Relative effectiveness of hepatic protector usage and physical exercises by patients with chronic diffuse liver disease
Introduction. Chronic diffuse liver disease remains an extremely relevant and complex problem. Wide spreading of viral hepatitis, high frequency and severity of complications, such as liver cirrhosis and hepatocellular carcinoma make this problem of very high importance. Despite of some success in development of diagnostic and treatment of diffuse liver disease, occurrence of viral hepatitis remains high. A higher occurrence of liver cirrhosis has also been noted. A chronic process in the liver affects its metabolic function to varying degrees. The disturbance of protein synthesis leads to change of aminoacid composition of blood, maladjustment in ammonium neutralization and blood coagulation. Inflammatory-necrotic processes in liver are accompanied with malfunction of lipid peroxidation, exhaustion of antioxidant resources and, as a result, injuries of phospholipid membranes of hepatocytes. All this justifies the usage of such group of medication as hepatic protectors in combined therapy of patients with chronic hepatitis and liver cirrhosis. For patients with alcoholic and non-alcoholic fatty liver disease hepatoprotectors serve as the basis of treatment. In recent years the attitude towards hepatoprotectors in clinical medicine has been reconsidered as to medication which has not been fully meeting the expectations. The only confirmed method of treatment of the fatty liver disease is a decrease of body mass. But recently data about positive effect of isometric physical exercises on the degree of intensity of fat infiltration in the liver without significant weight reduction appeared in literature.
In this connection we have conducted a comparative research, our goal was to compare effectiveness of hepatoprotectors and isometric physical exercises in restoration of metabolic activity of the liver, dynamics of cytolitic syndrome and clinical manifestations by chronic diffuse liver diseases.
Materials and methods. 53 patients (34 males and 19 females) with chronic diffuse liver disease (chronic viral hepatitis С with moderate activity – 10 people, fatty liver - 43 persons) were included into research. All the patients were examined with use of laboratory and instrumental methods (ultrasound, biochemical blood test (ALT, AST, GGT, ALP, cholinesterase, thymol sample, albumin). For determination of metabolic function of the liver of patients with chronic hepatitis C was used a 13s methacetin breath test (13s – MDT). Isometric exercises have been made 3 times a week during 8 weeks. By a simple blind method the patients were randomized into 2 groups. 6 persons with chronic hepatitis C and 22 with fattz liver belonged to the first group (n=28). Group 2 (n=25) had 4 patients with chronic hepatitis C and 21 with fatty liver. The patients of group 1 received silimarine in the dose of 90mg in a capsule of 3 t/d during 2 months. The patients of group 2 along with measures which were mentioned above dose were doing isometric physical exercises regularly. The biochemical study of blood has been made weekly in groups of comparison; ultrasound, and 13s-MDT were made for all patients before treatment and 2 months after the therapy.
Results. The received results indicate that, as the result of the treatment, levels of total bilirubin in both clinical groups improved reliably. ALT dynamic was positive in groups of patients who received silimarin and isometric exercises , there was no veracious positive dynamics of ALT and AST indicators in group of patients of patients' receiving simarine as hepatoprotector. It should be noted that normalisation of biochemical biochemical was occurring more rapidly in the 1st group.
As for the rates of cholestasis, in group 2 dynamics of alkaline phosphatase was veracious negative.
The two-month course of silimarin treatment with isometric physical exercises in researched groups led to veracious improvement of biochemical indicators, positive clinical dynamics.
No veracious improvement of detoxification liver function on treatment with silimarine and occurred, which puts into question consistency of their application as hepatoprotectors.
Isometric physical exercises with silimarine and therefore it is more preferable to use in complex treatment of patients with chronic diffuse liver disease.