RU2529414C1 - Method of treating patients suffering intrahepatic portal hypertension syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: abdominal paracentesis is performed to remove ascetic fluid to be concentrated and filtered by means of hemodialysis filter and plasma filter. The prepared concentrate is added with human recombinant interleukin-2 in a dose of 500 IU. The concentrate is refused intravenously at a perfusion rate of 60 drops a minute in an amount of 500 ml. On the day following the abdominal paracentesis, the concentrate is introduced again.

EFFECT: method provides effective elimination of hypo- and dysproteinemia in the given category of patients, as well as the correction of immune disorders by using plasma self-proteins and cytokines that enables the further surgical correction of the detected pathology.

3 ex

Description

The invention relates to medicine, in particular to surgery, and can be used in the treatment of patients with virus-associated cirrhosis, as well as for the preoperative preparation of patients with ascites who will undergo an operation to correct intrahepatic portal hypertension syndrome using one of the known methods.

In recent years, liver diseases occupy an increasingly solid place in the structure of mortality among people of the most active age group (see Smorodinsky A.V., Iontsev V.I. Prospects for the surgical treatment of complications of portal hypertension in cirrhosis in patients with decompensated liver failure // Russian Bulletin Military Medical Academy. - 2010. - No. 1. - P.210). A progressive disease with an unfavorable prognosis, regardless of the etiology, cirrhosis of the liver, causes the death of patients, usually due to the development of one or more complications (see Kotiv B.N., Dzizawa II, Kashkin D.P., Alentiev S.A., Chaly A.N., Bugaev S.A., Gerliani G.V. Results of partial portocaval bypass surgery in patients with portal hypertension syndrome // Russian Journal of Gastroenterology, Hepatology, Coloproctology. - 2003. - No. 1 (Pril .). - P. 16).

The diagnosis of “portal hypertension” is associated primarily with its most significant clinical manifestation, such as massive gastrointestinal bleeding. The second most important symptom is resistant ascites. Recently, however, the appearance of ascites in a patient has been regarded as a sign of decompensation of liver functions (see AK Eramishantsev / Surgical treatment of portal hypertension syndrome in Russia / Russian Journal of Gastroenterology, Hepatology, Coloproctology, 2001, No. 4. P.76) .

Moreover, in a number of studies of the last decade, the role and importance of hypoproteinemia, as one of the main factors of an unfavorable outcome of surgical treatment of patients with portal hypertension syndrome, have been established. So, according to the Order of the Ministry of Health and Social Development of the Russian Federation dated February 14, 2006 No. 78 “On approval of medical care standards for patients with portal hypertension” and the Order of the Ministry of Health and Social Development of the Russian Federation dated May 26, 2006 No. 404 “On the approval of medical care standards for patients with alcoholic, primary, secondary and unspecified biliary, other unspecified cirrhosis ”, the volume of transfused albumin for the correction of hypoproteinemia is 1200 ml, freshly frozen plasma up to 8 doses to the patient during one course of treatment.

Hypoproteinemia, which always accompanies portal hypertension syndrome, requires additional albumin injections, while ascitic fluid contains a high concentration of albumin. The use of donor plasma often causes allergic and pyrogenic reactions in patients. In addition, in addition to the hepatitis B and C viruses, HIV, syphilis, there is a real threat of infection of the recipient by more than 20 pathogens: malaria, brucellosis, tularemia, tuberculosis, echinococcosis, etc. The share of post-transfusion hepatitis “B” and “C” among all hepatitis in Russia is 10-20%. Forced multiple laparocentesis with ascitic fluid utilization leads to a significant decrease in plasma protein concentration, a high risk of infectious complications, cachexia and the rapid development of hepatic-renal failure.

The use of albumin, alvesine, and similar protein preparations is not always available, since 1 liter of freshly frozen plasma costs 3612 rubles, 1 liter of a 10% solution of albumin costs 9000 rubles. In this regard, the possibilities of reinfusion of auto-ascitic fluid are impressive.

There is a method of treating liver failure in patients with ascites (RU 2092107 C1, dated 10.10 1997), the essence of which is the simultaneous evacuation of ascitic fluid in full, which is sorbed, lyophilized and dissolved before reinfusion in such a way that two liters of the resulting fluid correspond to eight liters of ascitic liquid, while the remaining liquid is administered fractionally every other day. The disadvantage of this method may be that the process of sorption and lyophilization takes a long time, is financially expensive, the transfusion of the concentrate is possible only the next day, in this method there is no immune correction of the patient's status.

