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INVENTION
Russian Federation Patent RU2262341

METHOD regenerative treatment of patients with chronic cholecystitis

METHOD regenerative treatment of patients with chronic cholecystitis

Name of the inventor: Antonyuk MV (RU); Saino OV (RU); Knyshova VV
The name of the patentee: Far Eastern Scientific Center of Physiology and Pathology of respiration, Siberian Branch of the Russian Academy of Medical Sciences
Address for correspondence: 690105, Primorsky Krai, Vladivostok, Russian, 73G, Far Eastern Scientific Center of Physiology and Pathology of respiration, Siberian Branch of the Russian Academy of Medical Sciences
Starting date of the patent: 2003.09.10

The invention relates to medicine, namely to gastroenterology and may be used for the purpose of rehabilitation of patients with chronic cholecystitis. A method of rehabilitation treatment of chronic cholecystitis, which includes diet therapy and appointment hitamina at a dose of 0.6 g 3 times a day for 1-1.5 hours before a meal for 21-24 days. This method provides improved passage of bile, obstructing its stagnation, and anti-inflammatory effect, reducing the side effects.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely to gastroenterology and may be used for the purpose of rehabilitation of patients with chronic cholecystitis.

Among the diseases of the digestive system on the prevalence and complications is one of the main places takes a chronic cholecystitis. The problem of rehabilitation of patients with chronic cholecystitis is caused by the lack of an accepted and well-reasoned views on Lithogenesis and, as a consequence - in the pathogenetic therapy [5].

Chronic cholecystitis - a disease associated with the presence of inflammatory changes in the gallbladder wall. In the development of chronic cholecystitis is dominated by two factors: infection and bile stasis, which act at the same time. Infectious agents penetrate into the gallbladder hematogenous, lymphogenous or upward (from the lumen of the duodenum) through. of infection in the gall bladder emptying disorders contribute. At the same time, the inflammatory process in the gall bladder wall leads to its dysfunction bile stagnation and change its physicochemical properties, which, in turn, supports inflammation and promotes the formation of stones and [5].

Frequent exacerbations of chronic cholecystitis contribute to the spread of inflammation, scar on all of the gallbladder wall, which gradually creating sclerosis and thicken. In case of unfavorable course of the disease gall bladder heals adhesions with neighboring organs. Adhesions deformed gallbladder, disrupting its function, which creates conditions for the maintenance of the inflammatory process and periodic exacerbations. Infection of the gallbladder, bile stasis in it a violation of cholesterol metabolism contribute to stone formation in the gall bladder and the development of calculous cholecystitis.

In order to prevent progression of the disease is important to achieve stable long-term remissions. In this context, importance is a full replacement therapy during remission of chronic cholecystitis.

An important method of rehabilitation treatment of chronic cholecystitis is balneotherapy [4, 6]. For internal use of mineral water shows small and medium mineralization, in which structure is dominated by sulfate anions (sulfate, sulfate-chloride). Mineral water increase bile production and bile secretion, contribute to the normalization of liver function, it has a normalizing effect on the chemical composition of bile [6]. However, calculous cholecystitis drinking mineral water are of limited use and shows the patient only in the absence of frequent attacks of biliary colic and complications of the disease. In addition, despite the effectiveness of balneotherapy in chronic cholecystitis, this method of treatment has been applied mainly in sanatorium conditions. Balneoreabilitatsiya in chronic cholecystitis requires regular intake of mineral water for 3-4 weeks at a fixed time, the need to observe the temperature regime. In chronic cholecystitis shown drinking thermal (t 40-42 ° C) and vysokotermalnuyu (t 46-50 ° C) mineral water for 1.5 hours before eating. In the outpatient operating problematic patients to comply with the temperature and the multiplicity of reception of mineral water. After the course of balneotherapy in chronic cholecystitis the duration of remission, usually 5-6 months.

