Оптимізація діагностики вторинних метаболічних порушень та лікувальної тактики у пацієнтів із анемією злоякісного новоутворення при колоректальному раку

Abstract

The purpose of the study was to study the content of free fraction of heparin, histamine and serotonin in plasma of peripheral venous blood of patients with malignant neoplasm anemia in colorectal cancer, depending on the severity of anemia. Materials and methods. The material for the study was the blood plasma of 445 patients (228 men and 217 women). Among them, 53 patients (31 women and 22 men) with iron deficiency anemia were examined and included in the first observation group (І) and 392 patients (206 men (52.55 %) and 186 women (47.45 %)) with colorectal cancer whose course of the underlying disease was burdened with malignant neoplasm anemia (ICD-10 code: D63.0) were included in the second observation group (II). Among the patients in the second (II) observation group, there were 222 individuals (119 men and 103 women) with malignant neoplasms of the colon (ICD-10 code: С.18), 29 individuals (16 men and 13 women) with malignant neoplasms of the rectosigmoid junction (ICD-10 code: C.19), 138 individuals (82 men and 56 women) with malignant neoplasms of the rectum (code ICD-10 C.20) and 3 patients (2 men and 1 woman) with malignant neoplasms of the anus (ICD-10 code: C.21). The mean age of the patients was 63.3 ± 1.2 years old. The plasma level of free fraction of heparin of the examined patients was determined using the photocolorimetric method on photoelectric colorimeter 56-M after its preliminary isolation by electrophoretic method according to the appropriate procedure (B. V. Mykhailychenko, S. V. Vydyborets (2000)). The plasma level of free histamine and serotonin of the examined patients was studied using the method of fluorometric analysis on the analyzer “BIAN-130”-“BIAN-100” according to the procedure of B. V. Mykhailychenko, S. V. Vydyborets (1999). Results and discussion. It was found that prior to the initiation of treatment in patients with malignant neoplasm anemia, regardless of the course of colorectal cancer, there was a significant increase in the plasma level of free fraction of heparin, histamine, serotonin (p < 0.001); the ratio of free histamine to free serotonin was also changed in comparison with the values in the control group (p < 0.05), which indicated both an increased release of heparin, histamine and serotonin from the depot, and an impaired inactivation processes of these biologically active substances. Considering all of the above and the quite obvious reasons, namely, the secondary metabolic disorders of serotonin, histamine, heparin which manifested by a significant increase in their plasma level of patients with malignant neoplasm anemia in colorectal cancer, we suggested the need to use a medicinal product in a complex of therapeutic measures which can cause antihypoxic, membrane stabilizing and anti-edema action. Conclusion. Malignant neoplasm anemia in colorectal cancer is accompanied by significant changes in the metabolism of biologically active substances – free fraction of heparin, histamine, serotonin, and the ratio of free histamine to serotonin. It was correctly concluded that in addition to the baseline therapy the administration of arginine glutamate which causes both antihypoxic and membrane-stabilizing action, reliably contributes to the normalization of secondary metabolic disorders of histamine, serotonin and heparin metabolism in malignant neoplasm anemia in patients with colorectal cancer