There is a method of treating cirrhosis of the liver, complicated by diuretic-resistant ascites (see RU 2376039 C1, publ. 20.12.22009, Bull. No. 35), the essence of which is the collection and reinfusion through a fully implantable peritoneal port system, which is installed in the subcutaneous tissue, the port system catheter is inserted into the abdominal cavity, the catheter’s working end is inserted into the iliac fossa, the catheter is implanted into the rectus muscle by the cuff, it is connected to the port, and the transfusion system is connected to the port system through inf Uzomat, the venous end of the transfusion system is connected to the subclavian vein, additionally before and during reinfusion, irradiation of the ascitic fluid with a low-energy helium-neon laser with a laser output of 10 mW, exposure time 10-15 min, wavelength 0.63 μm in continuous mode carrying out reinfusion of ascitic fluid at a rate of 15-20 ml per minute, fractionally 500-700 ml with an interval of 5-7 minutes, daily in a volume of 1.5-2.5 liters with a decrease in the initial volume to 1.05-0, 55 l However, the disadvantage of this method may be the lack of detoxification filtration and concentration of ascitic fluid, as well as the impossibility due to the cumbersome system of its use in the preoperative period.

A known method of treating liver failure (see RU 2269363 C1, publ. 02/10/2006. Bull. No. 4), one of the goals of which is to increase the effectiveness of detoxification and patient safety through the use of the peritoneum and the absence of factors affecting hemodynamics and hemostasis. The essence of the method is the removal of albumin-bound toxins from the patient’s body through the peritoneum by introducing through a catheter into the abdominal cavity a solution containing albumin at a concentration of 30-40 g / l, with its exposure for 2-4 hours and subsequent removal from the abdominal cavity, and the perfusion rate a solution of albumin during its purification is 20-30 ml / min. The disadvantage of this method, in our opinion, may be that the use of albumin intraperitoneally at a specified dose does not create its therapeutic effect, evacuating it after 2-4 hours is economically expensive, the ascitic fluid containing the patient’s own proteins is not used, the detoxification effect is insignificant , and also immunocorrection is not carried out.

From patent sources it is known that in order to increase the effectiveness of treatment and the quality of life of patients with peritoneal carcinomatosis and intense malignant ascites, due to the effective correction of hypovolemic and hypoproteinemic disorders in patients with intense ascites due to peritoneal carcinomatosis (see RU 2359676 C2, publ. 27.06. 2009, Bull. No. 18) carry out the concentration of ascitic fluid, filtering it with a hemodialysis filter, and then concentrating using a plasma filter and adding to the resulting filter ho sodium hypochlorite oxidation, cefazolin 2.0 g / l, and prednisone 90 mg / l. However, the use of this technique in the treatment of patients with intrahepatic portal hypertension is not acceptable, since the introduction of antibiotics and prednisone is not part of the standard for the treatment of liver cirrhosis.

From the same literature sources it is known that in order to increase the efficiency of treatment of patients with portal hypertension, maintain protein balance and improve the immune and rheological characteristics of the blood, auto-ascitic fluid is taken from the abdominal cavity, it is irradiated with a helium-neon laser by a scanning method for 15 minutes, and then produce its reinfusion (see RU 2029489 C1, publ. 2000, Bull. No. 24). However, the introduction of non-concentrated ascitic fluid is less effective than concentrated due to the low concentration of protein in it, and the correction of immune imbalance is impossible without the use of immunotropic drugs in patients with cirrhosis.

The technical result of the invention is to improve the results of treatment of patients with virus-associated cirrhosis of the liver by eliminating hypo- and dysproteinemia (including with resistant forms), as well as for correcting immune disorders and preventing spontaneous bacterial peritonitis by administering an immunocorrecting drug based on a recombinant interleukin-2, which favorably affects further surgical correction of intrahepatic portal hypertension using one of the known methods.

The objective of the invention is to achieve a total result by replenishing plasma proteins with their own proteins by reinfusion of ascites fluid concentrate while preventing spontaneous bacterial peritonitis and cytokine immunomodulating therapy by introducing recombinant interleukin-2.

