Emelyanov D.N., Tumarenko A.V.
Volgograd State Medical University, Volgograd
Introduction.
Alcohol abuse is one of the most common causes of chronic liver damage in Russia. In this regard, the search for new effective methods of treating patients with alcoholic hepatitis is an urgent problem of internal diseases. One of the new approaches to the treatment of this pathology is TES-therapy.
In previous experimental studies on laboratory animals, the hepatoprotective effect of TES was established, accompanied by a decrease in the activity of hepatospecific enzymes, normalization of the synthetic, detoxifying functions of the liver, and these effects are endorphinergic in nature. It was also found that with partial hepatectomy, TES-therapy increases the proliferative activity of hepatocytes (Lebedev, Melikhova et al., 2000-2003).
It is known that alcoholic liver disease is an endorphin deficient condition. It seemed important to obtain clinical confirmation of the effect of TES therapy in this pathology.
Material and methods.
A course of transcranial electrical stimulation in the form of monotherapy was carried out in 40 patients with chronic hepatitis of alcoholic etiology. For carrying out TES-therapy, the apparatus “Transair-01” was used. The impact was carried out through the front-mastoid electrodes with a pulsed bipolar modulated current with a frequency of 77 Hz, a pulse duration of up to 3.5 ms, and a current of up to 3 mA.
The duration of the procedure was 20-30 minutes. The course of treatment was 10 procedures. In all patients, before and after the course of treatment, intrahepatic hemodynamics were studied using bipolar rheohepatography (HGH), microvasculature (by conjunctival biomicroscopy), activity of liver-specific enzymes: serum urocaninase (SU), serum histidase (SH), L-serine dehydrotase ( LSDH), L-threonine dehydrotase (LTDH), and N-acetyl-b-D-glucose aminidase (NAG).
The content of lipid peroxidation products (LPO) – malondialdehyde (MDA), and the activity of antioxidant defense enzymes – catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GP) were determined.
Results.
It was found that as a result of the treatment, the initially elevated plasma concentration of liver-specific enzymes became less: urocaninase by 34.5%, histidase by 27.4%, L-serine dehydrotase by 31%, L-threonine dehydrotase by 36%. The level of N-acetyl-b-D-glucosaminidase decreased by 36.9%. The activity of antioxidant defense enzymes increased: catalase by 37.5%, superoxide dismutase by 41.3%, glutathione peroxidase by 38.4%.
The content of peroxidation products, malondialdehyde, decreased by 43.5%. Improved indicators of intrahepatic hemodynamics: amplitude indicators increased: systolic index – by 44.2%, diastolic – by 41.5%. According to conjunctival biomicroscopy, the indicators of systemic microcirculation improved.
Findings.
The study shows that TES therapy in patients with alcoholic hepatitis of the liver has many-sided positive effects – on the severity of the cytolytic syndrome, LPO processes and the state of enzymatic antioxidant protection, on hemodynamics of the liver and systemic microcirculation and can be successfully used as a monotherapy method.
