Динаміка клініко-біохімічних порушень у пацієнтів з алкогольною залежністю в процесі терапії

Abstract

У статті наведено результати вивчення ефективності комплексної системи терапії у пацієнтів з алкогольною залежністю. В результаті дослідження виявлено вплив препаратів на показники вуглеводного обміну. Отримані дані свідчать про достатньо високу ефективність вказаної терапевтичної стратегії. Досліджувані препарати мають патогенетичний вплив на нормалізацію вуглеводного обміну, позитивно впливають на сомато-вегетативну сферу, сприяють редукції емоційних порушень астено-депресивного спектру, біологічній та соціальній адаптації хворих, що дозволяє створити передумови для проведення психокорекційних та реабілітаційних заходів; В статье приведены результаты изучения эффективности комплексной системы терапии у пациентов с алкогольной зависимостью. В результате исследования выявлено влияние препаратов на показатели углеводного обмена. Полученные данные свидетельствуют о достаточно высокой эффективности указанной терапевтической стратегии. Исследуемые препараты имеют патогенетическое влияние на нормализацию углеводного обмена, положительно влияют на сомато-вегетативную сферу, способствуют редукции эмоциональных нарушений астено-депрессивного спектра, биологической и социальной адаптации больных, что позволяет создать предпосылки для проведения психокоррекционных и реабилитационных мероприятий; Modern scientific advances in biological studies give more plausible evidence for an important pathogenetic role of carbohydrate metabolism disorders, which are in various psychiatric disorders, including those caused by alcohol. The aim of the research was to study the dynamics of clinical and psychopathological symptoms and carbohydrate metabolism in patients with alcohol dependence in the process of a comprehensive system of therapy and rehabilitation using metabolic action of drugs and psychotherapy. The study is based was the comprehensive clinical and psychopathological, psychodiagnostic, biochemical 200 patients with alcohol dependence, all men aged 23 to 59 years (mean age 35,9 ± 2,5 years). Nosological diagnosis was based on the criteria of ICD-10 (F10. 2-10. 4). To evaluate the therapeutic effects of using clinical and psycho¬pathological method, Hamilton Rating Scale for Depression (HDRS), Spielberger-Hanin Scale to assess the level of reactive and personal anxiety. Diagnosis of the condition of hormonal regulation of carbohydrate metabolism was carried out according to the criteria Y. I. Tomaszewski, A. J. Tomaszewski. All patients were randomized into 3 groups: the main group 1 (MG1, 75 persons who in addition to standard therapy, metabolic correction was carried out using actovegin and thioctic acid), the main group 2 (MG2, 75 per-sons who in addition to standard therapy conducted metabolic therapy and psychotherapy) and the comparison group (CG, 50 people who received only basic pharmacotherapy). In the first phase of a comprehensive system of therapy – phase active therapy – targeted therapeutic intervention was relief acute alcoholic psychoses and alcohol withdrawal symptoms that include detoxification of correction somato-vegetative and affective disorders. The sec¬ond phase begins after removal treatment abstinence disorders. In our study, combined therapy included the use of drugs that are traditionally used, correction of metabolic drug Actovegin and thioctic acid and psychotherapy. Dynamics of carbohydrate metabolism statistics Friedman ANOVA was correct in MG1 and MG2 groups (p < 0,001). The dynamics of the level of pyruvate in the blood and in the night piruvaturiyi СG was not statistically significant (χ²0,17, p > 0,05ta χ²3,74, p > 0,05, respectively) compared to MG1 (χ²8,77, p < 0,01 and χ²29,79, p < 0,001) and MG2 (χ²4,58, p < 0. 05 and χ²31,11, p < 0,001). Dynamics of PDG blood was statistically significant in СG (χ²44,32, p < 0,05), but with more pronounced tendency to normalization of observed in MG1 and MG2 groups (χ²79,87 and χ²84,9 respectively, p < 0,001). The maximum therapeutic effect in patients MG1 and MG2 is marked on the 18-21 day treatment, while in most cases (53,33 %) occurred stabilization affective sphere. It is noted that after 4 weeks of treatment in MG1 therapeutic effect was absent in 1 patient (1,3 %) with hypochondriac variant of depressive symptoms, in MG2 – 2 patients (2,7 %) of dysphoric manifestations, and СG – 8 (16,0 %). On a scale НDRS depression was before treatment was moderate. After 4 weeks of therapy significantly reduced levels of depression in all groups and reached a level of mild, while the group was recorded MG2 significant differ¬ence compared to the СG. The level of reactive and personal anxiety scale by Spielberger-Hanin was high before treatment, after 4 weeks of therapy RRT was significantly decreased in all groups to the level of moderately severe. Ass and mouth in MG1 fell to the upper limit of moderate but remained high and statistically significant difference was found. Roth MG2 group after 4 weeks of therapy fell to moderately severe (p < 0,05). These data suggest the feasibility of a combined therapy using drugs of metabolic action and psychotherapy in patients with alcohol dependence. The studied drugs have pathogenic effects on the normalization of carbohy¬drate metabolism, positively affecting the somato-vegetative sphere, contributing to the reduction of emotional disorders asthenic-depressive spectrum, biological and social adaptation of patients, allowing a prerequisite for psychotherapy and rehabilitation.