The specified technical result is due to the fact that human recombinant interleukin-2 at a dose of 500 ME is added to the ascites fluid concentrate, the injection is carried out intravenously at a perfusion rate of 60 drops per minute in a volume of 500 ml of the prepared concentrate, the concentrate is re-introduced the next day after laparocentesis .

The implementation of this method allows to increase the effectiveness of the treatment of patients with virus-associated cirrhosis of the liver due to their own reserves, to correct the existing immunological dysfunction, to reduce the loss of auto protein, colloids, enzymes, hormones due to reinfusion of ascites fluid concentrate, and also to reduce the risk of developing spontaneous bacterial peritonitis by adding recombinant cytokine.

The method is as follows

Subject to aseptic rules under local anesthesia with 0.5% novocaine solution 15.0 ml or 1% lidocaine solution (with novocaine intolerance) 15.0 ml, a 3 mm long skin incision is made with a scalpel along the midline of the abdomen 2-3 cm below the umbilical ring A metal puncture needle with a diameter of 1.4 mm is inserted through the skin incision into the abdominal cavity, inside of which there is a plastic conductor from the subclavian catheter of single use “Luer”. After removing the corner and leaving the conductor in the abdominal cavity, a modified Luer single-use subclavian catheter with a diameter of 1.4 mm is inserted onto the conductor with rotational movements until it enters the lumen of the abdominal cavity. Then the conductor is removed, the catheter is fixed with an aseptic bandage to the skin of the abdomen.

Highways for collecting biological fluids, the AK-10 artificial kidney apparatus (Gambro) is connected to a catheter, and an F60S hemodiafilter from Fresenius with micropores of 500-1500 daltons is installed. The collection of fluid is carried out in a sterile container for collecting plasma (such as hemocon).

An ascitic fluid is sampled and filtered at a rate of 6 liters per hour. A single intake is 10-15 liters of ascitic fluid, the proportion of concentrate in which is 1-3 liters. The concentrate is collected fractionally in hemocones of 500-550 ml.

Then, the concentrate is additionally subjected to ultraviolet radiation with a wavelength of 254 nanometers using an ultraviolet ultraviolet apparatus of the Izold type No. 0751 blood type. Produce heparinization of a concentrate in a dose of 1000 PIECES on 500 ml of liquid.

In the first dose of a 500 ml concentrate, 500 IU of human recombinant interleukin-2 dissolved in ascitic fluid concentrate is added. A recombinant human interleukin-2 concentrate is administered intravenously to a patient in a volume of 500 ml. The perfusion rate is 60 drops per minute. The remainder of the concentrate is collected in sterile hemocones of 500 ml and cooled at a temperature of + 2 ° C to + 4 ° C.

On the next day after laparocentesis, 500 ml of the concentrate is brought, brought to room temperature + 18 ... + 20 ° C with the addition of 500 ME recombinant human interleukin-2.

Then perform a surgical operation of splenorenal venous or transjugular intrahepatic portosystemic shunting.

