Abstract. The aim. Using special methods to investigate the functional state of the liver in patients with cirrhosis. Materials and methods. The study involved 95 patients with LC who were hospitalized from 2018 to 2020 in the Department of Anesthesiology and Intensive Care, Surgical and Gastroenterological Departments of the Transcarpathian Regional Clinical Hospital. Andriy Novak (Uzhhorod). All patients underwent C13-metacetin breath test (C13-MDT) to determine the degree of liver damage. To determine the degree of fibrosis in the examined patients used the following specially developed tests: Forns test, FibroIndex test, FIB-4 test (Fibrosis 4 Score), APRI test (AST-to-Platelet Ratio Index), MDA test (multivariate discriminant analysis), test GUCI (Gothenburg University Cirrhosis Index), FPI test. Results. In all examined patients with LC on the results of C13-MDT revealed changes characteristic of liver cirrhosis. In group I of patients with LC, the percentage of functioning hepatocytes was 54.7 ± 5.3%. MFG was the lowest in group III patients with LC - 18.2 ± 1.8% and was statistically significantly different from patients in group I (p <0.05). A statistically significant difference between MFG parameters was also found between groups I and II of patients with LC - p <0.05. We found a strong correlation between the results of C13-MDT and histostructure disorders and the stage of liver damage (mainly F4) by METAVIR in the examined patients (r = 0.72; p <0.01). Based on the results of statistical analysis, it was found that the most effective test based on serum biochemical parameters is the FPI test. Conclusions. The most pronounced changes that characterize the reduced functional capacity of the liver, found in patients of group III - p <0,05. The most effective test based on serum biochemical parameters is the FPI test. Severe liver cirrhosis is characterized by higher plasma levels of endothelial mediators, fibrinolysis regulators and lower platelet counts, levels of physiological anticoagulants, prolonged invertebrate values.
Мета роботи: за допомогою інструментальних методів оцінити зміни центральної гемодинаміки у хворих на цироз печінки (ЦП). Матеріали і методи. В дослідженні взяли участь 95 хворих на ЦП, які перебували на стаціонарному лікуванні з 2018 до 2020 р. у відділенні анестезіології та інтенсивної терапії, хірургічному та гастроентерологічному відділеннях Закарпатської обласної клінічної лікарні ім. Андрія Новака (м. Ужгород). У І групу (клас А за Child-Pugh – стадія компенсації) увійшло 18 (18,95 %) хворих, у II групу (клас В – стадія субкомпенсації) – 25 (26,3 %) хворих, у III групу (клас С – стадія декомпенсації) ввійшло 52 (54,7 %) хворі. Для визначення змін із боку серцево-судинної системи (ССС) всім хворим на ЦП проводили ЕКГ-дослідження, ехокардіографію. Проаналізували такі показники: систолічний АТ (САТ), діастолічний АТ (ДАТ), середньоденний АТ (САТд, ДАТд), середньонічний АТ (САТн, ДАТн), індекс варіабельності (ІВ) в денний і нічний час САТ (ІВ САТд, ІВ САТн) та ДАТ (ІВ ДАТд, ІВ Д), АТн), добовий індекс (ДІ САТ, ДІ ДАТ). Типи центральної гемодинаміки в обстежених хворих визначали як співвідношення індексу питомого периферійного судинного опору (ППО) в обох колах кровообігу та ударного індексу (УІ) лівого і правого шлуночків за даними доплерографії. Результати досліджень та їх обговорення. У хворих на ЦП І групи УІ до лікування становив (48,22±2,11) мл/м2 при (39,97±3,15) мл/м2 у контрольної групи – р<0,05, фракція викиду лівого шлуночка (ФВ ЛШ) – (63,18±2,46) % при нормі (68,42±2,31) % (р>0,05). Тоді як у хворих ІІ групи ударний індекс до лікування становив (44,11±5,7) мл/м2 порівняно з УІ ІІІ групи (32,5±4,4) мл/м2 – р<0,05, фракція викиду лівого шлуночка (ФВ ЛШ) – (62,4±3,3) % при 60,11±3,2 в ІІІ групі (норма (68,42±2,31) %; р>0,05). У хворих на ЦП із проявами ПЕ І групи переважав гіперкінетичний тип центральної гемодинаміки (55,0 % хворих), у ІІ групі переважав нормокінетичний тип центральної гемодинаміки – у 60,0 % хворих. Особливістю параметрів центральної гемодинаміки для хворих ІІІ групи (стадія декомпенсації) була поява гіповолемічного типу циркуляції – у 13,0 % хворих. У хворих на ЦП внаслідок порушення центрального і спланхнічного кровообігу характерною особливістю системної циркуляції є формування гіпердинамічного типу циркуляції. У хворих класу А переважає гіперкінетичний тип, у хворих класу В – нормокінетичний тип, а для хворих класу С – поява гіповолемічного типу гемодинаміки.
