Method of treating patients with pulmonary tuberculosis with accompanying non-specific bronchites

FIELD: medicine.

SUBSTANCE: for treatment of patients with pulmonary tuberculosis with accompanying non-specific bronchitis at the background of carrying out standard anti-tuberculosis therapy from the first day of treatment additionally daily for 3 months the preparation Wobenzym is introduced in a dose of 1 tablet 2 times per day, 30 minutes before meal, and inhalation with a solution of the preparation Hixozide in a dose of 350 mg in 10 ml of water for injections is performed 2 times per week, the course constitutes 24 procedures.

EFFECT: method makes it possible to increase treatment efficiency by indices of infiltration resorption, closing of the decay cavities and abacillation.

1 tbl, 2 ex

 

The invention relates to medicine, namely to Phthisiology, and can be used in the treatment of pulmonary tuberculosis patients with concomitant non-specific bronchitis.

According to who about a third of the world's population is infected with Mycobacterium tuberculosis and TB annually sick 8-10 million people. Currently in Russia and worldwide, tuberculosis remains a common disease. Occurrence of severe progressive forms of tuberculosis has decreased the effectiveness of the treatment due to the growth of drug resistance of Mycobacterium tuberculosis to anti-TB drugs (King I. Tuberculosis in children and adolescents / I. King // St. Petersburg: Piter, 2004. - P.27; Shilov MV TB in Russia in 2010 / MV Shilov // Moscow, 2012. - P.3-5). The problem of increasing the efficiency of treatment of patients with pulmonary tuberculosis is by far the most pressing problem of tuberculosis (Perelman M.I. Molecular medicine and treatment of TB / M.I. Perelman, N. Hamsters, Kiselev V.I., etc. // Problems of tuberculosis and lung diseases. - 2001. No. 5. - P.5-7).

A leading method in the treatment of pulmonary tuberculosis is treatment with anti-TB drugs, which are regulated by the Ministry of health of the Russian Federation from 21.03.03, No. 109 "On improving TB control in the Russian Federation". But the long experience of the use of anti-TB therapy in pulmonary tuberculosis indicates a lack of clinical and radiographic effects of standard modes of therapy.

In patients with pulmonary tuberculosis in 62.8% of cases are associated nonspecific bronchitis (smoked S.M. the formation of a combination of tuberculosis and chronic bronchitis (prevalence, pathogenesis, diagnostics, treatment), dis... Dr. med. Sciences, 2006. - 354 C.). This nonspecific inflammatory process is associated with fibrous warp and a violation of the drainage function of bronchi (Perelman M.I. Phthisiology / M.I. Perelman, VA Koryakin, IV Bogadelnikova // - M.: Medicine, 2004. - S-349). The progression of nonspecific inflammatory process in the bronchial tree in patients with pulmonary tuberculosis complicates the course of the disease, reduces the bioavailability of anti-TB drugs, which lowers the efficiency of treatment of tuberculosis.

This makes necessary the development of new methods of treatment of pulmonary tuberculosis patients with concomitant non-specific bronchitis, which could enhance the effectiveness of the treatment.

Conducted research on the medical-scientific and patent literature identified various methods of treatment of pulmonary tuberculosis with concomitant non-specific bronchitis.

In the patent of Russian Federation №2231379 (date of publication - 19.07.1999 g) described a method for the treatment of patients with destructive pulmonary tuberculosis with concomitant nonspecific bronchitis and - purulent endobronchitis, providing for anti-TB therapy, inhalation introduction kanamycin dissolved in ammoniacal solution of silver nitrate, with subsequent impacts on paravertebral area laser radiation with a wavelength of 0.89 μm, 4 W, pulse frequency of 80 Hz and a total exposure time of 256 seconds.

RF patent №2204408 (date of publication - 20.05.2003, protected "Method of treatment of pulmonary tuberculosis in patients with chronic bronchitis, providing for the introduction on the background of anti-TB therapy, herbal infusion, consisting of flowers of rosemary, plantain, thyme, leaves of a nettle, Valerian, black currant, marigold flowers and dandelion root.

In the monograph M.I. Perelman et al. (Perelman M.I. Phthisiology / M.I. Perelman, VA Koryakin, IV Bogadelnikova // - M.: Medicine, 2004. - S-349) described a method of treatment of pulmonary tuberculosis patients with concomitant non-specific bronchitis, impose, on the background of anti-TB therapy, antibiotics broad spectrum of action.

In S.M. thesis smoked (the formation of a combination of tuberculosis and chronic bronchitis (prevalence, pathogenesis, diagnostics, treatment), abstract. of thesis... Dr. med. Sciences, 2006. - P.7-10) described a method for the treatment of patients with tubes is kulesa with associated nonspecific bronchitis with the use of salbutamol sulfate in patients receiving anti-TB drugs.

In thesis, E.M. Zhukova (Improving diagnosis and treatment of pulmonary tuberculosis patients with concomitant obstructive syndrome, abstract. of thesis... Dr. med. Sciences, 2009 - P.8-11) described a method of treatment of TB patients with concomitant non-specific bronchitis and broncho-obstructive syndrome impose on the background of anti-TB therapy, drug amber-antitox.

