Zdorovʹe Rebenka (Oct 2019)
Predicting the effectiveness of choleretic therapy for functional disorders of the gallbladder and the sphincter of Oddi in children
Abstract
Background. Early detection of functional disorders of the gallbladder and the sphincter of Oddi in children and timely prescription of effective choleric therapy becomes important at the present stage. The purpose of the study was to determine prognostic risk factors for the development of functional disorders of the gallbladder and the sphincter of Oddi in children and to predict the effectiveness of choleric therapy with the addition of ursodeoxycholic acid (UDCA). Materials and methods. Seventy children with functional disorders of the gallbladder and the sphincter of Oddi aged 4 to 14 years were examined and treated. One hundred and forty clinical-laboratory, molecular-genetic and instrumental-diagnostic parameters were analyzed with the help of Wald’s sequential analysis. Relative risk (RR) and diagnostic coefficient were calculated for each of them. Results. Risk factors for the development of functional disorders of the gallbladder and the sphincter of Oddi were the presence of functional disorders of the gallbladder and the sphincter of Oddi in the father and relatives by maternal lineage (RR is 1.60 and 1.60, respectively), body weight at birth less than 3 kg (RR = 1.95), the onset of the first episode of clinical and paraclinic manifestations at the age of 2 to 6 years (RR = 1.47), the levels of biochemical hepatogram indicators: cholesterol — 43.7–52.0 mmol/l (RR = 1.83), aspartate aminotransferase — 45.0–59.0 n/l (RR = 3.21) and alanine aminotransferase — 28.3–38.0 n/l (RR = 3.21). High efficiency of choleric therapy with the addition of UDCA drugs in functional disorders of the gallbladder and the sphincter of Oddi in children was established (RR = 4.13). The use of UDCA as a part of choleric therapy in the past medical history is of significant importance (RR = 3.67). It was found that after receiving treatment, the levels of expression of microRNA-378f — 3.07–6.14 c.u. (RR = 0.37), microRNA-4311 — 2.51–5.01 c.u. (RR = 0.18), microRNA-4714-3p — 3.19–6.38 c.u. (RR = 0.31) are determined in children as a protective factor. Mathematical models have been developed that can be used to evaluate the risk of developing functional disorders of the gallbladder and the sphincter of Oddi in children and the effectiveness of choleric therapy. Conclusions. High efficiency and simplicity in the use of mathematical models for determining the risk of functional disorders of the gallbladder and the sphincter of Oddi in children and predicting the effectiveness of choleric therapy with the addition of ursodeoxycholic acid allow us to recommend them in the practice of a pediatrician, family physician and pediatric gastroenterologist for timely prescription of rational therapy and checking its effectiveness.
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