Examples of clinical use of the proposed method

Patient G., 28 years old, medical history No. 8585/184 was admitted to the Department of Portal Hypertension of Rostov State Medical University on November 17, 2003 with complaints of a feeling of heaviness in the right and left hypochondria, periodically occurring nausea, general weakness, malaise, and an increase in abdomen. From the anamnesis: considers herself a patient since 2000, when they found positive markers of viral hepatitis "C", about a year ago the abdomen began to increase in size, a feeling of heaviness appeared in the left hypochondrium. On physical examination, the skin, visible mucous membranes are pink, the tongue is moist coated with white plaque at the root, the stomach is enlarged due to ascites, there is a moderate expansion of the veins on the anterior abdominal wall in the form of a “jellyfish head”, perimetry at the level of the navel is 117 cm, no peripheral edema . Palpation of the abdomen is difficult due to free fluid in the abdominal cavity. Diuresis up to 800 ml per day while taking 100 mg of veroshpiron. According to additional research methods: with ultrasound, the liver is enlarged, diffusely heterogeneous, portal vein 14 mm, blood flow velocity 15 cm / sec, spleen increased in size 145 × 72 mm, splenic vein 9 mm, blood flow velocity 22 cm / sec s turbulent nature of blood flow, free fluid in the abdominal cavity. Video esophagogastroscopy: varicose veins of the esophagus 2-3 degrees. Histological examination of liver punctate: macro-micronodal cirrhosis of the liver of viral etiology with a minimum degree of activity (Knodl 36). Complete blood count: hemoglobin 125 g / l, red blood cells 4.5 × 10 ⁹ / l, white blood cells 7.0 × 10 ¹² / l, ESR 30, platelets 205 × 10 ⁹ / l, total bilirubin 15.0, ACT 0, 56, ALT 0.60, prothrombin index 76%, amylase 10 g / l, urea 6.23 mmol / l, total protein 78 g / l, albumin 28%, globulins α-13%, β-15%, γ- 44%, A / G = 0.37. Urinalysis: specific weight 1018, protein 0.025 g / l, red blood cells - no, white blood cells 4-8 ^x . The immune status shows signs of inhibition of the T-cell immunity, characterized by a decrease in the relative and absolute content of CD3 + and CD4 + lymphocytes and the percentage of lymphocytes carrying the receptor for interleukin-2 (IL-2) -CD4 + CD25 +, and a decrease in spontaneous phagocytic activity in HCT -test, signs of disimmunoglobulinemia, deficiency in NK cells. Conclusion: signs of secondary immune deficiency syndrome.

The patient was diagnosed with virus-associated cirrhosis (HCV), portal hypertension, class “C” chronic liver failure, hepatosplenomegaly, esophageal varicose veins, erosive gastritis, ascites, and secondary immunodeficiency syndrome.

November 22, 2003, laparocentesis was performed under conditions of separation of efferent methods of treatment, ultrafiltration of ascitic fluid and reinfusion of the concentrate in a volume of 500 ml with the addition of interleukin-2 human recombinant 500 ME. In total, 9 liters were evacuated, 2 liters of concentrate were procured. Analysis of ascitic fluid: total protein - 42 g / l, albumin - 31%, α-globulins 11%, β-globulins 12%, γ-globulins 46%, albuminoglobulin coefficient - 0.44; bilirubin - 13.4 μmol / l, creatinine - 61 μmol / l, urea - 4.3 mmol / l, lymphocytes - 58%, neutrophils - 18%, toxicity by the level of medium molecules - 0.431 conventional units

After ultrafiltration and sorption of ascitic fluid: total protein - 51 g / l, albumin - 36%, α-globulins 10%, β-globulins 16%, γ-globulins 38%, albuminoglobulin coefficient - 0.56; bilirubin - 12.4 μmol / l, creatinine - 53 μmol / l, urea - 3.8 mmol / l, toxicity by the level of medium molecules - 0.149 conventional units

After the first reinfusion, diuresis increased and amounted to 1450 ml per day.

November 23, 2003, in the operating room, 500 ml of ascitic fluid concentrate was added with the addition of human recombinant 500 ME interleukin-2, the operation was performed: splenectomy, splenorenal venous anastomosis, drainage of the abdominal cavity. Blood loss 400 ml, replenished with the introduction of blood substitutes.

In the postoperative period from 11/30/2003: General blood test: hemoglobin 102 g / l, red blood cells 3.1 × 10 ⁹ / l, white blood cells 14.0 × 10 ¹² / l, ESR 32, platelets 209 × 10 ⁹ / l, bilirubin total 17.0, ACT 0.57, ALT 0.60, prothrombin index 78%, amylase 11 g / l, urea 6.9 mmol / l, total protein 72 g / l, albumin 42%, globulins α-12% , β-17%, γ-29%, A / G = 0.72. Urinalysis: specific weight 1016, no protein, red blood cells - no, white blood cells 4-6 ^x .

In the postoperative period, drainage from the abdominal cavity was removed on the 2nd day, no discharge of ascitic fluid was observed, and the patient’s stomach was pulled with a bandage. Additional administrations of ascites fluid concentrate and protein preparations were not performed.

Sutures were removed 7-8 days after surgery, the wound healed by first intention. The patient's body temperature during the stay did not increase more than 37.2 ° C for 2 days after surgery. The perimeter of the abdomen is 92 cm.

