The method of treatment of patients with bronchopulmonary pathology

 

The invention relates to medicine, namely to pulmonology and concerns immunocorrective treatment of patients with bronchopulmonary pathology. To do this, on the background of basic therapy are inhalants introduction of Roncoleukin using an ultrasonic nebulizer or nebulizer at a dose of 250 thousand ME with an interval between inhalation 48-72 hours, while inhalation introduction of a subcutaneous administration of Roncoleukin, the treatment course of 2-3 treatments. The method allows to increase the efficiency of treatment of patients with bronchopulmonary pathology due to the normalization of local and systemic immunity table 4.

The invention relates to medicine, namely to immunology and pulmonology, and may find its application for immunocorrective therapy in patients with acute diseases of the lungs (pneumonia) and chronic lung disease (bronchial asthma).

Bronchial asthma and pneumonia remains one of the most actual problems of clinical medicine. Despite a steady increase in the number of antibiotics with improved characteristics, the trend towards increasing mortality from pneumonia. This is due to the increasing resistance of the microorganism is operating) have their preferred range of pathogens, differences within, clinical and pathogenetic features.

At the same time proven to us that, along with lower overall immunoreactivity of the body with nonspecific lung disease develops dysfunction in the system of local cellular and humoral immunity of the respiratory system. A significant degree of local emerging immunodeficiency patients may become pathogenic factor in chronic inflammatory process in the lungs, worsening of the clinical course of the disease.

In severe variants bronchopulmonary pathology develops systemic immunosuppression associated with the secretion and release of a large number of biologically active compounds that support an inflammatory response in lung tissue and causing more damage. Therefore, when treating patients, it is recommended to apply immunotropic drugs substitution actions that can bring the body from a state of immunosuppression.

There is a method of treatment of patients with acute and chronic lung diseases [1, 2, 4], including basic therapy differentially depending on the lung and the appointment of a recombinant preparation of IL-2 ("Rank diseases shows from one to five introductions 250-500 thousand IU with intervals of 48-72 hours.

However, this treatment regimen is not effective enough, as "Roncoleukin" not once has a direct effect on immunocompetent cells are the main target organ in bronchopulmonary pathology of the lung, mainly having systemic effects on other organs and tissues. Moreover, the invasiveness of the procedure (intravenous), long-term observation of patients within 6 hours and special training of personnel for the intravenous manipulation creates difficulties and disadvantages of its use.

In septic conditions in the complex treatment of surgical infections use the method of subcutaneous injection of the drug "Roncoleukin" [3]. It is more convenient, less traumatic, does not require long-term observations (within 6 hours) for the patient. However, this method also does not provide direct contact of the drug with lymphocytes in bronchoalveolar system. In addition, the literature was not found information about using subcutaneous injection of the drug "Roncoleukin" for the treatment of patients with bronchopulmonary pathology.

The objective of the invention is improving the efficiency of treatment of patients with bronchopulmonary pathology by reducing the manifestations of Disfuntion effects on target cells of the pulmonary system locally, that is inhaled, the introduction of Roncoleukin" using an ultrasonic nebulizer or nebulizer 250 thousand ME with an interval of 48-72 hours. Inhalation is performed on the background of basic therapy simultaneously with subcutaneous infusion in 250-500 thousand ME, the course of treatment consists of 2-3 treatments.

The study included 160 patients with bronchopulmonary diseases. Of these, 86 patients with bronchial asthma (36 - medium current, 40 - heavy flow) and 74 with pneumonia (nosocomial pneumonia heavy flow). All patients received appropriate disease basic therapy. By way of introduction immunotropic drug patients were divided us into three groups. The first 40 patients (18 with bronchial asthma and 22 with pneumonia) received Roncoleukin intravenous drip for ME 500 thousand. Second 46 patients (22 with bronchial asthma and 24 with pneumonia) received a subcutaneous injection of the same dose of the drug, and the patients of the third group of 74 patients (46 with bronchial asthma and 28 with pneumonia) received combined drug "Roncoleukin", namely 250 thousand inhalation ME with the help of a nebulizer or an ultrasonic nebulizer simultaneously with subcutaneous its introduction 250-500 thousand ME. All patients drug was administered is.

