DYNAMICS IN MAIN CLINICAL AND IMMUNOLOGICAL INDICATORS IN PATIENTS WITH COMORBIDITY OF CHRONIC HEPATITIS C AND CHRONIC PANCREATITIS FOLLOWING INTEGRATED THERAPY INCLUDING VITAMIN D

Abstract

The aim of this study is to evaluate the impact of integrated therapy including vitamin D on the clinical and immunological parameters of patients with chronic hepatitis C combined with chronic pancreatitis.
 Materials and methods. 52 patients with chronic hepatitis C and chronic pancreatitis with exocrine pancreatic insufficiency who had an insufficient level of vitamin D were under observation. They were divided into 2 groups depending on the treatment prescribed. All patients received antiviral therapy and sofosbuvir 400 mg + daclatasvir 60 mg once a day for 12 weeks and rabeprazole 20 mg once a day for a month. Depending on the scheme of taking enzyme preparations and vitamin D, all patients were divided into 2 groups. Group 1 (n=24) received Creon 25,000 according to the scheme and vitamin D 4,000 IU/day for 12 weeks of antiviral therapy and 12 weeks after the completion of antiviral therapy. Group 2 (n=28) took only Creon 10,000 according to the scheme. Analysis of findings obtained and their processing were carried out in Jamovi 2.3.2.1, Microsoft Office Excel for Windows 2016 programs using the Mann-Whitney, Wilcoxon U-test. The difference was considered statistically significant at p<0.05.
 Results: The administration of complex therapy, supplemented with vitamin D, resulted in a 100% achievement of sustained virological response (SVR) in patients belonging to group 1, while group 2 exhibited an SVR rate of 82.1%. It has been found out the treatment in group 1 demonstrated a significantly more pronounced reduction in ALT, AST, and total bilirubin levels compared to group 2. Furthermore, patients in group 1 exhibited more substantial changes in the cytokine profile, including a decrease in the levels of IL-6, TNF-б, neopterin, IL-4, IL-10, and TGF-в. Three months after the completion of antiviral therapy, the average FE-1 level in group 1 normalized, whereas in group 2, it only displayed a tendency toward normalization.
 Conclusion: The integration of a polyenzyme drug with minimal lipase activity (25,000 units) and vitamin D (4,000 IU/day) into the therapy for patients with comorbidity of chronic hepatitis C and chronic pancreatitis enhances the efficacy of antiviral therapy. This combination facilitates the rapid normalization of ALT, AST, and total bilirubin, mitigates cytokine imbalances, and improves exocrine pancreas function.