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Introduction. Alcohol-related liver cirrhosis is one of the leading causes of hospitalization and disability in patients with gastrointestinal disease. The aim of the study – to learn the effectiveness of treatment of patients with alcoholic liver cirrhosis (ALC) combined with obesity depending on the stage of decompensation using ademethionine and arginine glutamate. Research Methods. 215 patients, diagnosed with ALC, took part in the study, including 66 women and 149 men. 109 people had ALC with obesity and 106 people had ALC without obesity. Patients were divided into subgroups depending on the stage of decompensation according to Child-Pugh. Depending on the treatment protocol (b protocol – basic therapy, h protocol – basic therapy in combination with ademethionine and arginine glutamate), all patients were divided into subgroups. Results and Discussion. In this study, the values of carbohydrate metabolism, adiponectin and leptin were used to evaluate the effectiveness of a three-month treatment regimen with ademethionine and arginine glutamate in patients with ALC in combination with obesity. Obese patients with ALC have a more severe course of the disease, accompanied by more pronounced clinical manifestations, impaired carbohydrate metabolism and imbalance of leptin and adiponectin levels. The inclusion of ademethionine and arginine glutamate in the treatment regimen for 3 months allowed to improve the general condition of patients, their clinical and laboratory parameters and reduce the rate of disease progression, which is reflected in improved carbohydrate metabolism, leptin and adiponectin and reduced indicators of the severity scale according to Child-Pugh and the 3-month MELD mortality score. Conclusions. Inclusion of ademethionine and arginine glutamate in the complex treatment of patients with ALC in combination with obesity helps to reduce insulin resistance, improve leptin and adiponectin. In patients with ALC in combination with obesity, the inclusion in the complex treatment of ademethionine and arginine glutamate helps to improve the course of the disease according to the indicators of the severity scale using the Child-Pugh and MELD scales.

Today, it has been proven that about 10% of deaths among young and middle-aged people relate to the consumption of alcoholic beverages. Alcohol is ranked third among the causes of mortality in young people after tobacco and arterial hypertension, and second place-among the causes of liver transplantation in Europe. In Ukraine, mortality due to alcoholic liver disease (ALD) has taken second place in the structure of causes of death from diseases of the digestive system. The objective: to study the peculiarities of the causes of death in patients with ALD at the stage of liver cirrhosis (LC) associated with nonalcoholic fatty liver disease (NAFLD) on the basis of the analysis of pathoanatomical research protocols. Materials and methods. 216 protocols of the pathoanatomical study of the patients who died from LC have been analyzed. Results. It was found that people who abused alcohol died at the stage of subcompensation and compensation from pancreatic necrosis, and at the stage of decompensation-from the gastrointestinal bleeding (GIB) (more than half patients), hepatic, hepatic-renal insufficiency (HRI) and sepsis. The causes of death of people with NAFLD at the stages of compensation and subcompensation were myocardial infarction, cardiogenic shock, pulmonary embolism, mesenteric thrombosis and brain stroke; and in the stage of decompensation in most cases the hepatic and HRI were detected. In patients with a combination of ALD disease and NAFLD at the stage of LC, the causes of death were the following disorders at the stage of compensating: myocardial infarction, cardiogenic shock, pulmonary embolism, mesenteric thrombosis, brain stroke and pancreatic necrosis; at the stage of subcompensation, apart from the mentioned disorders, were: GIB and sepsis, and at the stage of decompensation there were myocardial infarction, cardiogenic shock, pulmonary embolism, mesenteric thrombosis, brain stroke, hepatic and HRI, GIB, sepsis, and hepatocellular carcinoma (5.7% of patients). Conclusions. Patients with NAFLD at the stages of compensation and subcompensation of LC are more likely to have acute cardiovascular mortality than patients with ALD. Patients with a combination of ALD and NAFLD, in addition to acute cardiovascular mortality, have more often septicemia and HRI, and hepatocellular carcinoma is diagnosed.

The effect of rivaroxaban on hemostasis was investigated in patients with alcoholic liver cirrhosis (ALC) in combination with obesity and non-valvular atrial fibrillation (NVAF). The study included 48 obese patients with ALC of class A (according to the Child-Pugh score) with NVAF, who were not previously treated with direct oral anticoagulants. There are 43 men and 5 women aged 35 to 64 years, mean age is (54.2±4.8) years. Depending on the treatment, patients were divided into two groups: group I included 22 patients who received oral anticoagulant rivaroxaban at a dose of 10 mg/day for 12 months, group II included 26 patients who received basic therapy without rivaroxaban for 12 months. Assessment of the patients’ condition was performed before treatment, 12, 24 and 48 weeks after treatment onset. The severity of LC was assessed according to the Child-Pugh and the MELD scores. Stratification of the risk of bleeding was performed according to the HAS-BLED score. It is shown, that in obese patients with ALC of class A according to the Child-Pugh score in the presence of NVAF, the use of rivaroxaban in combination therapy for 48 weeks contributed to the positive dynamics of hemostasis: decreased factor VIII activity, von Willebrand factor activity, reduced plasminogen activator inhibitor-1, D-dimer levels (p<0.05) and an increase in the activity of protein C (p<0.05), which was accompanied by a moderate decrease in the Child-Pugh and the MELD scores, and this was not observed in the comparison group. The use of rivaroxaban in this cohort of patients for 48 weeks did not increase the risk of major bleeding according to the clinical course and the HAS-BLED score. It is proved that the use of rivaroxaban in the complex treatment of patients with ALC of class A (according to the Child-Pugh score) in combination with obesity and NVAF, contributes to the positive dynamics of hemostasis with a reduced risk of hypercoagulation. Such therapy does not increase the risk of major bleeding at the stage of compensation of ALC in combination with obesity and NVAF.

