effect of L-ornithin-L-aspartate on patients with and without TIPS undergoing glutamine challenge: a double blind, placebo controlled trial, GUT 2000; 47: 571-574), decreasing manifestations of hepatic encephalopathy (Lopatkina T .N., Nastestnikov EV L-ornithine-L-aspartate in the complex therapy of port-systemic encephalopathy. "Liver diseases and hepatic encephalopathy", Satellite symposium, 2002, p.3; Podymova SD, Nadinskaya M.Yu. Treatment of hepatic encephalopathy with Hepa-Merz. Satellite symposium "Liver diseases and hepatic encephalopathy", 2002. - p.1-2; Radchenko VG, Radchenko ON Hepatic encephalopathy. The manual for physicians- SPb: SPbGMA, 2001. - 32 seconds; Rose C, Michalak A, Pannunzio P, et al. Ornithine-L-Aspartate in experimental portalsystemic encephalopathy: therapeutic efficacy and mechanism of action. Metab. Brain Dis. 1998; 13: 147-157; Stauch S., Kircheis G., Adier G., et al. Oral L-ornithin-L-aspartate therapy of chronic encephalopathy: results of a placebo-controlled double-blind study. J.Hepatol. 1998; 28: 856-64).

With the above method of treating patients with liver diseases with L-ornithine-L-aspartate, we first discovered a new property of the drug that is related to its effect on liver hemodynamics, which is of fundamental importance in the therapy of patients with liver pathology. According to a number of authoritative hepatologists: "The liver should be considered as a bivouac tree with a developed vasculature, where only the total area of ​​hemocapillaries is about 400 m 2. The structure of the liver is not the result of a rigid anatomical structure, but arises under the influence of functional hemodynamic factors" (Elias 1952) . It is also important that hemodynamic disorders are reversible and this allows us to place certain hopes on the possibility of pathogenetic therapy of patients with liver diseases due to correction of local porto-hepatic hemodynamics (MD Patsior, 1974).

As an example, an extract from the case histories

Example №1

The patient J., 52 years old. Diagnosis: Chronic alcoholic hepatitis, chronic cholecystitis, chronic pancreatitis in the phase of moderate exacerbation. From anamnesis, it is known that he works as a seller in a liquor store. Over the past 15 years, daily use of alcoholic beverages. At the time of the examination I complained of nausea, belching, a decrease in appetite, a feeling of heaviness in the right hypochondrium and epigastric region, bloating, unrelated periodic stitching behind the sternum, palpitations. With an objective examination of the patient, a strengthening of the venous pattern on the breast was noted against the background of the sub-type of the skin and visible mucous membranes. The boundaries of the heart are widened to the left by 1.5 cm. With auscultation, 1 tone at the top and at the Botkin point is weakened, a gentle systolic noise is heard in the projection of these points. Breath hard. The frequency of breathing is 16 per minute, there is no rattling. When examining the abdominal cavity: the abdomen is of normal shape, with palpation soft, painless, the liver is enlarged by 6 cm, the liver edge is even, elastic, rounded, the spleen is not palpable, the size of the spleen is not increased percussionally. The kidneys are not palpable, there is no peripheral edema. When studying peripheral blood, the content of hemoglobin, erythrocytes, white blood cells, platelets did not differ from normal parameters, an increase in ESR - 25 mm / h. In the biochemical studies of blood: Total protein - 73 g / l, albumins - 54%, gamma globulins 36.3%, a sulphure test - 1.6 ml, ALT - 17.1 mmol / l, bilirubin 24.8 mkmol / L, ESR - 11 mm / h, CEC - 19.1. When carrying out the ELISA: HbsAg (-), HBeAg (-), anti-HBcor sums, anti-HCV sums. (-). The patient underwent polyhepatography (PGH), where an increase in the base resistance was noted against the background of a high amplitude of rheographic curves. Disturbances of porto-hepatic hemodynamics are associated with a predominant violation of venous outflow. Rheographic signs of sinusoidal intrahepatic hypertension. During the SMAD, the formation of the blood pressure profile of the "non-dipper" type was noted. Rhythmocardiography showed signs of a vagosympathetic imbalance during an orthostatic test and the preservation of the normotonic type of regulation in other positions. ECG - supraventricular extrasystole. Echo-cardiography - an increase in the fraction of the ejection of the left ventricle. When performing a liver scan, diffuse liver changes, hepatomegaly are noted. According to the ultrasound dopplerographic duplex study of the abdominal cavity organs, the liver was enlarged: the right side of the lobe was 215 mm (+6.0), the left share was 170 mm (+6.0 cm). The structure of the liver is heterogeneous, moderately diffusely altered. The spleen is not enlarged - 106/50 mm. Portal vein - 10.6 mm, not enlarged. Splenic vein - 6.2 mm, not enlarged. With dopplerography of the vessels of the liver - the vascular tree is uniform, moderately saturated, the venous component predominates. Blood flow through the veins is bi-directional, segmental veins - linear, unidirectional. Velocity characteristics of blood flow in the veins is from 8 to 14 cm · s. The diameter of the veins of the liver at the level of confluence in the lower vena cava is 4 and 5 mm, the blood flow is bi-directional. Blood flow in the hepatic arteries could not be identified due to poor visualization of the arteries. Pancreas, head 24.2 mm, body 16.6, tail 15 mm. Contours equal. The structure of reduced echogenicity with fibrosis sites, there are no focal changes. The virsungov duct is 2.4 mm in diameter. Holedoch 3.7 mm. Gallbladder: the wall is thickened to 0.4 cm, there are no concrements. Conclusion: hepatomegaly, diffuse liver changes, diffuse pancreatic changes. Ultrasound signs hr. Cholecystitis. The patient underwent a liver biopsy, where morphologic studies indicated that the lobular structure was preserved, the large-droplet, fatty degeneration of hepatocytes, pronounced nuclear polymorphism, and few focal hepatocyte necrosis. Fibrosis of central veins. The portal tracts are slightly enlarged and fibrotic with mild lymphomacrofagal infiltration. Hemosiderosis of the 1st degree with pulverized pigment granules, Orcain color is negative.

