CURRENT ASSESSMENT OF DIAGNOSIS AND INTEGRATED TREATMENT OF LIVER ECHINOCOCCOSIS

Abstract

Purpose: to improve the results of diagnostics and treatment of patients with liver echinococcosis by applying the most appropriate methods and means of integrated therapy. Methods. When analyzing the material of conservative treatment using Immunofan, attention was drawn to the dynamic changes in the laboratory parameters under the study during and after the treatment. On the 1st, 3rd, 5th, 10th days of the postoperative period, we investigated the functional state of the liver in the patients by the level of total protein and its fractions and a blood test for bilirubin content, amylase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, gamma-glutamine transferase (GGT). Results. Some biochemical indices and red blood indices revealed that there was an increase in the level of cytolytic enzymes (AsAt, AlAt) under moderate hyperbilirubinemia. The results of the use of the drug Immunofan in the treatment of patients with severe liver echinococcosis demonstrated a significant decrease in cytolysis and cholestasis indicators, as well as an increase in the albumin content over all stages of laboratory studies; moreover, its indicators significantly grew up from 38.5±0.3 g/L to 40, 7±0.2 g/L, respectively, on the 1st and 5th day after the beginning of the course of standard therapy (t=3.2; p <0.001). At the final stage of the research, the protein content increased to 41.9±0.3 g/L, versus 42.6±0.6 g/L, which were reference values for this factor in the control group of healthy individuals (p >0.05). We observed a decrease in cholestasis indices in the patients: cholesterol in the main group significantly lowered from 210.5±1.9 mg/dL to 205.6±0.8 mg/dL, respectively, before the treatment and in 5 days of the therapy (t=4,9; p <0.001), but was still higher compared to the control group at the initial stages of observation, when the dynamics of the decline was significantly slower. There was a significant (t=18.0; p <0.001) increase in C-reactive protein (CRP) values on day 1 of the postoperative rehabilitation period in the main group of patients with liver echinococcus (from 9.5±0.4 mg/L to 12.6±0.5 mg/L, respectively, before treatment and at the indicated time) compared to the control group, where the indicators were 3.6±0.2 mg/L. Conclusions. This study has proven the diagnostic and prognostic significance of the proposed method for the treatment of liver echinococcosis and prevention of its complications. Their efficacy has been supported by the analysis of laboratory data reflecting the capability of the biosynthetic function of the liver.