Immunotropic effects of including a combination of hepatoprotectors in the complex therapy of chronic pancreatitis combined with chronic viral hepatitis C

Abstract

Among significant etiological factors contributing to chronic pancreatitis (CP), the infectious factor plays a role in 56.88% of patients and the hepatobiliary factor in 44.50%, which has drawn attention to the particular importance of these factors. Hepatitis C virus (HCV) is the most common and important viral agent that causes or worsens CP. HCV is not only a disease of the liver but also a systemic (generalized) infection that involves other organs, in particular the pancreas and the immune system.
 The aim is to study the state of the cellular and humoral immune systems of patients with CP against the background of treated chronic HCV (CHCV) under the influence of the proposed complex treatment with the additional inclusion of hepatotrophic drugs heparizine (HZ) and metadoxine (MD).
 Materials and methods. We examined 80 patients with a combined course of CP and CHCV. According to the methods of treatment, the patients were divided into 3 groups: group 1 (20 patients with CP and CHCV) received the generally accepted complex of protocol treatment (PT) for three months; group 2 (25 patients with CP and CHCV) received PT with the additional inclusion of the hepatotrophic agent Heparizine PLC 1 capsule 3 times a day after meals for 3 months; and group 3 (35 patients with CP and CVHC with CAGE ≥2.0) received PT with the additional inclusion of the hepatotrophic agent Heparizine PLC (one capsule) 3 times a day after meals for 3 months with the addition of MD (Liveria IS) 500 mg (one tablet) 2 times a day 15–30 min before meals for 3 months.
 Results and discussion. With the additional administration of HZ, a higher dynamics of cellular immunity indices was reached in relation to those in the PT group. When using a combination of HZ and MD, even better results were obtained in the dynamics of the following indices: an increase in the total population of T-lymphocytes by 5.2%, 22.9%, and 57.7% in groups 1–3, respectively; NK cells — by 13.1%, 23.0%, and 39.4%; T-helpers — by 10.7%, 22.8%, and 36.3%; T-suppressors — by 26.0%, 38.9%, and 45.3%; a decrease in the number of B-lymphocytes — by 10.4%, 18.9%, and 35.6%. An increase in the immunoregulatory index (CD4/CD8) was also achieved — by 11.5%, 17.7%, and 45.7%. The decrease in the levels of B-lymphocytes under the influence of treatment in all three groups was accompanied by a decrease in the activation of humoral factors in groups 1–3, respectively: a decrease in the content of IgG in blood serum by 8.7%, 15.5%, and 19.2%; IgA — by 21.8%, 70.2%, and 88.5%; and IgM — by 24.0%, 55.5%, and 84.9%; as well as a significant decrease in the levels of circulating immune complexes by 38.6%, 1.9 times and 2.9 times (p<0.001).
 Conclusion. A positive immunocorrective effect of all three programs of complex treatment was proven, with a significantly higher level of those with the additional inclusion of HZ and especially the combination of HZ and MD in the complex therapy of patients with CP against the background of CHCV treated causally. Based on the results of correcting cellular and humoral immunity as an integral part of nutritional trophological status, it seems reasonable to include the proposed programs to eliminate nutritional and other disorders in people with CP and CHCV.