The patient was treated with: Intravenous drip injection of 5% glucose solution and B vitamins, C. Creon, LIV 52, tocopherol acetate was administered. However, despite the ongoing therapy, no significant dynamics were obtained, which resulted in a course of 7 days of intravenous drip injection of L-ornithine-L-aspartate (Hepa-Mertz), previously dissolved 10 g in 400 ml Low molecular weight dextran (Reopoliglyukin). After this therapy, the patient's condition improved significantly, weakness, nausea, a feeling of heaviness in the right hypochondrium and epigastric region, belching, bloating, and appetite normalized. In an objective examination of the patients normalization of the color of the skin and mucous membranes, reduction of liver size was noted. When performing polyhepaticography, a positive dynamics was obtained in dynamics, which was manifested by improvement of venous outflow, decrease in rheographic features of sinusoidal hypertension (Fig. 1). (Number 1 shows the rheogram of patient J. in the area of ​​the left lobe of the patient's liver before L-ornithine-L-aspartate therapy (Hepa-Mertz.) Number 2 rheogram of patient J. in the left lobe of the patient's liver after L-ornithine L Aspartate (Hepa-Mertz)).

Against the background of improved porto-hepatic hemodynamics, the clinical and laboratory parameters improved: the total protein was 73 g / l, albumins 54%, gamma globulins 36.3%, the sulphate test 1.6 ml, ALT 17.1 mmol / l, Bilirubin 24.8 μmol / L, ESR 11 mm / h, CEC 19.1.

Example №2

Patient F., 40 years old. Diagnosis: Chronic viral hepatitis C, replication phase, with pronounced activity, grade 2 fibrosis, initial signs of portal hypertension. At admission, she complained of weakness, decreased ability to work, pain in the right upper quadrant, unstable stools. She is sick for 3 years, when she first began to notice a decrease in working capacity, the appearance of unmotivated weakness, increased fatigue, episodic pain in the right hypochondrium and epigastric region, mainly associated with physical and psychoemotional stress. She did not go to doctors. Occasionally, ultrasound examination showed hepatomegaly, in the clinical analysis of blood, thrombocytopenia increased with ESR. In this connection, the patient was referred to a hospital for examination and treatment. Objectively: at the time of admission, the condition is satisfactory, the skin is clean, of normal color, the sclera is sub-bacterial. Pulse 76 beats per minute, rhythmic. Blood pressure 130/70 mm Hg Heart sounds are clear, rhythmical, the tone ratio is not changed. The liver is enlarged, protrudes from under the edge of the costal arch by 4 cm, the spleen is not palpable.

