THE IMPACT OF COMPREHENSIVE TREATMENT ON THE PROGRESSION OF LIVER FIBROSIS IN PATIENTS AFTER POLYCHEMOTHERAPY
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i2.13902Keywords:
drug-induced liver injury, polychemotherapy, fibrosisAbstract
SUMMARY. The toxic effects of medications on the body, particularly the liver, are often observed during the administration of antineoplastic agents. Despite this, there is currently no standardized treatment strategy for such drug-induced liver injuries, which are among the most serious complications of chemotherapy [1, 3, 4, 7]. This article examines the impact of comprehensive treatment on the progression of liver fibrosis in patients after polychemotherapy.
The aim – to investigate and explore the possibility of comprehensive treatment for post-hepatitis liver fibrosis as a medication-induced condition resulting from cytostatic therapy for breast cancer, in combination with overweight and obesity.
Material and Methods. The study involved women aged 35 to 79 years with liver fibrosis classified as F1-F2 and varying body mass index (normal weight, overweight, and grade 1 obesity), who were divided into two groups. Patients in Group I received non-medication therapy, while patients in Group II received medication therapy in the form of ursodeoxycholic acid and vitamin E. After completing the treatment, patients underwent a comprehensive set of clinical, laboratory, and instrumental examinations to compare the effects of the prescribed therapy.
Results. Administration of ursodeoxycholic acid at a dose of 15 mg/kg per day and vitamin E at a dose of 400 IU per day led to a reduction in clinical manifestations of the disease and stiffness indicators of liver parenchyma based on shear wave elastography (by 17.9 %). It also resulted in the normalization of indirect markers of liver fibrosis such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and prothrombin time, as well as gradual normalization of direct markers COL-4 and TGF-β1 according to dynamic observation. The proposed treatment approach in a significant portion of patients not only reduced liver echogenicity but also slowed down the rate of liver fibrosis progression.
References
Health of Ukraine. INFOMEDIA (n.d.). Hepatocellular damage: current concepts, labora-tory markers, and their clinical significance. Retrieved from: https://health-ua.com/article/41195-gepato tcelyulyarne-poshkodzhennya-suchasne-ponyattya-laboratorn-markeri-tah [in Ukrainian].
Hryshko, Ye.Yu., & Synytsia, T. (2021). Ozdorovchyi fitnes, yak zasib proty nadmirnoi masy tila u zhinok. Rol fizychnoi kultury i sportu v zberezhenni ta zmitsnenni henofondu natsii [Health fitness as a remedy against excess body weight in women. The role of physical culture and sports in preserving and strengthening the gene fund of the nation]. Proceedings of the Ukrainian science and practice online conference. Poltava: Simon [in Ukrainian].
Nedashkivskyi, S.M. (2019). Medykamentozno zumovleni urazhennya pechinky: pryntsypy diahnostyky, pa-tolohichni zminy y pidkhody do likuvannya [Medicamen-tally induced liver damage: principles of diagnosis, patho-logical changes, and approaches to treatment]. Medytsyna nevidkladnykh staniv – Medicine of Emergency Conditions, 2(97), 63-70 [in Ukrainian].
Khukhlina, O.S., Antoniv, A.A., Rudnytska, L.R., & Stanovych, Kh.G. (2017). Osoblyvosti perebihu nealkohol-noho steatohepatytu u khvorykh na ozhyrinnya [Features of non-alcoholic steatohepatitis course in obese patients]. Colloquium Journal, 9(2), 21-24 [in Ukrainian].
Fedorenko, Z.P., Hulak, L.O., & Horokh, Ye.L. (2011). Rak v Ukraini, 2009–2010. Zakhvoriuvanist, smertnist, pokaznyky diialnosti onkolohichnoi sluzhby [Cancer in Ukraine, 2009–2010. Morbidity, mortality, performance indicators of the oncology service]. Biul. Nats. kantser-reiestru Ukrainy – Bul. National Chancery Registry of Ukraine, 12, 116 [in Ukrainian].
Derkach, A., Sampson, J., Joseph, J., Playdon, M. C., & Stolzenberg-Solomon, R.Z. (2017). Effects of dietary sodium on metabolites: the Dietary Approaches to Stop Hypertension (DASH)-Sodium Feeding Study. The American Journal of Clinical Nutrition, 106(4), 1131-1141. DOI: 10.3945/ ajcn.116.150136.
European Association for the Study of the Liver (2019). Clinical Practice Guidelines on nutrition in chronic liver disease. J. Hepatol., 70(1), 172-193.
Jemai A., Siegel R., & Ward E. (2008). Global Cancer Facts and Figures 2008. CA Cancer J. Clin., 58, 76.
Marcellin, P., & Kutala, B.K. (2018). Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening. Liver International, 38(1), 2-6. DOI: 10.1111/liv.13682.
Non-alcoholic fatty liver disease: A patient guide-line. EASL-The Home of Hepatology. Retrieved from: https://easl.eu/publication/non-alcoholic-fatty-liver-disease-a-patient-guideline/.
Non-alcoholic fatty liver disease: A patient guide-line. EASL-The Home of Hepatology. Retrieved from: https://easl.eu/publication/non-alcoholic-fatty-liver-dis-ease-a-patient-guideline/.
Nutrition in Chronic Liver Disease EASL Guideline – EASL-The Home of Hepatology (2018). EASL-The Home of Hepatology. Retrieved from: https://easl.eu/publication/guideline-nutrition-in-chronic-liver-disease/.
