Особливості лікувальної тактики при хронічному панкреатиті у поєднанні з хронічним обструктивним захворюванням легень Резюме Метою роботи стало висвітлення особливостей стратегії та тактики лікування хронічного панкреатиту за умов коморбідності з хронічним обструктивним захворюванням легень. Автори акцентували увагу на виконанні рекомендацій уніфікованих протоколів, які затверджені наказами Міністерства охорони здоров'я для лікування кожної хвороби, а також уніфікованих Європейських клінічних рекомендацій з діагностики та лікування ХП (2017 р.) і рекомендацій GOLD (2018 р.) щодо лікування хронічного обструктивного захворювання легень. Підкреслюється значення препаратів, які спрямовуються на ліквідацію абдомінального болю, зовнішньосекреторної недостатності підшлункової залози, оптимальності застосування бронхолітичної терапії, особливостей призначення кортикостероїдів та показань для використання антибіотикотерапії.
The review article provides up-to-date information on the complications of pancreatitis that are important for the tactics and strategy of patient management both at the inpatient and outpatient stages of observation. The purpose of the review was to emphasize the importance of complications for the course and life of patients with chronic pancreatitis. The authors draw the attention of internists to the course of such complications as pseudocysts, cysts, fistulas, thrombohemorrhagic, cholestatic syndromes, compression syndrome of adjacent organs, pancreatic encephalopathy (acute and chronic). The symptomatology of complications of chronic pancreatitis is discussed in detail, which is very important for differential diagnosis with the corresponding diseases. Such complications include the formation of erosive and ulcerative lesions, varicose veins of the esophagus and bleeding from varicose veins of the esophagus and stomach, portal hypertension syndrome with pancreatic ascites and chronic pancreatic encephalopathy, idiopathic non-cirrhotic portal hypertension, pancreatic cancer. The authors emphasize the need to analyze the corresponding symptoms, indicating the possibility of complications, negative consequences with each recurrence or exacerbation of chronic pancreatitis, since it concerns the prognosis and life of the patient.
In this article, the authors analyze a number of known and probable mechanisms involved in the formation of metabolic disorders upon chronic pancreatitis in comorbidity with metabolic syndrome. The issue of involvement of pancreatic endocrine apparatus in development of insulin resistance upon chronic pancreatitis, namely, the role of such a hormone as insulin, is highlighted. The role of this hormone in development of disorders of fat metabolism, obesity and arterial hypertension is presented. The authors emphasize the role of adrenal hormones, estrogen in the pathogenesis of both diseases. The issue of effect of endocrine function disorders on the state of external pancreatic secretion with subsequent development of disorders in the microbiota composition is considered (which also contributes to the progression of both diseases). The data on presence of a possible relationship between the composition, functional activity of the intestinal microbiota and development of metabolic syndrome, chronic pancreatitis are given. The significance of intestinal microbiota in the maintenance of various vital processes of a healthy person, food digestion, as well as synthesis, metabolism, recycling, utilization of various biologically active substances (vitamins, hormones, steroids, immunoglobulins) and elimination of toxins is revealed. The role of microorganisms in the formation of feeding behavior via axis “intestinal microbiome — intestine — brain” is analyzed. Modern ideas on the ability of microorganisms to provoke formation of metabolic disorders upon chronic pancreatitis are presented. The data confirming connection of certain dysbiotic changes (increased ratio of Firmicutes/Bacteroidetes, reduced number of Bacteroidetes and increased number of Firmicutes) with development of obesity, overweight, type 2 diabetes mellitus (known risk factors of metabolic syndrome) is given. It is suggested to prevent formation of metabolic syndrome in chronic pancreatitis by increasing the number of specimens of Bifidobacterium genus and Faecalibacteriumprausnitzii strains in the intestine.
Aim of research is to evaluate significance of changes in the lipid spectrum of blood in patients with chronic pancreatitis with coronary heart disease in the pathogenesis of the comorbidity of these diseases and in the dynamics of treatment with polycosanol. Materials and methods. The study was conducted in 22 patients (10 patients with chronic pancreatitis and dyslipidemia, 12 patients with comorbidity of chronic pancreatitis and coronary heart disease in CHD II-II A-B syndrome of stage II-III functional class) and in 10 almost healthy individuals. There were 13 men, 9 women, 31–69 years old. Patients of two groups in addition to protocol treatment were prescribed polycosanol 10 mg 1 time in the evening during dinner, up to 3 months. To study the characteristics of the lipid spectrum of the blood, the level of total cholesterol, high-density lipoprotein cholesterol, triglycerols was determined (using the Zlatix-Zack-based Lachema reagents (Czech Republic)). The level of low-density lipoprotein cholesterol was determined using the Friedewald calculation method, taking into account that the triglycerol concentration did not exceed 4.5 mmol/l. In addition, very low density lipoprotein cholesterol and an atherogenicity index were determined using conventional calculation methods. Results. In patients with a combined course of chronic pancreatitis with coronary heart disease, in most cases there is a significant (p<0.05) increase in total cholesterol, low and very low-density lipoproteins and triglycerols. When analyzing the types of dyslipidemia, it was found that ІІа and ІІв types were more common (22 і 25%, respectively), but with comorbidity ІІ and ІV type of dyslipidemia was more often detected. In the dynamics of a three-month treatment with polycosanol in patients with chronic pancreatitis, the cholesterol levels of high-density lipoproteins increased significantly and the triglycerol values significantly decreased, indicating a hypolipidemic effect of the drug and the possibility of using it in combination with statins in order to reduce the risk of cardiovascular events. Conclusion. The comorbidity of chronic pancreatitis with ischemic heart disease increases the risk of progression of dyslipidemia and atherosclerosis. This is confirmed by an increased atherogenic index in this group of patients, along with the severity of lipid spectrum disorders. The addition of polycosanol to patients with chronic pancreatitis and dyslipidemia, as well as in combination with coronary heart disease, contributes to the reduction and normalization of certain parameters of the lipid spectrum of the blood. This allows us to recommend a drug for long-term treatment of these groups of patients, including in combination with statin therapy.
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