At the examination: erythrocytes 4,36 × 10 12 / l, hemoglobin 132 g / l, color index 0,92, leukocytes 6,0 × 10 9 / l, platelets 153,8 × 10 9 / l, ESR 26 mm / hour , ASAT 0.48 mmol / L, ALT 2.04 mmol / L, bilirubin 30.6 μmol / L, 100 mg ED / L, GGTP 77 ED / l, thymol test 7.0 ALL, albumins 48%, gamma Globulins - 38,5%. HCV-RNA (++) in the blood serum is positive by PCR, positive antibodies to the hepatitis C virus (ELISA). Indicators of adaptive and nonspecific immunity: CD3 0.620 × 10 9 / l, CD4 0.410 × 10 9 / l, CD8 0.252 × 10 9 / l, CD4 / CD8 1.62; CD72 0.192 × 10 9 / l, CEC 142.38 units, IgG 21.4 g / l. The patient underwent PGH, where against the background of an increase in the base resistance and a decrease in the amplitude of the rheographic curves, a perversion of the rheographic curves in the region of the right, left lobe of the liver and spleen was noted. Infringements of intrahepatic hemodynamics are caused by a predominant infringement of a venous inflow. Signs of violation of venous outflow from the spleen.

During the GSC, inhibition of autonomic regulation was noted with an increase in the role of humoral-metabolic influences in the sinus node. On ECG signs of left ventricular hypertrophy, prolongation of the QT interval. When performing ultrasound of the heart, signs of mild hypertrophy of the left ventricle, an increase in the end systolic and diastolic volumes (CSR, BWW), stroke volume (VO), cardiac index (SI), minute volume of blood flow (IOC). FGDS - gastroduodenitis. According to ultrasound, hepatomegaly is noted, signs of chronic cholecystitis, according to ultrasound duplex Dopplerography of liver vessels, the liver is increased. The right lobe of 191 mm (+4.1 cm), kt. Left lobe 128 (2.8 cm), the structure of the liver is non-uniform, there are moderately diffuse liver changes. The spleen is not enlarged. With dopplerography, the vascular tree is uniform, moderately saturated, and the venous component predominates. Velocity characteristics in arteries and veins correspond to normal values. Ventral vein 15 mm wide, blood flow linear unidirectional. Conclusion: Liver enlargement due to both lobes of the liver, moderate diffuse changes, signs of portal hypertension. In the radioisotope study of the liver - hepato-splenomegaly, diffuse liver changes, signs of portal hypertension, the accumulation of radiopharmaceutical in the spleen was 35%.

When morphological study of the liver: lobular architectonics preserved, expressed granular, hydropic and focal fatty degeneration of hepatocytes, moderate polymorphism of nuclei. Common focal, stepwise and single bridged necrosis of hepatocytes. The individual portal tracts are moderately expanded, fibrotic in places with the formation of port-portal septum with dense lymphoid infiltration. The staining for iron and orsein is positive. The histological picture of the liver corresponded to chronic hepatitis with a moderate degree of activity and fibrosis.

The patient underwent therapy: course for 15 days of the daily intravenous drip of L-ornithine-L-aspartate (Hepa-Mertz), previously dissolved 10 g of the drug in 400 ml of low molecular weight dextran (Reopoliglyukin). In addition, intravenous drip injection of a 5% solution of glucose and vitamins of group B, C, tocopherol acetate, thymalin No. 10 in / m was prescribed. A pancitrate of 10,000 was appointed. After this therapy, the patient's condition improved significantly, weakness, a sense of heaviness in the right hypochondrium and epigastric region, normalized appetite. With an objective examination of patients noted: the normalization of the color of the skin and mucous membranes, reducing the size of the liver.