Test results dated 12/04/2003: General blood test: hemoglobin 108 g / l, red blood cells 3.2 × 10 ⁹ / l, white blood cells 9.0 × 10 ¹² / l, ESR 25, platelets 221 × 10 ⁹ / l, total bilirubin 16.0, ACT 0.56, ALT 0.61, prothrombin index 77%, amylase 12 g / l, urea 5.9 mmol / l, total protein 72 g / l, albumin 48%, globulins α-11%, β-14%, γ-27%, A / D = 0.92. Urinalysis: specific weight 1016, protein - no, red blood cells - no, white blood cells 4-6 ^x .

2. Patient M., 43 years old, medical history No. 9666/305, was admitted to the surgical department No. 2 of Rostov State Medical University on 01.12.2008 with complaints of general weakness, nausea, dizziness, an increase in the abdomen, a feeling of heaviness in the right and left hypochondrium, edema both lower limbs. From the anamnesis: considers herself a patient since 2008, when she was hospitalized by ambulance with gastrointestinal bleeding, where the viral hepatitis "C" was first verified.

An objective examination: the patient's condition is moderate, determined by the swelling of both feet. The abdomen is enlarged due to ascites, painless in all departments. The perimetry of the abdomen is 125 cm. The liver is enlarged, the edge is palpated 2-3 cm from under the costal arch. The spleen protrudes 5-6 cm from under the costal arch, deep palpation is difficult due to free fluid in the abdomen. Diuresis up to 700-800 ml per day while taking 200 mg of veroshpiron.

According to additional research methods (spiral tomography with bolus contrasting), the liver is 217 × 158 × 125 mm, the contours are clear, bumpy, the density is reduced by 50%, the portal vein is 22 mm, the blood flow speed is 13 cm / sec, the spleen is 183 × 177 × 109 mm , the contours are clear, the splenic vein is 12 mm, the blood flow velocity is 17 cm / sec, free fluid is in the abdominal cavity. Video esophagogastroscopy: varicose veins of the esophagus 3 degrees.

Complete blood count: hemoglobin 98 g / l, erythrocytes 4.1 × 10 ¹² / l, hematocrit 25.5%, leukocytes 1.9 × 10 ⁹ / l (stab - 4%, segmented - 40%, lymphocytes - 51% monocytes - 5%); ESR 23, platelets 95 × 10 ⁹ / l, total bilirubin 18.8, ALT 57, alkaline phosphatase 133, prothrombin index 81%, amylase 146 g / l, urea 4.4 mmol / l, total protein 73 g / l, albumin 39%, globulins α-12%, β-10%, γ-39%, A / D = 0.64.

General urine analysis: ud.weight 1013, protein - no, red blood cells - no, white blood cells 1-2 ^x , epit. 1-2 ^x mp.

Immunologist: signs of cell-type immune deficiency with a deficiency of CD3 +, CD4 + positive lymphocytes, decreased CD4 +, CD25 + lymphocytes and NK cells, disimmunoglobulinemia.

The patient was diagnosed with virus-associated cirrhosis of the liver (HCV, intrahepatic type), portal hypertension, varicose veins of the esophagus of the 3rd degree, hepatosplenomegaly, hypersplenism, Childa’s chronic liver failure, syndrome of secondary immune deficiency.

December 3, 2008, laparocentesis was performed in the department of efferent methods of treatment, ultrafiltration of ascitic fluid and reinfusion of the concentrate in a volume of 500 ml with the addition of interleukin-2 human recombinant 500 ME. A total of 8 liters were evacuated, 1.8 liters of concentrate were procured. Analysis of ascitic fluid: total protein - 44 g / l, albumin - 40%, α-globulins 11%, β-globulins 9%, γ-globulins 40%, albuminoglobulin coefficient - 0.67; bilirubin - 17.9 μmol / l, creatinine - 61 μmol / l, urea - 4.3 mmol / l, lymphocytes - 68%, neutrophils - 10%, toxicity by the level of medium molecules - 0.386 conventional units

After ultrafiltration and sorption of ascitic fluid: total protein - 58 g / l, albumin - 46%, α-globulins 9%, β-globulins 13%, γ-globulins 32%, albuminoglobulin coefficient - 0.85; bilirubin - 12.5 μmol / l, creatinine - 53 μmol / l, urea - 3.6 mmol / l, toxicity by the level of medium molecules - 0.122 conventional units

After the first reinfusion, diuresis increased and amounted to 1400 ml per day.

