Vplyv systémovej enzýmovej terapie na hojenie jazvy po cisárskom reze

Ciele:
Cieľom našej štúdie bolo sledovať zmeny v hojení uterotomických jaziev po cisárskom reze u pacientiek užívajúcich systémovú enzymoterapiu v porovnaní s pacientkami, ktoré neužívali systémovú enzymoterapiu (Wobenzym).

Metodika:
Prospektívna kohortová štúdia bola vykonaná u 60 prvorodičiek, ktoré rodili cisárskym rezom. Porovnávali sme nasledovné premenné: hrúbku jazvy po cisárskom reze, koeficient dehiscencie (DRC), závažnosť defektu jazvy po cisárskom reze, dilatáciu dutiny maternice, pooperačnú bolesť, C-reaktívny proteín a telesnú teplotu pacientiek.

Výsledky:
Hrúbka jazvy 6 týždňov po cisárskom reze bola významne väčšia v skupine pacientiek, ktoré dostávali Wobenzym (7,1 ± 0,9 mm; priemer ± SD), ako u pacientiek bez Wobenzymu (5,3 ± 0,7 mm) (p = 0,01). Ťažký defekt jazvy po cisárskom reze bol pozorovaný u jednej užívateľky Wobenzymu (1/30, 3,3 %) a u 5 žien (5/30, 16,7 %), ktoré Wobenzym neužívali, a teda nešlo o štatisticky významný rozdiel (p = 0,195).

Záver:
Napriek tomu, že v skupine pacientiek užívajúcich Wobenzym bolo menej ťažkých defektov jaziev po cisárskom reze, rozdiel nedosiahol štatistickú významnosť, čo možno pripísať malému súboru pacientiek.

Kľúčové slová:
enzymoterapia, cisársky rez, ultrazvuk, jazva po cisárskom reze

Autoři: Erik Dosedla ¹ ; A. Grendelova ¹; P. Calda ²
Působiště autorů: Department of Obstetrics and Gynecology, P. J. Safarik University, 1st Private Hospital Košice-Šaca Inc., Košice-Šaca, Slovak Republic ¹; Charles University, Prague, First Faculty of Medicine and General Teaching Hospital, Department of Gynecology and Obstetrics, Prague, Czech Republic ²
Vyšlo v časopise: Ceska Gynekol 2016; 81(3): 202-207

Souhrn

Kľúčové slová:
enzymoterapia, cisársky rez, ultrazvuk, jazva po cisárskom reze

Zdroje

1. Dosedla, E., Calda, P. Ultrazvuková diagnostika maternice v šestonedelí. Actual Gyn, 2011, 3, p. 52–60.

2. Fitzpatrick, KE., Kurinczuk, JJ., Alfirevic, Z., et al. Uterine rupture by intended mode of delivery in the UK: a national case-control study. PLoS Med, 2012, 9(3), p. e1001184. Epub 2012 Mar 13.

3. Dosedla, E. Ultrazvuková diagnostika jaziev na maternici po cisárskom reze. Moderní gynekologie a porodnictví. 2012, 21, 4, s. 490-497.

4. Wang, CB., Chiu, WW., Leem, CY., et al. Cesarean scar defect: correlation between Cesarean section number. Defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol, 2009, 34(1), p. 85–89.

5. Bij de Vaate, AJ., Brölmann, HA., van der Voet, LF., et al. Ultrasound evaluation of the Cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol, 2011, 37(1), p. 93–99.

6. Paradise, ME., Couture, P., Gigleux, I., et al. Impact of systemic enzyme supplementation on low-grade inflammation in human. Pharma Nutrition. 2015 Article in Press.

7. Klein, G., Kullich, W., Schnitker, J., Schwann, H. Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind. randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs. Clin Exp Rheumatol, 2006, 24, p. 25–30.

8. Goodlin, RC. Modified Joel-Cohen technique for Caesarean delivery. Brit J Obstet Gynaecol, 1999, 106(12), p. 1329.

9. Dosedla, E., Calda, P., Kvasnička, T. Ultrasonography of the uterus within 6 weeks following Cesarean section. Cent Eur J Med, 2012, 7(2), p. 235–240.

