Clinical and pathogenetic aspects of chronic pancreatitis in combination with viral hepatitis C in outpatient practice
Background. In recent years, attention has increased to an infectious agent whose effects may lead to the development of pancreatic inflammation. Significant prevalence of viral hepatitis C among the population, the variety of its extrahepatic manifestations condition the relevance of the problem. The inadequacy of solving the issues of primary and secondary prevention of chronic pancreatitis motivates a deeper study of the mechanism of its development against the background of viral hepatitis C. Purpose: to study the clinical course of chronic pancreatitis in patients with concomitant viral hepatitis C. Materials and methods. A total of 57 patients with chronic pancreatitis and concomitant viral hepatitis C were examined. The comparison group consisted of 20 persons with chronic pancreatitis. In order to establish a clinical diagnosis of chronic pancreatitis and viral hepatitis C, all patients were examined in accordance with the protocols adopted on orders No. 638 of the Ministry of Health of Ukraine dated September 10, 2014 and No. 729 of the Ministry of Health of Ukraine dated July 18, 2016. Diagnosis of chronic pancreatitis and viral hepatitis was verified on the basis of the medical history, clinical manifestations and research results. General clinical and biochemical examinations were performed in patients with chronic pancreatitis during the phase of exacerbation and unstable remission, in patients with viral hepatitis C — during the phase of stable remission. Results. In the clinical course of chronic pancreatitis with concomitant viral hepatitis C, the pain syndrome, dyspepsia and disturbed emptying were more pronounced than in the comparison group (the probable difference with respect to the parameters of group II; p < 0.05). Patients with chronic pancreatitis and concomitant viral hepatitis C had mild anemia, decreased blood albumin, hyperbilirubinemia, hypercholesterolemia, elevation of alanine aminotransferase and aspartate aminotransferase, increased levels of blood amylase and diastase of urine (a significant difference in relation to group II; p < 0.05). In patients with chronic pancreatitis and concomitant viral hepatitis C, the coprogram amounted to (5.20 ± 0.82) points, and in patients with chronic pancreatitis — (3.10 ± 0.32) points (significantly lower indices, more severe inflammatory syndrome and dysbiosis). In the two study groups, steatorrhea of type II prevailed. The depth of structural changes in the pancreas according to the data of ultrasound in the group of patients with chronic pancreatitis and concomitant viral hepatitis C was (2.56 ± 1.10) points, which corresponds to the process of moderate severity. In the control group, the degree of injury was (1.90 ± 0.60) points. Conclusions. According to the data of the study, the negative influence of the concomitant viral hepatitis C on the course of chronic pancreatitis was established.
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