In the course of polyhepatography, positive dynamics was obtained in the dynamics, manifested by an improvement in the venous influx, an increase in the blood filling of the liver, a decrease in the signs of presynusoidal hypertension, and hemodynamic disorders of the spleen (FIG. 2).

Where, under number 1, was the rheogram of the patient F. in the region of the left lobe of the patient's liver before L-ornithine-L-aspartate therapy (Hepa-Mertz), and number 2 was the rheogram of the patient F. in the left lobe of the patient's liver after L-ornithine therapy -L-aspartate (Hepa-Mertz).

Improvement of hemodynamics of the liver was accompanied by an improvement in clinical and laboratory indicators. At the examination: erythrocytes 4,32 × 10 12 / l, hemoglobin 131 g / l, leukocytes 6.0 × 10 9 / l, platelets 173.8 × 10 9 / L, ESR 16 mm / h, AsAT 0.45 mmol / L, AlAt 0.64 mmol / l, bilirubin 10.6 μmol / L, APF 86 ED / l, GGTP 67 ED / l, thymol test 5.0 ALL, albumins 58%, gamma globulins 22.5 %, ESR - 16 mm / h, CEC - 19.0 RNA PCR C (+) HCV (+).

Test Case

Case history patient K., 36 years old. Diagnosis: Chronic viral hepatitis B with marked activity. When you receive a complaint: weakness, pain in the right upper quadrant, edema on the legs. She is 2 years old, was treated in various therapeutic hospitals. Objectively: the patient's condition is satisfactory, the stomach is swollen, the liver protrudes from under the costal arch for 3 cm, dense at palpation, the spleen is palpated, the pastostess of the lower extremities is noted. In the analyzes: total protein - 64 g / l, albumins - 41.8%, gamma globulins - 32%, sulphate test - 0.9 ml, bilirubin - 38.9 mkmol / l, ALT - 30.1 mmol / l , ESR - 28 mm / h, CEC - 39 units. HBsAg (+). RHG: a violation of liver hemodynamics primarily due to a violation of the venous influx. Treatment: triampur, vitamins B and C, mezim-forte, solution of 5% glucose IV drip No.10, rheopolyglucin IV drip No.10. To improve the hemodynamics of the patient, the patient was assigned clonidine 0,075 1/2 times a day. Against the background of the therapy, pains in the right hypochondrium occurred. In the assays: HBsAg, determined by the enzyme immunoassay. The total protein is 73 g / l, albumins 44.3%, gamma globulins 28.3%, the sulphate sample 1.1 ml, ALT 25.1 mmol / l, bilirubin 36.8 μmol / L, ESR - 24 mm / h, the CEC - 29.1 units. However, 3 weeks after the therapy, the patient refused to take clonidine because of pronounced dry mouth and pronounced weakness. When studying porto-hepatic hemodynamics against the background of this therapy, no significant dynamics were obtained.

These excerpts from the case histories have shown that using the proposed method, it is possible to treat patients with liver diseases more effectively in comparison with the prototype by improving the hemodynamics of the liver. The presented method of treatment was applied in 20 patients with liver diseases. The results of treatment of the claimed method are shown in diagram No. 1 (Fig. 3). Data of treatment by the prototype therapy method of 10 patients are presented in diagram No.2 (Fig. 4).

As can be seen from the presented data, the claimed method significantly improves clinico-biochemical and immunological data in comparison with the prototype.

Thus, the results obtained by us on the effect of L-ornithine-L-aspartate (Hepa-Mertz) on porto-hepatic hemodynamics in patients with liver diseases indicate a new mechanism of action of this drug, indicated in Scheme 1 (Fig. 5).

CLAIM

The method of normalizing hemodynamics in liver diseases by drug treatment is distinguished by the fact that L-ornithine-L-aspartate is injected intravenously every day by intravenous injection, previously dissolving 10 g of this preparation in 400 ml of a solution of low molecular weight dextran, with a course of 7-15 days.

print version
Date of publication 28.03.2007gg