Yu.G. USKOVA, V.F. PAVELKINA

N.P. Ogarev Mordovian State University, Saransk

 Pavelkinа V.F. ― MD, Professor, Head of the Department of Infectious Diseases

Address: 68 Bolshevistskaya Str., Saransk, Russian Federation, tel. +7-937-513-46-59, e-mail: pavelkina@rambler.ru

 Objective ― to study the indicators of intoxication syndrome in hemorrhagic fever with renal syndrome with impaired liver function and to evaluate the possibilities of its correction with drugs of metabolic type of action.

Material and methods. Patients of two groups were examined: the first group of 40 patients received basic therapy (comparison group), the second (main) group of 35 patients received stepwise metabolic therapy: intravenous drip «Remaxol» (inosine + meglumin + methionine + nicotinamide + succinic acid), 400.0 ml intravenously drip 1 time per day for 10 days, then cytoflavin (inosine + meglumin + nicotinamide + succinic acid + riboflavin) 2 tablets 2 times a day in combination with hepatoprotector methionine (250 mg 3 times a day) for 20 days. Laboratory parameters were studied: urea, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), medium-weight molecules (MSM), total and effective concentration and binding ability of albumin (OCA, ECA, CCA), toxicity index (IT), activity of peroxide processes lipid oxidation (lipid peroxidation) and antioxidant protection (AOD).

Results. Of the features of the HFRS clinic, hepatomegaly was observed, combined with cytolysis of hepatocytes. An increase in laboratory parameters of intoxication syndrome (IS) was revealed: MSM254 and MSM280, a change in albumin parameters (decreased OKA, ECA, CCA, increased IT), an imbalance in the LPO-AOD system. These changes indicate the presence of endogenous intoxication syndrome, which is not stopped by basic therapy. This is the basis for the use of detoxification and membrane protective agents. The appointment of stepwise metabolic therapy reduced the severity of the clinical manifestations of IP, shortened the main periods of the disease: oliguric and polyuric, contributed to the correction of the above laboratory parameters of IP, lipid peroxidation, AOP and hepatic dysfunction (decreased indicators of the cytolytic syndrome ― ALT and AST).

Conclusion. In the Republic of Mordovia, a high incidence of HFRS persists. The clinical features include the frequent absence of cyclical course of the disease. One of the leading syndromes of the disease is intoxication, which is combined with liver dysfunction. In the clinical recovery of patients, normalization of IP and oxidative stress was not observed. Stepwise metabolic therapy contributed to the correction of the above clinical and laboratory parameters. All this confirms that the metabolic therapy has detoxification, antioxidant, and hepatoprotective effect and is its use promising.

Key words: hemorrhagic fever with renal syndrome, intoxication syndrome, liver, clinic, treatment.

(For citation: Uskova Yu.G., Pavelkina V.F. Optimizing the pathogenetic therapy for hemorrhagic fever with renal syndrome. Practical medicine. 2019. Vol. 17, №8, P. 90-96)

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