Aim: to study the changes in liver parenchymal fibrosis under the influence of treatment of patients with alcoholic liver cirrhosis in combination with obesity using ademethionine and arginine glutamate. Material and methods. 215 patients, diagnosed with alcoholic liver cirrhosis (ALC), took part in the study, including 66 women and 149 men aged (48.1±9.7) years and a median disease duration (5.8 ± 2.6) years. 109 people had ALC with obesity (group I) and 106 people had ALC without obesity (group II). Patients were divided into subgroups depending on the stage of decompensation according to Child-Pugh: class A – group IA (n=40), class B – group IB (n=39), class C – group IC (n=30) and IIA (n=39), IIB (n=36), IIC (n=31) groups, respectively. Depending on the treatment protocol (b protocol – basic therapy, h protocol – basic therapy in combination with ademethionine and arginine glutamate), all patients were divided into subgroups. Results. In patients with ALC in combination with obesity, the elasticity of the liver parenchyma according to shear wave elastography and the FIB-4 index were higher than classes A, B and C compared to those in patients with ALC without obesity. According to the study results, obese patients with ALC had a more severe course of ALC according to the Child-Pugh and MELD scores. There is a direct relationship between the level of fibrosis in patients with ALC in combination with obesity according to elastography and the FIB-4 index with the severity of the disease according to the Child-Pugh ad MELD scores. The inclusion of ademethionine and arginine glutamate in the treatment regimen has improved the general condition of patients, compensated for clinical and laboratory parameters and reduced the rate of progression of liver fibrosis. Conclusion. In patients with ALC in combination with obesity, the inclusion in the treatment of ademethionine and arginine glutamate has improved the course of the disease, as evidenced by changes in the parameters of the disease severity by Child-Pugh and MELD scores, and helped to reduce the rate of progression of liver fibrosis according to elastography and the FIB-4 index.

Annotation. Liver cirrhosis is characterized by an increase in morbidity and prevalence, life-threatening complications, disability and increased mortality of the working population. The aim of the study was to study the effect of albumin on the course of alcoholic liver cirrhosis in combination with obesity at the stage of decompensation. The study included 52 patients with alcoholic liver cirrhosis in combination with obesity (confirmed before the onset of ascites) with the primary uncomplicated ascites of 2-3 degrees, 46 men and 6 women aged 35 to 59 years; 32 patients were diagnosed with class B and 20 – with class C according to the Child-Pugh score. Depending on the treatment, patients were divided into 2 groups: Group I included 26 patients who received in their combination therapy albumin 40.0 g/week for 2 weeks of inpatient treatment and 20.0 g/week for 12 weeks of outpatient treatment, followed by a maintenance dose of 20.0 g/month (10.0 g/2 weeks) for 12 weeks; 24 weeks after the start of treatment, 16 patients gave their consent and continued maintenance therapy for another 24 weeks. Group II included 26 patients who received basic therapy without albumin. Assessment of patients was performed before treatment, 12, 24, 48 weeks after treatment onset; in 96 weeks – according to medical documentation. Statistical processing of the results was performed using software Microsoft Excel spreadsheet and application package Statistica v. 12.0 StatSoft, USA. In patients with alcoholic liver cirrhosis in combination with obesity, the inclusion in the complex therapy of long-term use of albumin improves the course of the disease according to the Child-Pugh score, MELD, DMF and CLIF-SOFA indices. There was a reduce the recurrence of ascites, the number of complications, a re-hospitalization within a year, an increase in the survival of patients within 48 months. No side effects of albumin were noted. Thus, long-term use of albumin in complex treatment of patients with alcoholic liver cirrhosis in combination with obesity contributes to an increase in the effectiveness of treatment.

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ДВНЗ «Івано-Франківський національний медичний університет»РЕЗЮМЕ. Метою дослідження було виявлення проявів дисбактеріозу (ДБ) товстого кишечника у хворих на АД під впливом препарату «Біосім'я».Обстежено і проліковано 84 хворих на атопічний дерматит (АД). Таким пацієнтам на фоні базового лікування призначали препарат «Біосім'я» у дозі 1 флакон двічі на день впродовж 1 міс. Клінічно у всіх хворих з ПТК спостерігали здуття живота, порушення випорожнення, у 82,8 % пацієнтів -алергічні реакції. Дослідження крові показало підвищення еозинофілів і рівня IgЕ відповідно в 1,5-2 та 2-3 рази. При бактеріологічному дослідженні калу виявлено значне зниження кількості нормальної кишкової мікрофлори. В 55,2 % пацієнтів спостерігався ріст умовно-патогенної мікрофлори. Через 1 тиждень після лікування відмітили зменшення проявів АД, супутніх алергічних реакцій та розладів кишечника у 82,8 %, а у 17,2 % -їх зникнення, через 2 тижні прояви зникли ще у 72,4 %. Показники ЗАК та ІА у них нормалізувались. Через місяць проявів АД та кишкових розладів не виявлено у жодного пацієнта. Необхідно відмітити, що через 2 тиж. лікування у хворих без ПТК прояви АД зникли у 65,4 % осіб.КЛЮЧОВІ СЛОВА: атопічний дерматит; дисбактеріоз; сімейний лікар.