10. Ofili-Yebovi, D., Ben-Nagi, J., Sawyer, E., et al. Deficient lower-segment Cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol, 2008, 31, p. 72.

11. Wittenborg, A., Bock, PR., Hanisch, J., et al. Comparative epidemiological study in patients with rheumatic diseases illustrated in an example of a treatment with non-steroidal anti-inflammatory drugs versus an oral enzyme combination preparation] Arzneimittelforschung, 2000, 50, p. 728–738.

12. Shah, SA., Nerurkar, RP. Evaluation of prescribing trends and rationality of use of oral proteolytic enzymes. Indian J Pharmacol, 2013, 45(3), p. 309–310.

13. Talaieva, TV., Bratus, VV. Proteolytic enzyme combination reduces inflammation and oxidative stress and improves insulin sensitivity in a model of metabolic syndrome. Advances in Enzyme Res, 2015, 3(1), p. 1–8.

14. Huang, JR., Wu, CC., Hou, RC., Jeng, KC. Bromelain inhibits lipopolysaccharide-induced cytokine production in human THP-1 monocytes via the removal of CD14. Immunol Invest, 2008, 37, p. 263–277.

15. Braun, JM., Schneider, B., Beuth, HJ. Therapeutic use, efficiency and safety of the proteolytic pineapple enzyme Bromelain-POS in children with acute sinusitis in Germany. In Vivo, 2005, 19, p. 417–421.

16. Bolten, WW., Glade, MJ., Raum, S., Ritz, BW. The safety and efficiency combination in managing knee osteoarthritis pain in adults: a randomized, double blind, placebo-controlled trial. Arthritis, 2015.

17. Neumayer, C., Fugl, A., Nanobashvili, J., et al. Combine enzymatic and antioxidative treatment reduces ischemia-reperfusion injury in rabbit skeletal muscle. J Surg Res, 2006, 133(2), p. 150–158.

18. Lorkowski, G. Gastrointestinal absorption and biological activities of serine and cysteine proteases of animal and plantorigin: review on absorption of serine and cysteine proteases. Int J Physiol Pathophysiol Pharmacol, 2012, 4(1), p. 10–27.

19. Desser, L., Holomanova, D., Zavadova, E., et al. Oral therapy with proteolytic enzymes decreases excessiveTGF-beta levels in human blood. Cancer Chemother Pharmacol, 2001, 47, Suppl, p. S10–S15.

20. Lauer, D., Müller, R., Cott, C., et al. Modulation of growth factor binding properties of alpha2-macroglobulin by enzymetherapy. Cancer Chemother Pharmacol, 2001, 47, Suppl. p. S4–S9.

21. Adámková, E., Balcar, J., Bartovičová, E., et al. Systémová enzymoterapie v komplexní léčbě recidivujících zánětů dýchacích cest u dětí – postregistrační retrospektivní multicentrické hodnocení. Čes.-slov. Pediatrie, 2004, 59(1), s. 513–521.

22. Jezdínský, J. Systémová enzymoterapie. In: Lincová, D., Farghali, H., eds. Základní a aplikovaná farmakologie. 2. vydání. Praha: Galén, 2007, s. 606–611.

23. Luerti, M., Vignali, M. Influence of bromelain on penetration of antibiotics in uterus, salpinx and ovary. Drugsexptl Clin Res, 1978, 4(1), p. 45–48.

24. Sukhikh, GT., Loginova, NS., Faizullin, LZ., et al. The use of Wobenzym® to facilitate interferon synthesis in the treatment of chronic urogenital chlamydiosis. Int J Immunotherapy, 1997, 3/4, p. 131–133.

25. Förstl, M., Kalousek, I., Navrátil, P., et al. Zkušenosti s enzymoterapií v rámci komplexní léčby urogenitálních infekcí Chlamydia trachomatis. Urolog pro Praxi, 2006, 5, p. 243–245.

26. Rahn, HD. Begleitende Therapie durch hydrolytische Enzyme bei arthroskopischer Meniskusresektion. Prakt Sport-Traumatol Sportmedizin,1994, 10(3), p. 123–127.