Метаболічна Підтримка Хворих З Інфарктом Міокарда З Порушеннями Функціонального Стану Печінки

Abstract

The aim – to improve the existing therapeutic programs for patients with myocardial infarction (MI) by differentiated approach to therapy depending on the presence or absence of liver dysfunction. Materials and methods. 149 patients with acute MI were included to the study – 114 (76.5 %) men and 35 (23.5 %) women of average age 59.9±1.0 years. A comparative clinical-laboratory and instrumental examination was performed in these groups: 107 patients with MI with functional liver disorders (main group) and 42 patients with MI without functional liver disorders (comparison group). For the study of intracardiac hemodynamics, echocardiography was performed in B-mode. 52 patients of main group and 22 patients of comparison group received standard treatment for MI (ACE-inhibitors, β-blockers, clopidogrel and acetylsalicylic acid, anticoagulant therapy, statins). The other 55 patients of main group and 20 patients of comparison group received modified treatment with the addition of the antioxidant bioflavonoid – quercetin to the standard scheme. Results and discussion. In the initial condition of patients of main group there are more pronounced violations of central and peripheral hemodynamics which cause the disorders of protein synthesis, detoxification, energetic dysfunction of liver and lipid metabolism. At the same time there is an excessive activation of lipid peroxidation, suppressed activity of enzymes of the antioxidant protection system, deepening of pathological processes in the heart and in the liver. Inclusion of bioflavonoid quercetin to the complex therapy of patients with myocardial infarction provided the improvement of hemodynamic parameters – increased EF by 22.89 % and elimination of diastolic dysfunction, which were accompanied by normalization of clinical and laboratory parameters of liver function disorders – normalization of levels of bilirubin and ALT, GGT, ALP on 14-th day and reduction of LDL-level by 25.61 % after 3 weeks was marked. Conclusions. Introduction of bioflavonoid quercetin to the complex therapy of patients with MI provided improvement of hemodynamic parameters and restoration of oxidation-reduction equilibrium, reduction of clinical and laboratory manifestations of liver dysfunction and contributed to a significant decrease in the frequency of MI complications development. Restoration of parameters of cardiac hemodynamics, metabolic processes and liver functions provides a significant reduction in the rate of development of acute heart failure by 63.9 %, early post-infarction angina by 22.2 %, rhythm and conduction disorders by 43.6 %.