HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE.
Wiad Lek. 2023;76(3):487-494. doi: 10.36740/WLek202303104.
The aim: To conduct a comparative analysis of parameters of the structural and functional state of the liver and pancreas in patients with chronic pancreatitis in comorbidity with treated etiologically chronic viral hepatitis C, depending on the results of testing according to the international CAGE questionnaire.
Materials and methods: 100 ambulatory patients with CP with concomitant HCV, treated etiotropically, were examined. All patients were examined ac-cording to generally accepted algorithms. To establish the role of alcohol on the formation of CP and the condition of patients with treated HCV, latent craving for alcohol was verified using the international CAGE questionnaire. The study of the density of the liver parenchyma and the liver of the patients was carried out not only according to the ultrasound data in the B-mode, but also with the simultaneous measurement of the shear wave elastography (SWE) method on the Ultima PA scanning ultrasound device with the further determination of the median of the parameters, which characterizes the stiffness in kilopascals (kPa). Determination of the presence and depth of pancreatic exocrine insufficiency (PEI) was carried out by the content of fecal elastase-1 (FE-1), which was determined by the enzyme immunoassay method.
Results: Screening-testing of patients with CP on the background of etiotropically treated HCV using the CAGE scale made it possible to state that 65.0% of such patients had a hidden craving for alcohol, and 21.0% of this cohort were women, which needs to be taken into account in the management of such patients. It has been proven that in the group of patients with CAGE≥2.0, the level of functional and structural changes in the liver and liver was significantly more severe (according to the deepening of the PEI, a decrease in fecal α-elastase by 13.01%, according to an increase in the total index of the coprogram by 15.11% and the total US-indicator of the pancreas structure by 28.06%, and the total US-indicator of the liver structure - by 40.68% (p<0.05) and corresponded to the average degree of severity of the process in panceas according to the criteria of the Marseille-Cambridge classification, and in the group with CAGE<2.0 - only a mild degree.
Conclusions: The negative effect of the factor of increased alcohol use according to CAGE was proven by increasing the density of the echostructure of the liver by 5.73% (p<0.05), and the liver by 5.16% (p<0.05). According to the results of the correlation analysis of the dependence of the structural state of the liver and PW of the studied patients on the value of the CAGE scale, which was R=0.713, p<0.05, and R=0.686, p<0.05, respectively, it was established that there is a strong direct dependence of the structural state of the liver and PW from the value of the CAGE questionnaire, which proved an independent, reliably significant role of alcohol consumption for patients with a comorbid course of CP and HCV.
对伴有经病因治疗的慢性丙型病毒性肝炎的慢性胰腺炎患者，根据国际 CAGE 问卷的检测结果，进行肝、胰结构和功能状态参数的对比分析。
共检查了 100 例伴有慢性丙型病毒性肝炎的慢性胰腺炎门诊患者，对其进行了病因治疗。所有患者均按照公认的算法进行了检查。为了确定酒精在 CP 形成中的作用和经治疗 HCV 患者的状况，使用国际 CAGE 问卷验证了对酒精的潜在渴望。对患者的肝实质和肝脏密度进行了研究，不仅根据 B 型超声数据，而且还通过 Ultima PA 超声设备上的剪切波弹性成像 (SWE) 方法进行了同时测量，进一步确定了表征千帕斯卡 (kPa) 硬度的参数中位数。通过粪便弹性蛋白酶-1 (FE-1) 的含量确定胰腺外分泌功能不全 (PEI) 的存在和深度，FE-1 的含量通过酶免疫测定法确定。
对伴有经病因治疗的丙型病毒性肝炎的 CP 患者进行 CAGE 量表筛查检测，结果表明，65.0%的此类患者存在隐性酒精渴望，其中 21.0%为女性，在管理此类患者时需要考虑到这一点。已证明，在 CAGE≥2.0 的患者组中，肝和肝的功能和结构变化程度明显更严重（根据 PEI 的加深，粪便 α-弹性酶降低 13.01%，根据粪脂酶试验总指数增加 15.11%和胰腺结构总 US 指数增加 28.06%，以及肝结构总 US 指数增加 40.68%（p<0.05），并与根据马赛-剑桥分类标准的胰腺过程的平均严重程度相对应，而在 CAGE<2.0 组中，仅为轻度。
通过 CAGE 增加酒精使用的因素的负面影响被证明为肝回声结构增加 5.73%（p<0.05），肝回声结构增加 5.16%（p<0.05）。根据依赖关系的结构状态的肝和 PW 的研究患者的相关性分析的结果对 CAGE 量表的价值，这是 R=0.713，p<0.05，和 R=0.686，p<0.05，分别建立了肝和 PW 的结构状态有一个强大的直接依赖关系从 CAGE 问卷的值，这证明了酒精消费的独立，可靠的重要作用为伴有 CP 和 HCV 的并发病程的患者。
