Лещук Я.Л. Применение флуренизида в комплексном лечении язвенной болезни: влияние на клинико-лабораторные показатели и вариабельность сердечного ритма. – Рукопись.
Диссертация на сoискание научной степени кандидата медицинских наук за специальностью 14.01.02 – внутренние болезни. – Львовский национальный медицинский университет имени Данила Галицкого. – Львов, 2008.
Диссертация посвящена изучению эффективности флуренизида в комплексном лечении язвенной болезни двенадцатиперстной кишки, ассоциируемой с Helicobacter pylori.
В диссертационной работе впервые изучено влияние флуренизида на кислотопродуцирующую функцию желудка, вследствие чего выявлены кислотоугнетающие свойства препарата, доказана и обоснована клиническая эффективность флуренизида в лечении Hp-ассоциируемой язвенной болезни двенадцатиперстной кишки. Усовершенствована комплексная диагностика этой нозологии путем использования метода исследования вариабельности сердечного ритма.
Выполненная работа позволяет повысить эффективность диагностики и лечения язвенной болезни двенадцатиперстной кишки, ассоциируемой с Helicobacter pylori.
Ключевые слова: язвенная болезнь двенадцатиперстной кишки, Helicobacter pylori, лечение, вариабельность сердечного ритма, флуренизид.
ANNOTATION
Leshchuk Ya.L. Use of Flurenizide in complex treatment of ulcerative disease: by the results of clinico-laboratory evaluation and investigations of cardiac rhythm variability. – Manuscript.
Dissertation for conferment of the scientific degree of candidate of medical sciences in the specialty 14.01.02 – internal diseases. – Danylo Halytskyi national medical university. – Lviv, 2008.
The dissertation is devoted to the research of Flurenizide efficacy in complex treatment of ulcerative disease of the duodenum associated with Helicobacter pylori.
Flurenizide has been known to possess antibacterial, antioxidant and immunomodulating properties but effect of the drug in question on gastric secretion has not been investigated. For this reason, the task of utmost importance set in our research was to determine the response of parietal cells of the stomach to the action of Flurenizide. Therefore, at the first stage of the investigation, effect of a single dose of Flurenizide on the acidogenic function of the stomach was for the first time studied in patients with ulcerative disease of the duodenum.
Results of the investigation have shown that Flurenizide reduces acidogenic function of the stomach. This property of Flurenizide, first discovered due to our research, enables its administration to potentiate the effect of antisecretory preparations, that are implied to include into the tertiary or quadricomplex recommended for the eradication of Hp.
The second stage of the research was concerned with determination of the clinical efficacy of Flurenizide in complex treatment of ulcerative disease. Thus, according to the results of investigation, a month after the course of treatment, subjective and objective improvement of the general condition has been noticed in 98.3 % of the assessed group (those administered Flurenizide in complex treatment) and in patients of the control group (treated by standard methods) this index was 90.8%.
On fibroesophagogastroduodenoscopy, performed a month after the course of treatment, macroscopic morphological changes in the form of bulbitis and superficial erosions of the mucous membrane of gastroduodenal area were diagnosed in 3.4 % of the assessed and in 9.2 % of the control group.
Comparative study of the efficiency of Hp eradication revealed that in patients of the assessed group the eradication index has reached as high as 86.7 % as compared to the control group with the Hp eradication index of 76.5 %.
Analysis of existence and incidence of adverse effects caused by the administered preparations in both groups, has shown that incidence and severity of adverse effects induced by the drugs, included into the eradication scheme, was considerably lower in the assessed (18.3 %) than in the controls (41.5 %).
Results of the investigation of cardiac rhythm variability have displayed a more pronounced improvement of variability parameters in the assessed group as compared to the controls and these indexes are evidence of a higher efficacy of therapy administered for the former. The share of low-frequency oscillations decreased and, correspondingly, the share of high-frequency oscillations increased, vegetative balance normalized and effect of central humoro-metabolic factors on the regulation of cardiac rhythm reduced.
Beneficial therapeutic effect of Flurenizide on the metabolic processes and status of the regulatory systems of the organism is due to antioxidant and antiradical properties of the preparation. It has also to be mentioned that Flurenizide as a biologically active preparation effects the cellular and humoral links of immunity due to its immunomodulating properties, and inclusion of Flurenizide into the complex treatment of Hp-associated ulcerative diseases normalizes immune homeostasis and thereby increases the efficacy of therapy.
Complete remission achieved in the assessed group was in total 96.6 % and eradication of Hp infection – 86.7 % cases. In the control group, remission of the disease has been clinically observed in 90.8 % and Hp eradication – in 78.5 %.
Carried out investigation enables improvement of the preciseness of diagnosis and efficacy of treatment for ulcerative disease of the duodenum associated with Helicobacter pylori.
Key words: duodenal ulcer disease, Helicobacter pylori,treatment, heart rate variability, Flurenizide.
ПЕРЕЛІК УМОВНИХ СКОРОЧЕНЬ
ВНС – веґетативна нервова система
ВСР – варіабельність серцевого ритму
ВХ – виразкова хвороба
ДПК – дванадцятипала кишка
ЕҐДФС –езофаґоґастродуоденофіброскопія
ФІ – функціональний інтервал
HF – high frequency (укр.: коливання високої частоти)
Hp – Helicobacter pylori
LF – low frequency (укр.: коливання низької частоти)
pNN 50% – відсоток пар сусідніх кардіоциклів, які відрізняються більше ніж на 50 мс
SDNN – стандартне відхилення середньої величини RR інтервалу
TP – total power (укр.: загальна спектральна потужність)
VLF – very low frequency (укр.: коливання дуже низької частоти)