Overall, local immunity and biochemical markers of inflammation were assessed prior to administration of the drug and on the 15th day from the start of treatment. Selected terms made it possible to assess the initial state of immunoreactivity each patient and to carry out control for changes in local and General immunity (degree of recovery after treatment. The results of these studies are presented in table. 1 and 2.

As a result of the studies (table. 1) found that all three ways of introducing Roncoleukin on the background of basic anti-inflammatory therapy of asthma provide positive dynamics of indicators of the General immunity (LED3, CD4, CD8, CD of peripheral blood lymphocytes, circulating immune complexes, serum immunoglobulins and IFN), while the state of the local immunoreactivity lungs almost restored only when combined inhalation and subcutaneous injection of the drug (patients significantly reduced levels of IgE, normal content of metabolites of nitric oxide and Ostrovskogo protein1acid glikoproteid in the condensate of exhaled moisture, reaching similar display the most cases, by the 15th day normalized breathing rate. However, daily assessment of this criterion is established that for the combined method of introduction of immunotropic drug normalization of respiratory rate was 2.70.1 days earlier than the other methods of its introduction. It is important to note that the regression of the x-ray performance was complete only when applying our proposed method of treatment. The overall immune status of patients with pneumonia had a tendency to recovery (table. 2) in patients of all groups. While biochemical evidence of local inflammatory process (NO-and1KGP) and failure sIgA virtually no recorded only in the group of patients with pneumonia treated with Roncoleukin both inhalation and systematically. Thus, the combined introduction of Roncoleukin with bronchopulmonary pathology provides an improvement in the overall immune status, normalization of local immunity and rapid regression of the inflammatory process in the lung tissue.

We conducted selection dose inhalation administered drug. For this purpose, we have analyzed its impact on the local immunobiochemical indicators when use is demonstrated to improve the recovery performance of local immunity: remain high content cellular elements, the level of TNFand low levels of IL-2 and IFNin bronchoalveolar lavagno fluid. The effect of doses of 250 thousand ME and ME 500 thousand were comparable. Therefore, from the clinical, immunological and economic point of view, the optimal use of inhaled doses of 250 thousand ME (PL. 3).

When analyzing the ratio of introduction of the drug we found (PL.4) that a single injection of Roncoleukin not suffice as indicators of local immunity, and the rate of recovery of the same with 2-3 times the combined method of drug administration and depend on the severity of the condition and the severity of inflammation in the pulmonary system. The increase in the number of the introduction of Roncoleukin" not accelerate the rate of clinical recovery and rate of recovery of the immune indices, and biochemical criteria, the severity of inflammation in the Airways.

Thus, the 2-3-fold simultaneous introduction of Roncoleukin inhalation and subcutaneous routes on the background of basic therapy provides a normalization of the indicators General and local immunity in patients with bronchopulmonary pathology.

Example 1. Ill M 48 years old, was admitted to the intensive care unit and intensive terap the day he had cough, chest pain, body temperature of 38.7oC. Objectively: the skin is pale, diffuse cyanosis. In lung fine-bubble moist rales on the right in the lower lobes. On radiographs of the chest from 21.12.01 recorded several infiltrative areas in the middle and lower lobe of the right lung, increased vascular pattern. The roots of both lung restructure, expanded. CBC: er-3,21012/l b-103 g/l, L-14,8109/l e-0, p-18, I-56, l-20, m-6. Immune status: LED3-36%, CD4-27%, CD8-9%, SD-16%, CEC-180 units /opt. PL, IgM-1.1 g/l, IgG-6.7 g/l, IgA-0.9 g/l, IFN-18,2 PG/ml, NO-SSC-11.0 nmol/ml1-PSC SSC-of 18.4 ng/ml, sIgA SSC-18,0 mg/ml diagnosed with Pneumonia proximal to the right. Severe course. The patient received intensive therapy, antibiotic therapy with ceftazidime to 4 grams per day and amikacin - 2 g per day, Roncoleukin 500 thousand ME and subcutaneously 250 thousand inhalation ME with an interval of 72 hours.