December 4, 2008, under X-ray operating conditions, 500 ml of ascitic fluid concentrate was added with the addition of interleukin-2 human recombinant 500 ME, the operation was performed: transjugular intrahepatic portosystemic shunting (TVPSh).

In the postoperative period of December 6, 2008: General blood test: hemoglobin 96 g / l, red blood cells 3.9 × 10 ¹² / l, hematocrit 20.9%, white blood cells 1.6 × 10 ⁹ / l (eosinophils - 3, basophils - 1, stab - 1, segmented - 38, lymphocytes - 54, monocytes - 3), an ESR 20, platelets 98 × 10 ⁹ / l, bilirubin total 18.9 mol / l, prothrombin index 81%, 146 gchas amylase / l, urea 4.4 mmol / l, total protein 76 g / l, albumin 46, globulins α-11, β-14, γ-29, A / D = 0.85. Urinalysis: specific weight 1014, no protein, red blood cells - no, white blood cells 1-3 ^x .

Additional administrations of ascites fluid concentrate and protein preparations were not performed. The patient's body temperature during the stay did not deviate from 36.7 ° C. Perimeter of the abdomen 88 cm.

Test results dated 12.12.2008: General blood test: hemoglobin 100 g / l, erythrocytes 3.2 × 10 ¹² / l, white blood cells 2.0 × 10 ⁹ / l (eosinophils - 4, basophils - 2, stab - 4, segmented - 39, lymphocytes - 44, monocytes - 7), ESR 15, platelets 102 × 10 ⁹ / l, total bilirubin 19.0, prothrombin index 82%, amylase 122 gh / l, urea 4.9 mmol / l, total protein 79 g / l, albumin 49, globulins α-11, β-15, γ-25, A / G = 0.96. Urinalysis: specific weight 1015, protein - no, red blood cells - no, white blood cells 2-4 ^x . The patient was discharged on the 14th day after the operation of TBPS.

3. Patient Sh., 61 years old, medical history 004540/80, was admitted to the surgical department of Rostov State Medical University on 04/19/10 with complaints of heaviness in the right hypochondrium, bloating, occasional nausea, weakness, weight loss of 5 kg over the past 2 months. From the anamnesis of the disease: considers himself sick since 2008, when in November there was bleeding from varicose veins of the esophagus. Bleeding was stopped by conservative measures. About 6 months ago, laparocentesis was performed, 10 liters of ascitic fluid were evacuated. During military service, hepatitis C was diagnosed.

An objective examination: the patient’s condition is moderate, the skin, pink mucous membranes, there is an increase in the size of the abdomen due to free fluid, the perimeter of the abdomen is 123 cm. On the front abdominal wall there are dilated saphenous veins in the form of a “jellyfish head”. With percussion and palpation of the abdomen, the liver protrudes from under the costal arch by 2-3 cm, of a dense consistency, the spleen is not palpated due to ascites. Diuresis up to 600-700 ml per day on the background of taking diuver.

According to additional treatment methods: ultrasound - the liver parenchyma is diffuse, heterogeneous, the vascular pattern is significantly depleted, portal vein 1.6 cm, splenic vein 7 mm, 9.5 mm in the spleen portal, 6.8 mm hepatic vein. Portocaval, cavacaval anastomoses, recanalization of the umbilical vein with a diameter of 7 mm are visualized. EFGDS - varicose veins of the esophagus 2-3 degrees, signs of portal gastropathy.

General blood test at admission: hemoglobin 106 g / l, red blood cells 3.3 × 10 ¹² / l, white blood cells 5.2 × 10 ⁹ / l (eosinophils - 1, stab - 2, segmented - 44, lymphocytes - 48, monocytes - 5), the ESR 15, the platelets 198 × 10 ⁹ / l, total bilirubin 22.0, 0.78 ACT, 0.69 ALT, prothrombin index 72%, amylase 119 g / l, urea 5.0 mmol / l, total protein 69 g / l, albumin 36%, globulins α-16%, β-11%, γ-37%, A / G = 0.56. Urinalysis: specific weight 1020, protein 0.025 g / l, red blood cells - no, white blood cells 2-3 ^x . In the immune status, inhibition of T-cell immunity, a decrease in the relative and absolute content of CD3 + lymphocytes is noted. CD4 + lymphocytes and the percentage of lymphocytes carrying the receptor for interleukin-2 (IL-2) - CD25 +, a decrease in spontaneous phagocytic activity in the HCT test, there are signs of disimmunoglobulinemia. Conclusion: signs of secondary immune deficiency.

