Журнал «Медицина неотложных состояний» Том 16, №3, 2020
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Change of the indicator enzyme levels in detoxication process including plasma sorption in the stage of intensive treatment
Авторы: Akentiev S.O., Berezova M.S.
Bukovinian State Medical University, Chernivtsi, Ukraine
Рубрики: Медицина неотложных состояний
Разделы: Медицинские форумы
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Comprehensive treatment of severe diseases, accompanied by liver (acute and chronic), renal (acute and chronic) and hepatic-renal failure syndromes, requires intensification in therapeutic measures involving the introduction of efferent therapy (plasmapheresis, hemosorption, plasma sorption, etc.). Direct damage of the liver parenchyma, its functional load under the conditions of these syndromes is due to the depth of cytolytic processes, characterized by an increase in the level of indicator enzymes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and others.
The purpose was to study the dynamics of levels of indicator enzymes of ALT, AST, ALP, and others in the process of extracorporeal detoxification. The studies were conducted in three groups of patients with hepatic failure syndromes (9 patients), kidney failure (20 patients) and liver failure (26 patients). All patients underwent plasma sorption (PS) for detoxification. PS was carried out through routine intermittent (fractional) way. The blood was separated into the globular and cellular components by gravity forces. 11 sessions of the PS were carried out in the group of patients with liver failure syndrome (on average, one session per patient). During a session, 1200 ml of plasma was obtained, purified and returned. The following nosological forms caused severe hepatic failure: cirrhosis of the liver, viral hepatitis, toxic hepatitis, purulent cholangitis, hepatosis. The amount of ALT in the blood, on average, amounted to 93.6 ± 23.8 μmol/L before the session, after separation of the cell pool, separately in the plasma, the activity of the enzyme was 81.3 ± 23.4 μmol/L. After conducting the sorption itself its activity decreases to 53.6 ± 19.9 μmol/L. Decrease in the activity of the enzyme on the first day after the PS — 55.3 ± 21.5 μmol/L was significant. The tendency to the activity decrease of the enzyme persisted in the following days. The content of AST in blood before the PS was 101.7 ± 13.9 μmol/L, in the plasma before the sorption — 85.3 ± 7.9 μmol/L, after the sorption on the hemosorbent column the ALT activity decreased to 58.3 ± 3.3 μmol/L. Beginning with the first day after the PS there is a clear tendency to AST decrease activity similar to ALT. The content of ALP before the sorption in the blood was 568.7 ± 68.5 μmol/L, in plasma before the sorption — 459.0 ± 36.1 μmol/L, in plasma after the PS — 252.3 ± 90.1 μmol/L. On the next day after the PS in the blood, the ALP was 213.0 ± 20.0 μmol/L. Similarly to the dynamics of previous enzymes ALP also had a clear tendency to decrease.
In the group with renal failure syndrome the patients underwent 37 sessions of the PS, on average 2 sessions per patient. During the session, 800–1200 ml of plasma was obtained, purified and returned. The structure of nosological forms included both acute cases and exacerbation of chronic diseases: chronic glomerulonephritis, chronic pyelonephritis, acute glomerulonephritis, sepsis, peritonitis of various genesis, pancreatic necrosis, calculous cholecystitis, dysentery, acute intestinal obstruction, obliterative atherosclerosis of the vessels of the lower extremities, state after surgery. The influence of PS on the dynamics of individual enzymes is given below in the table. The list of enzymes in the table includes, along with ALT, AST, ALP, lactate dehydrogenase, gammaglutamyltranspeptidase, creatine phosphokinase.
Therefore, the PS is a powerful detoxification method in which the reduction of the excess of enzymes in the blood is carried out through the absorption capacity of the sorbent to these substances. The activity of indicator enzymes decreases most actively, which affects the reduction of the load on the liver and promotes its functional rest. Reduction of the level of cytolytic enzymes, along with the reduction of bilirubinemia correlated with the data of toxicological control.
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