After 2 days the patient's condition improved somewhat, reintubate. A serious condition. BH-28 in 1 min, HR-90 in 1 min, body temperature 37,1oC. Clinical analysis of blood: er-3,41012/l b1-PSC SSC is 22.6 ng/ml

10 day (5.01.02) a state of moderate severity, BH-20 BPM 1 min, HR-86 1 min, body temperature 36,8oWith the breath in the lungs hard, no wheezing. The patient was transferred to the medical Department, where he continued the course of therapy. After a course of immunotropic therapy 10.01.02 a satisfactory condition, BH-18 min, HR-84 in 1 min, in the lungs vesicular breathing, wheezing no. On the control radiographs - no focal changes. CBC: er-4,21012/l b-130 g/l, L-9,3109/l, e-2, p-1, I-70, l-21, m-6. Immune status: LED3-67%, CD4-53%, CD8-13%, SD-22%, CEC-56 units /opt. PL, IgM-1.06 g/l, IgG-of 9.2 g/l, IgA-1.84 g/l, IFN-48 PG/ml, NO SSC-1.6 nmol/ml1-PSC SSC-9.7 ng/ml, sIgA SSC, with 47.4 mg/ml

Thus, a comprehensive treatment of the patient with pneumonia with the use of a combination of inhaled and subcutaneous injection of the drug "Roncoleukin" helped in the short term (10 day) to achieve a significant clinical effect. On the 15th day of the disease has complete regression of the inflammatory process in the lung tissue (on the basis of x-ray data and biochemical markers of inflammation) and the recovery rate is and immunological efficacy of treatment of patients with bronchopulmonary diseases, to reduce the duration of a hospital stay and costs of care for patients.

References 1. Lacinski S. C. , Smirnov, M., Surkiewicz P. E., N. Efimov.In. Experience in the use of interleukin-2 at therapeutic complications of combat trauma. Actual problems of practical medicine (Ed. by C. A. Novitsky, N. And. Vishnyakov, V. M. Trofimova). - SPb.: 2000. - S. 219-220.

2. Nikulin L. A., Borovikov O. C., Levchenko, L. A., E. Borovikov Century, Hantaran R. A. Efficacy of Roncoleukin in complex therapy of congenital pneumonia in premature infants. //Medical immunology. - 2001. So 3. - 1, S. 95-98.

3. Ostanin, A. A., Black, E. P. the Effectiveness of citicentre the ronkoleykin in treatment of surgical infections. -SPb.: Izd-vo S.-Petersburg Academy of Sciences. University, 2002, to 28 C.

4. Peradze, A. T., Saparova N. L., Malyshkin K. A., Trofimov C. I., O. Galkin Century, Kalugin A. P., Maslansky A. L., Lebedev A. E., Smirnov, M., Totolan A. A. Immunological rationale for the clinical use of Roncoleukin in patients with atopic asthma. //Medical immunology. - 2000. - 3. - S. 311-320.

5. Tolstoy, A. D., Andreev, M. A., Goltsov C. R., Egorova C. N., Smirnov, M. N. The use of Roncoleukin (recombinant interleukin-2) for the prevention of suppurative complications of acute is C. 245.

Claims

Method of treatment of bronchopulmonary pathology, including basic therapy and injections of Roncoleukin 250-500 thousand ME with an interval of 48-72 h, characterized in that simultaneously with subcutaneous injection of Roncoleukin the drug is administered by inhalation at a dose of 250 thousand ME using ultrasonic inhaler or nebulizer, and the interval between inhalation 48-72 h, and treated 2-3 treatments.

 

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