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Abstract
Activation of systemic inflammation and fibrotic processes in the lungs and pancreas contributes to the progression of chronic pancreatitis (CP) and chronic obstructive pulmonary disease (COPD) in their comorbid course, forms the prerequisites for the development of exocrine pancreatic insufficiency and pulmonary insufficiency. The results of the conducted studies prove the participation of intensification of oxidative stress, activation of lipid peroxidation — as a universal mechanism of membrane damage in the pathogenesis of destruction of the acinar epithelium of the pancreas with activation of systemic inflammation in CP. Therefore, in the complex treatment of CP, especially in conditions of comorbidity with COPD, cytoprotective agents of polytropic action with antioxidant, anti-inflammatory, anti-edema properties should be added, which would have a limited list of side effects and positively affect a number of pathogenetic links of the inflammatory process in the pancreas.
Aim of the study: to determine the probable effect of Antral on the dynamics of clinical syndromes of exacerbation of CP, the state of oxidant-antioxidant homeostasis, the state of factors of the proteinase inhibitory system and the intensity of systemic inflammation in patients with CP with comorbid COPD.
Material and methods. 85 patients with CP of mixed etiology in the phase of moderate exacerbation with comorbid COPD, group E, were examined. To determine the effectiveness of treatment, two representative groups of patients were formed randomly. The control (C) group (group 1–40 people) received a normocaloric diet with the elimination of extractive foods, the proton pump inhibitor esomeprazole 40 mg 2 times a day for 10 days, Platyphylline hydrotartrate 0.2% 1 ml for 10 days, a polyenzyme agent (pancreatin 40–50 000 per meal), as well as complex treatment of COPD (budesonide 160 mcg/d + formoterol fumarate 4.5 mcg/d) inhalation 2 times a day for 30 days, ipratropium/fenoterol (250/500 mcg/ml) nebulizer inhalations 2 times a day for 10 days) for 30 days. The main (O) group (45 people), in addition to the above therapy, received Antral® (Farmak) 200 mg 3 times a day for 30 days.
Research results. Improvement of well-being, reduction of signs of astheno-vegetative, intoxication syndromes, dyspeptic manifestations in patients of group O were noted on the 5–7th day from the start of treatment, while in patients of group K only after 10 days of therapy. After a month of treatment, pain and feeling of heaviness in the epigastric region disappeared in most patients of group O (respectively in 45 (100.0%) versus 16 (40.0%). In patients of group O, elimination of edema of the head of the pancreas on the 30th day of treatment was 100.0% versus 47.5% in group K (p <0.05), body and tail — 95.5% (p <0.05) versus 42.5% (p <0.05), respectively. The activity indicators of α-amylase in the blood after 30 days of treatment significantly decreased in patients of group O (100.0%) versus 72.5% in the control group (1.4 times, p >0.05). The activity indicators of elastase-1 in feces on the 30th day of treatment increased with the normalization of the indicator in 73.3% of patients of group O (p <0.05) versus 30.0% in group K. The use of Antral® contributed to a significant decrease in the content of medium-molecular peptides in the blood — in groups K and O, respectively — by 1.2 and 2.0 times (p <0.05). The content of protein-bound oxyproline in the blood, which was increased before treatment, decreased by 1.5 times (p <0.05) in the dynamics of treatment of patients of group O with the normalization of the indicator, and in patients of group K — only had a slight tendency to decrease (p >0.05). The content of free oxyproline in the blood, which is a biochemical marker of collagenolysis intensity, in patients of group O after treatment increased by 1.3 times with normalization of the indicator (p >0.05), and in patients of group K the changes were not significant (p >0.05) with the presence of a difference with the indicator after treatment in group O (p <0.05).
Conclusions. 1. Adding Antral® to the complex therapy of exacerbation of CP in patients with COPD for 1 month contributed to a faster achievement of clinical remission of CP, elimination of hyperamylasemia, restoration of exocrine pancreatic function, significant reduction in inflammation activity, reduction in TSS index.
2. Complex therapy of patients with CP on the background of COPD with the use of the anti-inflammatory agent Antral® (Farmak) contributed to the normalization of oxidant-antioxidant homeostasis, a decrease in the degree of endotoxicosis, a balance in the processes of synthesis and breakdown of collagen and glycoproteins of the extracellular matrix of the pancreas, inhibition of unlimited proteolysis, enhancement of collagenolysis, which underlies the achievement of stable remission of pancreatic inflammation, comorbid COPD, and a reduction in the risk of their progression.
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