Along with the use of mineral water in the rehabilitation of patients with chronic cholecystitis used peloidotherapy. Peloids have anti-inflammatory, antispasmodic, analgesic effect, improves the functional state of the gallbladder, the liver [7]. Despite the widespread popularity peloidotherapy medically with calculous cholecystitis is of limited use, especially soon after an exacerbation. To a certain extent it limits the use of this method is labor and dorogostoimost mud-cure process. For storage and transportation of dirt and requires special storage container, whose use is only possible in sanatorium.

In chronic cholecystitis in remission applied herbal medicine. The efficiency of the plant collection of three components: herbs centaury, calamus root, flowers Helichrysum 1 part. It is advisable to use the official and cholagogue teas [3]. With ease of use, this method has a negative side. Herbal medicine as a way to treat chronic cholecystitis should be used with great caution, because in recent years an increasing number of people suffering from allergic reactions to plants up to anaphylactic shock. The efficacy of herbal medicine is observed in its long-term use, and the cancellation causes pain, dyspeptic syndromes.

A basic method of rehabilitation of patients with chronic cholecystitis is diet therapy. For this category of patients is a diet №5 by Pevzner, which is based on the following principles: frequent (4-6 times a day), split meals; inclusion in the diet of additional sources of fiber; increase in oil content (olive, sunflower, corn, soybean) to 50% of fat; limit spicy, salty, fried foods [3]. However, the recovery period of the disease, when clinical symptoms are mild, patients often do not comply with diet, violate dietary recommendations that usually leads to an exacerbation of the disease. A prerequisite of diet therapy is its long and often life-long observance. The disadvantages include diet therapy and the inability of many segments of the population as a result of financial difficulties to acquire the necessary dietary products.

To improve the effectiveness of diet therapy is possible through the use of biologically active additives (BAA) to food [1]. By Badam sorption action relates hitamin. Hitamin - mineral-organic complex of polysaccharide in the gel form of chitosan and zeolite. It refers to natural chitosan polymers obtainable from sea crab carapace. Hitamin has a high ability to adsorb molecules with both organic and inorganic substances. As enterosorbent hitamin shown at high toxic load on the body by living on environmentally unfavorable territories persons working in hazardous industries [2]. It is known to use hitamina with endogenous intoxication in patients with infectious diseases, but also in case of poisoning [2]. For the rehabilitation of patients with chronic cholecystitis hitamin not previously used.

Object of the invention - increase the effectiveness of rehabilitation of patients with chronic cholecystitis and increase in terms of remission.

The method provides for the appointment of diet therapy (table №5 by Pevsner) and receiving hitamina at a dose of 0.6 g 3 times a day for 1-1.5 hours before a meal with the use of large quantities of water (200 ml). The course of treatment is 21-24 days.

Hitamin (registration certificate №002512.R643.02.2001;. Developer OOO "Ark-III", Vladivostok) is fully compatible with body tissues and non-toxic.

We observed 57 patients with chronic cholecystitis in remission. The main group supervision (group 1) consisted of 30 people who received diet therapy (diet №5 by Pevzner) in conjunction with hitaminom at a dose of 0.6 g (1 capsule) 3 times a day for 1-1.5 hours before a meal . control patients (2 nd) group (27 persons) received only diet therapy. The course of treatment was 21-24 days.

The effectiveness of ongoing rehabilitation was assessed by the dynamics of clinical symptoms, expressed in the point system, according to laboratory studies of blood and duodenal contents.

At the initial examination of patients with a range of scores ranged from 0 to 3, and reflects the severity of pain, dyspeptic and other symptoms. Scoring system allows us to trace the dynamics of the process and to assess the effectiveness of rehabilitative measures in terms of the integral (PI), especially in the stage of remission because of the low severity of their symptoms. Score included the following characteristics identified by a subjective study: 0 points - there is no symptom; 1 point - symptoms are negligible; 2 points - symptoms are moderate; 3 points - symptoms are sharply. Scoring was carried out by dividing the sum by the number of scores of patients. For each group calculated the integral index (PI) before and after treatment, and the dynamics of these indicators - the degree of improvement of the clinical picture of the disease. Coefficient of clinical efficiency was calculated by dividing the SP to SP treatment on the group after the treatment. Calculation of the coefficient of clinical efficacy makes it possible to objectively evaluate the effectiveness of ongoing rehabilitation therapy.

