Personified treatment and prevention of sexual developmental disorders in pubertal age girls with diffusive liver diseases
DOI:
https://doi.org/10.12775/JEHS.2020.10.01.036Keywords
adolescents, chronic diffuse liver disease, chronic viral hepatitis, nonalcoholic fatty liver disease, autoimmune hepatitis, neuroendocrine status, sexual development, menstrual health, therapeutic and prophylactic agents, vitamin D, phytocompositions, viAbstract
Diffuse liver disease can have a pronounced detrimental effect on the developing reproductive system. Hepatoprotection in gynecological practice is not so much in the choice of drugs that protect or restore the liver, as in the appointment of optimal safe therapy for this category of patients, especially in adolescence. The aim: to study the effectiveness of therapeutic and prophylactic drugs for disorders of the reproductive system in adolescent girls with diffuse liver disease. Material and methods. Under observation for the period 2010-2020 were 486 girls aged 12-17 years, of which 120 - with chronic viral hepatitis (CVH), 120 - with non-alcoholic fatty liver disease (NAFLD), 66 - with autoimmune hepatitis (AIH), 180 - conditionally somatically and gynecologically healthy girls with normal sexual development of the control group. All patients underwent general clinical, hepatological examination, determination of features of neuroendocrine status, sexual development. The author proposed a differentiated method of treatment and prevention measures to restore reproductive health in adolescents with chronic diffuse liver disease, which included the appointment of vitamin D, phytocompositions, vitamin-mineral complexes with myo-inositol, if necessary - hormonal hemostasis. Results. Against the background of improved neuroendocrine status in the examined girls there was a decrease in the number of cases of amenorrhea in the group with CVH from 5.00% to 0.00% (p<0.01), in the group of NAFLD - from 27.50% to 3.33% (OR 11.00 [3.757-32.207]), in the AIH group - from 13.64% to 0.00% (p<0.01); opsomenorrhea - from 24.17% to 2.50% (OR 12.43 [3,670-42,092]), from 67.50% to 7.50% (OR 25.62 [11.750-55.843]) and from 27. 27% to 6.06% (OR 5.81 [1.846-18.304]); oligomenorrhea - from 25.83% to 1.67% (OR 20.55 [4.791-88.152]), from 62.50% to 5.83% (OR 26.91 [11.52-62.83]) and from 27.27% to 4.55% (OR 7.88 [2.192-28.286]); juvenile uterine bleeding - from 18.33% to 1.67% (OR 13.25 [3.039-57.728]), from 10.00% to 0.00% (p<0.01) and from 9.09% to 0.00% (p<0.01); dysmenorrhea - from 38.33% to 12.50% (OR 4.20 [2.181-8.087]), from 14.17% to 5.00% (OR 3.14 [1.191-8.257]) and from 31.82 % to 13.64% (OR 2.96 [1.234-7.078]). Conclusions. The applied personalized treatment-and-prophylactic measures taking into account individual disorders of neuroendocrine status and menstrual health in adolescent girls with diffuse liver diseases are effective and allow to recommend this complex as a means of treatment and prevention of reproductive disorders.
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