The patient was diagnosed with virus-associated cirrhosis of the liver, portal hypertension (intrahepatic type), Childe’s chronic liver failure class C, varicose veins of the esophagus 2-3 degrees, hepatosplenomegaly, ascites, secondary immune deficiency.

04/22/2010, laparocentesis was performed in the department of efferent methods of treatment, ultrafiltration of ascitic fluid and reinfusion of the concentrate in a volume of 500 ml with the addition of interleukin-2 human recombinant 500 ME. In total, 10 liters were evacuated, 2 liters of concentrate were prepared.

Analysis of ascitic fluid: total protein - 28 g / l, albumin - 41%, α-globulins 12%, β-globulins 10%, γ-globulins 37%, albuminoglobulin coefficient - 0.69; bilirubin - 20.9 μmol / l, creatinine - 66 μmol / l, urea - 4.9 mmol / l, lymphocytes - 52%, neutrophils - 9%, toxicity by the level of medium molecules - 0.346 conventional units

After ultrafiltration and sorption of ascitic fluid: total protein - 48 g / l, albumin - 42%, α-globulins 11%, β-globulins 13%, γ-globulins 34%, albuminoglobulin coefficient - 0.72; bilirubin - 19.5 μmol / l, creatinine - 56 μmol / l, urea - 4.6 mmol / l, toxicity by the level of medium molecules - 0.162 conventional units

After reinfusion, diuresis increased and amounted to 1100 ml per day.

04/23/2010, re-introduction of ascitic fluid concentrate in a volume of 500 ml with the addition of interleukin-2 human recombinant 500 ME was performed.

After re reinfusion - complete blood count: Hemoglobin 108 g / L, erythrocytes 3,4 × ^{12 October} / l, leukocytes 6,2 × 10 ⁹ / L (eosinophils - 2, stab - 2, segmented - 64, lymphocytes - 27, monocytes - 5), ESR 12, platelets 196 × 10 ⁹ / l, total bilirubin 22.0, ACT 0.78, ALT 0.69, prothrombin index 73%, amylase 116 g / l, urea 5.5 mmol / l total protein 74 g / l, albumin 44%, globulins α-12%, β-16%, γ-28%, A / G = 0.78. Urinalysis: specific weight 1018, protein - no, red blood cells - no, white blood cells 1-3 ^x . The patient's body temperature during the stay did not deviate from 36.8 ° C. The perimeter of the abdomen is 92 cm.

Results of analyzes of 28-04-2010: CBC: Hemoglobin 110 g / L, erythrocytes 3,5 × ^{12 October} / l, leukocytes 6,0 × 10 ⁹ / L (eosinophils - 4, basophils - 1, stab - 2, segmented - 63, lymphocytes - 25, monocytes - 5), ESR 11, platelets 197 × 10 ⁹ / l, total bilirubin 21.9, prothrombin index 74%, amylase 102 g / h, urea 5.9 mmol / l, total protein 79 g / l, albumin 49%, globulins α-12%, β-16%, γ-23%, A / G = 0.96. Urinalysis: specific weight 1018, protein - no, red blood cells - no, white blood cells 1-3 ^x . The patient was discharged on the 10th day.

This method treated 12 patients with intrahepatic portal hypertension.

The method is easily reproducible in hospitals with an efferent treatment unit equipped with an AK-10 artificial kidney apparatus (Gambro company) and an Isofold type UFD apparatus No. 0751, which does not require additional material costs.

Claims (1)

A method of treating patients with intrahepatic portal hypertension syndrome, including removal of ascitic fluid, its concentration, filtration using a hemodialysis filter and a plasma filter, subsequent reinfusion, characterized in that human recombinant interleukin-2 is added to a concentrate of ascitic fluid at a dose of 500 ME, intravenous administration at a perfusion rate of 60 drops per minute in a volume of 500 ml of the prepared concentrate, re-introduction of the concentrate is carried out the next day after the paw rocentesis.