The patients of both groups during treatment revealed different dynamics of clinical manifestations (Table 1). As can be seen in the main group at the end of a course of rehabilitation gone most of the manifestations of dyspeptic syndrome, significantly reduced the severity of pain. Integral index in this group at the end of treatment was 0.08, and the effectiveness of treatment - 92.8%. In the control group dynamics of clinical symptoms by the end of recovery was less pronounced efficacy of the treatment was 48%.

The study of duodenal contents showed a positive trend against the background of diet therapy in combination with hitaminom inflammatory mezehimalnyh indicators: the number of white blood cells was reduced by 30%, sodium bilirubinate - by 28.6%, whereas in the control group, the corresponding figures have decreased by 10% and 8% respectively. In the blood of patients in Group 1 installed decline increased activity of alkaline phosphatase, AST and ALT levels (Table 2). The findings suggest that regression syndrome and cholestatic membranodestruktivnyh stabilization processes in the hepatocytes against a background of diet therapy in combination with hitaminom. Dynamics of lipid abnormalities identified in patients of the observation group, characterized by a decrease in total cholesterol (TC) at 6.36%, triglycerides (TG) - by 18.2%, an increase in high density lipoprotein cholesterol content (HDL-C) - 15.7 %. In the control group of patients of similar dynamics of indicators was insignificant (Table 2)

Thus, the analysis of clinical and laboratory research suggests that hitamin anti-inflammatory effect, corrects cholesterol metabolism, and normalizes the composition of bile, preventing stone formation, which is the basis for the application hitamina in chronic cholecystitis.

After a course of rehabilitation of the patients were under the watchful for 1 year. Analysis of the frequency of exacerbations in the study group and in the control of observation showed that patients treated with hitamin, exacerbations frequency decreased significantly (see. Figure). For example, 7% of patients with chronic cholecystitis mild during the entire follow-up period was not relapse. Half the patients were exacerbation 1 times a year, the number in the control group of patients was 30%. A significant proportion of patients (11%) in the control group of disease exacerbation was observed 3 times a year (the main group - 3%). Duration of remission on average in the group of patients receiving hitamin, was 9.3 months in the control group - 7.2 months.

The results of the study suggest that the use of diet therapy in combination with hitaminom in chronic cholecystitis increases the effectiveness of rehabilitation treatment in remission and prolongs remission to 9.3 months, exerting a positive influence on the dynamics of clinical displays, indicators of mesenchymal inflammation, lipid metabolism and and improve the composition of duodenal contents, preventing stone formation. The proposed method is efficient, does not cause side reactions, easy to use and malozatraten.

BIBLIOGRAPHY

1. Belyakov NA Enterosorption. - Leningrad, 1991. - 327 p.

2. Gichev JJ, Yu Gichev Guide to biologically active food additives - M .: Triad-X, 2001. - 232 p.

3. Gurvich MM Health Diet. - M .: Legprombytizdat, 1995 - 210 p.

4. Lim VI Action Shmakovsky mineral water biliary liver function and effectiveness of the treatment of the water of patients with chronic cholecystitis in the resort "Shmakovka". - Dis .... kand. honey. Sciences. - Khabarovsk, 1971 - 15.

5. Manual of Gastroenterology / Ed. F.I.Komarova, A.I.Grebneva, A.I.Hazanova. - Volume 2. - M .: Medicine, 1995. - 324.

6. Serebrina LA Drug-free treatment in the clinic of internal diseases. - Kiev: 3dorovya, 1995. - 525 p.

7. Shustov LP Extracts of silt sulfide mud and its therapeutic use. - Tomsk: Publishing house TPU, 1996. - 182 p.

CLAIM

A method of rehabilitation treatment of chronic cholecystitis, including diet therapy, characterized in that it further hitamin administered at a dose of 0.6 g three times a day for 1-1.5 hours before meals for 21-24 days.

print version
Publication date 28.01.2007gg