Оценка эффективности левокарнитина в сопроводительной терапии при множественной миеломе

Аннотация

Ключевые слова: Сопроводительная терапия, назначаемая при применении Сопроводительная токсичных препаратов, во многом помогает пациентам довести терапия, лечение до конца, а врачу придерживаться терапии выбранной левокарнитин, линии оценка токсичности, фортекарнит, Целью исследования явилось изучить влияние метаболическая левокарнитина на биохимические показатели крови и на коррекция. переносимость химиотерапии. Материалы и методы. Исследование проводилось в отделении по лечению стволовыми клетками при центре Гематологии. Оценка токсичности химиотерапии проводилась – по стандартам ВОЗ и NCIC. Результаты. В сравнительном исследовании у 30 пациентов, получающих ПХТ при миеломной болезни с различной степенью токсичности при добавлении к стандартной терапии фортекарнита (100 мг/кг/сутки) в течение 2 месяцев и более отмечено значимое положительное изменение цитохимических показателей (аланин трансфераза (АЛТ), аспартат трансфераза (АСТ)), что позволило авторам рекомендовать метаболическую коррекцию всем пациентам, получающим ПХТ, особенно при 2-й и 3-й степени токсичности. 57 Жамият ва инновациялар – Общество и инновации – Society and innovations Issue – 2 № 1 (2021) / ISSN 2181-1415 Concomitant therapy prescribed when using toxic drugs, in many ways helps patients to complete treatment, and the doctor to adhere to the therapy of the chosen line [4, 5]. In the treatment of neurological, cardiological, nephrological diseases, the use of targeted medications is repeated many times until remission is achieved. Hematological and oncological diseases, all the more, are no exception [7,10]. At present, when conducting PCT courses, great importance is attached to the issues of metabolic therapy as a significant pathogenetic link in almost all complications caused by chemotherapy [1,2,7,10]. In this regard, the search for drugs with a general effect on metabolism is relevant. One of these drugs is discovered by Russian scientists R. Krimberg and V.S. Gulevich, carnitine is a natural compound, the metabolic functions of which are associated with the transport of fatty acids into the mitochondria, where they are oxidized with the release of energy ATP, modulation of the intracellular homeostasis of coenzyme A in the mitochondrial matrix, detoxification of excess acetic and a number of other organic acids, as well as participation in the process of glycolysis, exchange of ketone bodies and choline [2,3,4,9]. In the presence of carnitine, free radical binding reactions occur, which is manifested by a decrease in intoxication syndrome. Carnitine is found in all organs, especially in tissues that require high energy supply - muscles, myocardium, brain, liver, kidneys. The need for carnitine is individual (usually 200-500 mg per day for an adult), and with mental, physical and emotional stress, diseases and functionally special conditions (stress, pregnancy, breastfeeding, sports, etc.) 20 times. In patients receiving chemotherapy, the need for carnitine increases due to an increase in oxidation products in the body and an increase in the catabolic syndrome associated with the direct tumorlytic effect of cytostatics [7,8,9]. Endogenous synthesis in an adult provides only about 10% of the body's need for carnitine, and this requires vitamins C, B3, B6, folic acid, iron, a number of amino acids and enzymes. With a deficiency of at least one of the components, carnitine deficiency with its various systemic manifestations may develop. During chemotherapy, the endogenous synthesis of carnitine decreases, which makes them vulnerable to insufficient intake of exogenous carnitine from food, especially when there is a deficiency in the diet of animal protein [1,2,4,7]. Despite the widespread use of carnitine in medicine in the treatment of various diseases, the presented results of its use in correcting the side effects of chemotherapy are insufficient. The normal diet covers half of the carnitine requirement at best, so there is a clear need for additional sources of carnitine to meet optimal physiological requirements. The natural L-stereoisomer of carnitine is biologically active, therefore only L-carnitine, which is almost completely absorbed in the human gastrointestinal tract, should be used as a food additive or drug [4,9]. The domestic company "Rapid Solution" produces the drug "Fortecarnit" (INN LEVOCARNITINE) for oral administration, containing a 20% aqueous solution of L-carnitine, which is identical in chemical structure and biological activity to natural. The aim of the study was to study the effect of levocarnitine on blood biochemical parameters and on the tolerance of chemotherapy. MATERIAL AND METHODS The study was carried out in the department for stem cell treatment at hematology center. The study involved 60 patients. The patients are divided into 2 groups of 30 people each. Age ranged from 33-59 years old (on average 42 years old), men - 27, women -33. Group 1 - 30 people who were prescribed standard concomitant th