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DOI: 10.18413/2313-8955-2019-5-1-0-5

Pharmacological correction of immune and metabolic disorders in acute biliary pancreatitis of varying severity

Background:The incidence of acute pancreatitis is up to 40 cases per 100,000 adult population per year, including about 10-15% of patients with severe forms of this disease, and mortality reaching up to 80%.The aim of the study: to establish the pharmacological effectiveness of the combined use of immunomodulators, antioxidants and membrane protectors in acute biliary pancreatitis of varying severity in the experiment and clinic. Materials and methods: Acute pancreatitis was modeled in Wistar rats. Before and after the introduction of combinations of drugs, indicators of the immune status and parameters of the oxidative system were evaluated. 72 patients of Kursk City Hospital No. 4 were clinically examined and treated with minimally invasive surgical methods in combination with pharmacotherapy, using Polyoxidonium, Emoxipine and Essentiale N. The blood levels of cytokines, complement system parameters, and oxidant system were evaluated. Results: It was experimentally established that in relation to the mild form of acute pancreatitis, the changes were completely corrected by combinations of Ferrovir, Mexidol and Phosphogliv or Polyoxidonium, Emoxipine and Essentiale N, and with medium and high severity, pronounced immunometabolic disturbances were observed, which were not effectively corrected with the proposed combinations. Clinically, with mild, to a lesser extent, with a medium form of acute biliary pancreatitis, a more pronounced pharmacological efficacy of a combination of Polyoxidonium, Emoxipine and Essentiale N. was observed. Conclusion: The combination of Polyoxidonium, Emoxipine and Essentiale N in experimental acute pancreatitis of varying severity in the correction of immune and metabolic disorders was most effective. In patients with acute pancreatitis of biliary etiology of mild, to a greater extent with medium severity, in plasma, there was found an increase in the level of pro-, anti-inflammatory cytokines, metabolic activity of peripheral blood neutrophils, activation of lipid peroxidation, a decrease in the content of C3-and C4-complement components, phagocytic activity of blood neutrophils. In a medium degree of severity, a further increase in the content of IL-10, the activity of superoxide dismutase, catalase, a decrease in the levels of IL-2, IL-1Ra were observed. The inclusion in the treatment of patients with acute pancreatitis of biliary etiology of mild severity of a combination of polyoxidonium, emoxypine with Essentiale N has completely normalized changes in immune and oxidant parameters. In the medium severity the used scheme has corrected totally 78.4% of the laboratory immunometabolic parameters

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