The aim: To investigate the features of coagulation homeostasis in patients with liver cirrhosis (LC) in COVID-19 infection. Materials and methods: At the clinical base of the Department of Propaedeutics of Internal Medicine, 32 patients with LC infected with COVID-19 were examined – 1 Group of patients. The study also included 30 patients with LC who were not infected with COVID-19 (2 Group of patients). Results: The analysis of the obtained data indicates disorders of the hemostasis system in patients with LC without the COVID-19 infection (Group 2), as well as in patients with LC at the time of being infected with COVID-19. The violation of the protein synthesis function of the liver is manifested through a decrease in the level of fibrinogen in blood serum (up to 2.0±0.5 gr/l in patients of Group 1 at the time of admission for inpatient care) and up to 21.9±0.5 gr/l in patients of group ІІ – р<0.05. This was accompanied by an acceleration of prothrombin time, thrombin time and activated partial thromboplastic time in patients with LC, as well as an increase in the level of antithrombin III. The level of D-dimer was reduced both in patients of group II and in patients of group I at the time of being infected with COVID-19 Conclusions: Changes in coagulation homeostasis characteristic of hypocoagulation syndrome have been established in patients with LC. COVID-19 infection in patients with LC leads to hypercoagulation, especially in patients with complicated stage of LC (ascites, encephalopathy, hepatorenal syndrome).
Aim: To assess endothelial dysfunction in patients with liver cirrhosis. Material and methods: The study involved 95 patients with alcoholic liver cirrhosis. The data were subjected to analysis of variance involving the calculation of arithmetic mean value and variance (М±m), estimating the values validity according to Student’s t-test and measuring Pearson correlation coefficient for binary variables. Results: The brachial artery diameter was 0.4±0.02 mm narrower, with its blood velocity flow being 25.8±3.4 cm/s slower in the mean, in the patients with liver cirrhosis with signs of hepatic encephalopathy as compared to the control group. The maximum EDV values were recorded in the patients in Group I (7.5±1.9 %), while Group III patients displayed the lowest EDV value (5.6±1.9 %). The LC patients were found to exhibit a significant increase in the concentration of ET-1 up to 1.14±0.07 fmol/ml as opposed to 0.34±0.05 fmol/ml in the control group (р<0.01), an increase in the level of VWF by 139.4±24,8 % as compared to the control group (р<0.01) and D-dimer by a factor of 6.8. Conclusions: The patients with liver cirrhosis were found to have endothelial damage, namely the dysfunction of the vasoregulating activity of vascular wall against the background of portal hypertension. Changes in the vasoactive BAS values are indicative of the damage to the vascular endothelium in LC patients with signs of HE. A steady and gradual increase or decrease in the levels of ЕТ-1, VWF, АТ ІІІ, and D-dimer may suggest the progressive character of ED in the LC patients.
Objective. To investigate serum amino acid pool changes in patients with liver cirrhosis. Materials and methods. 95 patients with liver cirrhosis were participated in the study. In the 1st group (class A disease severity according to Child- Pugh score) there were 18 (18.95%) patients, in the 2nd group (class B) - 25 (26.3%), in the 3rd groups (class C) - 52 (54.7%) patients. The amount of free amino acids in blood serum was determined by reversed-phase high-performance liquid chromatography in isocratic elution mode with electrochemical detection. Results. Violations of free amino acid reserves were revealed in patients with cirrhosis of the liver with a predominant accumulation of aromatic amino acids: phenylalanine - (162.45 ± 14.12) nmol/ml, tyrosine - (99.05 ± 10.07) nmol/ml, tryptophan - (76.10 ± 12.40) nmol/ml, as well as an increase in the content of proline, lysine, cysteine (p <0.05) . In parallel, the decreasing of free serum amino acids with branched side chain levels were observed: valine - up (150.10 ± 8.92) nmol/ml leucine - up (75.14 ± 5.12) nmol/ml (p < 0.05) and isoleucine - up to (80.40 ± 8.01) nmol/ml. Conclusions. The correlation between the second degree of thick guts dysbiosis and increased levels of tryptophan was determined (r = 0.77; p <0.01). III degree thick dysbiosis was correlated with increasing levels of phenylalanine (r = 0.71; p <0.01). In patients of 2nd group the correlations between levels of tryptophan and II degree of intestinal dysbiosis (r = 0.58; p <0.01) and the levels of tyrosine in phenylalanine in III stage intestinal dysbiosis were detected.
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