medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2022-055medsovet-7563Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERЭффективность применения глюкокортикостероидов при тяжелом алкогольном гепатитеEfficiency of glucocorticosteroids in severe alcoholic hepatitishttps://orcid.org/0000-0001-6311-3772РодинаА. С.RodinaA. S.

Родина Алиса Сергеевна, аспирант кафедры пропедевтики внутренних болезней и гигиены 

185910, Петрозаводск, проспект Ленина, д. 33 

Alisa S. Rodina, Рostgraduate Student of the Department of Propaedeutics of Internal Diseases and Hygiene 

33, Lenin Аve, Petrozavodsk, 185910

alisarodina2015@yandex.ruhttps://orcid.org/0000-0001-7620-7065КурбатоваИ. В.KurbatovaI. V.

Курбатова Ирина Валерьевна, к.б.н., cтарший научный сотрудник лаборатории генетики Института биологии Scopus Author ID: 6603406315 

185910, Петрозаводск, ул. Пушкинская, д. 11; 

Irina V. Kurbatova, Cand. Sci. (Biol.), Senior Researcher at the Genetics Laboratory of the Institute of Biology 

11, Pushkinskaya St., Petrozavodsk, 185910

irina7m@yandex.ruhttps://orcid.org/0000-0002-4272-9612ШубинаМ. Э.ShubinaM. E.

Шубина Марина Эдуардовна, к.м.н., доцент кафедры пропедевтики внутренних болезней и гигиены 

185910, Петрозаводск, проспект Ленина, д. 33

Marina E. Shubina, Cand. Sci. (Med.), Associate Professor of the Department of Propaedeutics of Internal Diseases and Hygiene 

33, Lenin Аve, Petrozavodsk, 185910

Isu@gmail.comhttps://orcid.org/0000-0003-2613-5694ДудановаО. П.DudanovaO. P.

Дуданова Ольга Петровна, д.м.н., профессор, заведующая кафедрой пропедевтики внутренних болезней и гигиены Scopus Author ID: 6603343207 

185910, Петрозаводск, проспект Ленина, д. 33

Olga P. Dudanova, Dr. Sci. (Med.), Professor, Head of the Department of Propaedeutics of Internal Diseases and Hygiene 

33, Lenin Аve, Petrozavodsk, 185910

odudanova@gmail.comПетрозаводский государственный университетРоссияPetrozavodsk State UniversityRussian FederationКарельский научный центр Российской академии наукРоссияKarelian Research Centre of the Russian Academy of SciencesRussian Federation20232505202308135141Copyright © Родина А.С., Курбатова И.В., Шубина М.Э., Дуданова О.П., 20232023Родина А.С., Курбатова И.В., Шубина М.Э., Дуданова О.П.Rodina A.S., Kurbatova I.V., Shubina M.E., Dudanova O.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7563

Введение. Целесообразность и риски применения глюкокортикостероидов (ГКС) при тяжелом алкогольном гепатите (ТАГ) активно обсуждаются гепатологами, и существует реальная потребность в разработке новых биомаркеров как для определения показаний к использованию ГКС, так и для оценки их результативности. Цель. Оценка эффективности ГКС при ТАГ с использованием маркера апоптоза гепатоцитов и воспалительных цитокинов, наряду с традиционными лабораторными показателями.Материалы и методы. Преднизолон в дозе 40 мг в сутки получили 68 пациентов ТАГ, развившемся на фоне цирроза печени той же этиологии. Эффективность терапии оценивалась через 7 дней по индексу Лилль, а также по динамике уровня фрагментов цитокератина-18 (ФЦК-18) и цитокинов ИЛ-1β, ТНФ-α, ИЛ-6 и ИЛ-8. Результаты. У 50 (73,5%) пациентов отмечался позитивный эффект ГКС, через 7 дней индекс Лилль у них составил 0,23 ± 0,09, достоверно снижались уровни ФЦК-18, ИЛ-6, ИЛ-8, ТНФ-α с последующим снижением и улучшением печеночных функциональных показателей. Эти пациенты имели 100%-ную краткосрочную (в течение 28 дней) выживаемость. У 18 (26,5%) пациентов был негативный результат ГКС, индекс Лилль составил 0,61  ±  0,11, не  было достоверного снижения уровня ФЦК18  и  цитокинов. После отмены ГКС у  них прогрессировала печеночная недостаточность, у  1/3  развились бактериальные инфекции, все данные пациенты умерли от полиорганной недостаточности в течение 28 дней. Выводы. Краткосрочный эффект терапии ГКС у пациентов ТАГ составил 73,5%. Наряду с традиционным индексом Лилль, диагностическую значимость продемонстрировали следующие показатели: фрагменты цитокератина-18, цитокины ИЛ-6, ИЛ-8, в меньшей степени – ТНФ-α и ИЛ-1β.

Introduction. The feasibility and risks of glucocorticosteroids (GCS) in severe alcoholic hepatitis (SAH) are actively discussed, and there is a real need to develop new biomarkers both to determine indications for the GCS use and to evaluate their effectiveness. Аim. Тo evaluate the effectiveness of GCS in SAH using a marker of hepatocyte apoptosis and inflammatory cytokines along with traditional laboratory parameters. Materials and methods. Prednisolone at a dose of 40 mg per day was received by 68 patients with SAH. The effectiveness of therapy was assessed after 7 days by the Lille index, the level of cytokeratin-18 fragments (FCK-18) and cytokines – IL-1β, TNF-α, IL-6 and IL-8. Results. A positive effect of GCS was noted in 50 (73.5%) patients, after 7 days the Lille index was 0.23 ± 0.09, the levels of FCK18, IL-6, IL-8, TNF-α were significantly reduced, with subsequent decrease and improvement in hepatic functional parameters. These patients had a 100% short-term (within 28 days) survival rate. Eighteen (26.5%) patients had a negative result, the Lille index was 0.61 ± 0.11, there was no significant decrease in FCK-18 and cytokines. After GCS was discontinued, they developed liver failure, 1/3 developed bacterial infections, all patients died of multiple organ failure within 28 days. Conclusion. The short-term effect of GCS therapy in SAH patients was 73.5%. Along with the traditional Lille index, the following indicators demonstrated diagnostic significance: fragments of cytokeratin-18, cytokines IL-6, IL-8, and, to a lesser extent, TNF-α and IL-1β.

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The authors declare that there are no conflicts of interest present.