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Alcohol abuse is associated with psycho-somatic health and social
problems. It leads to multi-organ, especially cardiovascular
system, alimentary tract, liver, pancreas and immunologic system
dysfunction. Therefore withdrawal and anti-relapse therapy should
be undoubtedly undertaken in every case. Nevertheless our knowledge
about alcohol withdrawal consequences is insufficient. The main
purpose of the authors' investigation was to determine the
metabolic, endocrine, haemostatic and immunologic changes during
six-month long abstinence period. They studied the abstinence
effect on exercise capacity and autonomic nervous system activity
estimated by heart rate variability analysis. Their research
concerned also changes in upper digestive tract macroscopic and
microscopic appearance and its motility, liver function, pro- anti-
oxidative balance parameters level, cytokine TNF- alpha and nitric
oxide (NO) metabolites plasma concentration. The authors estimated
inter-relationships between studied parameters, what seems to be
very important in complete analysis. Within six-months long
abstinence period pro-atherogenic metabolic changes expressed by
decreased HDL and increased LDL- cholesterol plasma concentration
occurred. These unfavourable changes were less expressed in
patients treated with naltrexone. In the early abstinence period
indirect markers of platelets activation were determined. The
highest level of fibrinogen, thrombomodulin, antithrombin, markers
of trombinogenesis activation in vivo (thrombin- antithrombin, TAT
complexes), tissue type plasminogen activator antigen (t-PA:Ag),
antigen of plasminogen activator inhibitor type 1 (PAI-1:Ag),
markers of fibrinolysis activation in vivo, such as D-dimers,
plasmin- alpha2- antiplasmin (PAP) complexes was also observed.
Mentioned changes were expressed in patients with determinable
TNF-alpha plasma level. Abstinence improved effort capacity,
positively changed autonomic nervous system activity via vagal
nerve influence on heart rate variability. The last finding was
also affected by TNF-alpha level. No significant changes appeared
in alimentary tract function, estimated by esophageal and gastric
pH-metry, esophageal manometry and abdominal ultrasonography,
whereas some changes were observed in endoscopic examinations and
influence of patients mental status on investigated parameters
became noticeable. Favourable effect on liver function tests was
affected by pituitary-thyroid and pituitary-gonadal axes hormones,
cytokine TNF-alpha, nutrition status, Helicobacter pylori infection
and gastric acidity. Some of studied parameters, such as mean
platelets volume and nitric oxide metabolites plasma level may be
used as new, valuable markers of alcohol abuse. Alcohol withdrawal
and early abstinence is a dynamic period with potentially harmful
health consequences, especially in cardiovascular system. This
suggests the need of multicentre studies to estimate clinical
importance of found changes and cost- benefits analysis of selected
interventions.
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