Hepatic encephalopathy, diagnostics, differential diagnostics and therapy with ornithine

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Abstract

Hepatic encephalopathy (HE) is a frequent complication and one of the most debilitating manifestations of liver disease, severely affecting the lives of patients and their caregives. Furthermore, cognitive impairment associated with cirrhosis results in utilization of more health care resources in adults than other manifestations of liver disease. The aim of the study: To study the incidence and degrees of hepatic encephalopathy in patients with drug-induced liver disease (DILD) during chemotherapy (CT) of breast cancer (BC) and ovarian cancer (OC) and in patients with rheumatoid arthritis (RA) receiving long-term methotrexate therapy, depending on the presence of diabetes mellitus (DM), and evaluate the efficacy of HE treatment with L-Ornithine-L-aspartate. Materials and methods. The study groups included 52 patients with OC and 53 patients with breast cancer who developed DILD on the background of chemotherapy, as well as 88 patients with RA whose DILD developed on the background of long-term (more than 5 years) methotrexate therapy. The degree of hepatic encephalopathy was determined using the West-Haven scale and the critical flicker frequency test (CFF) using the HepatonormTM (Germany) hepatoanalyzer at 0 (initially) and 8 (at the end of the treatment) weeks of study. Patients with HE received L-ornithine-L-aspartate therapy for 1 packet of granules, previously dissolved in 200 ml of liquid, 3 times a day. Results. Hepatic encephalopathy (in particular, minimal HE) is a frequent manifestation of DILD in the group of patients with rheumatoid arthritis who have been receiving long-term methotrexate therapy, and in patients undergoing CT for breast and ovarian cancer. Diabetes mellitus is a risk factor for DILD, which adversely affects the degree of HE. Conclusions. Treatment with L-ornithine-L-aspartate for 8 weeks proved to be effective in cupping of HE manifestations, which is confirmed by the results of CFF test

About the authors

E. V Maksimova

S.I.Georgievsky Medical Academy of the V.I.Vernadsky Crimean Federal University

Email: HelenMaksimovatt@mail.ru
канд. мед. наук, ассистент каф. терапии, гастроэнтерологии, кардиологии и общей врачебной практики (семейной медицины) фак-та подготовки медицинских кадров высшей квалификации и дополнительного профессионального образования МА им. С.И.Георгиевского 295006, Россия, Симферополь, б-р Ленина, д. 5/7

I. L Kliaritskaia

S.I.Georgievsky Medical Academy of the V.I.Vernadsky Crimean Federal University

д-р мед. наук, проф., зав. каф. терапии, гастроэнтерологии, кардиологии и общей врачебной практики (семейной медицины) фак-та подготовки медицинских кадров высшей квалификации и дополнительного профессионального образования МА 295006, Россия, Симферополь, б-р Ленина, д. 5/7

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