The disadvantages of the above methods of treatment of pulmonary tuberculosis patients with concomitant non-specific bronchitis are their lack of effectiveness in relation to the closure of decay cavities, resorption of infiltration and conversion.

The closest in its essence, and is taken as a prototype is protected by RF patent No. 2262938 (date of publication - 27.10.2005 St,) "Method of treatment of pulmonary tuberculosis with concomitant purulent endobronchitis". The method provides for TB treatment according to the standard modes, and the use of ozonated physiological solution with ozone concentration of 5-10 µg/ml, which is administered rectally in the amount of 40 ml at a rate of 30 drops per minute with an interval of 1-2 times per week with duration of 2 months.

The disadvantage of the prototype is its lack of efficacy in closure of decay cavities, is rassasyvaniya infiltration and conversion.

The objective of the invention is to increase the efficiency of treatment of pulmonary tuberculosis patients with concomitant non-specific bronchitis.

The technical result is to increase the efficiency of treatment of pulmonary tuberculosis patients, namely the closure of decay cavities, resorption of infiltration and abacillation.

The technical result is achieved by assigning the patient TB treatment according to the standard modes. From the first day of treatment the patient additionally daily for 3 months, injected the drug Wobenzym 1 tablet 2 times a day 30 minutes before meals. At the same time, 2 times per week, a rate of 24 procedures, perform the inhalation solution of 350 mg drug Hexose in 10 ml of water for injection. Further treatment is carried out according to the standard modes of TB treatment.

Drug Hexose (registration number LSR-007824/10) is a combination of an antibacterial agent dioksidina (hydroxymethanesulfinic) and anti-tuberculosis drug isoniazid drug in the form of a lyophilisate for preparation of solution for intrapleural injection and inhalation. Hexose inhibits the synthesis of microway acid, which leads to disruption of the structure of the cell wall of Mycobacterium tuberculosis (MBT), and also disrupts DNA synthesis m is Krasnoi cells (Glushkov RG, Sokolova G.B. New combined anti-TB drug Hexose, journal of Antibiotics and chemotherapy", 2008, №5-6, S.11-13). In addition, the inhalation route of administration Hexose, bypassing the liver, unaltered reaches of the upper respiratory tract and lungs.

Preparation Wobenzym (registration number - P # 011530/01 from 15.04.2005 g) is a balanced blend of enzymes. Part of the preparation Wobenzym include trypsin, chymotrypsin, bromelain, papain, amylase, Pancreatin and rutin. The ability of Wobenzym to increase the concentration of anti-TB drugs in the lesion gives us the opportunity to use it in the pathogenetic therapy of pulmonary tuberculosis (SHOVKUN L.A. Systemic enzyme therapy in tuberculosis / L.A. Showman et al. / Rostov-on-don. - 2009. - P.9-15). Wobenzym reduces the activity of the inflammatory processes and modulates physiological protective response of the body: reduces infiltration interstitial plasma cells, improves elimination of protein debris and deposits of fibrin in the area of inflammation. This ensures the restoration of microcirculation, and disposal of the products of inflammation and improves the supply of oxygen and nutrients (Sizechina L.P. Systemic enzyme therapy in the treatment of allergic and immunopositive diseases / SPb.: Ed. "Tactics-Studio", 006).

Practical feasibility of the claimed method is illustrated by examples from clinical practice.

Example 1: the patient K., aged 40, case history No. 8653/11, was admitted for inpatient treatment in state "TB clinic" Rostov region about infiltrative tuberculosis S1, 2 of the right lung in the phase of disintegration, ILO+, concomitant chronic obstructive bronchitis in the acute stage. The patient's condition at admission is not quite satisfactory, expressed in the phenomenon of tuberculosis intoxication, the temperature is raised to 37,7°C. Auscultation: the lungs breathing hard, listening scattered dry rales in the upper sections of the right lung - single moist rales. Respiratory rate (BH) - 24 in 1 minute, blood pressure (BP) - 125/75 mm Hg, pulse rate (PE) - 78 in 1 minute.

Survey data at entry:

Radiograph and CT - S1, 2 in the right lung area inhomogeneous infiltration of the lung tissue, focal patterns of size 4×5 cm, with small destructions and a few polymorphic lesions around with bronchoscopists "path" to the root of the lung.

Blood analysis: hemoglobin - 131 g/l, erythrocytes - 4,1×1012/l, leucocytes - of 7.4×109/l, eosinophils - 1%, stab neutrophils - 6%, segmented neutrophils - 68%, lymphocytes - 21%, monocytes - 4%,ESR - 24 mm/hour.

Analysis of sputum smear method of direct microscopy - acid-fast bacilli (AFB) found: 8-12 in the field of view.

The sputum gave rise to 3 colonies of Mycobacterium tuberculosis (MBT).

Mantoux test with 2 tuberculin units (TU) - 15 mm

Sample preparation Diaskintest 14 mm

Fibrocolonoscopia - identified chronic nonspecific catarrhal endobronchitis in the acute stage.

Based on the survey data the patient was diagnosed with infiltrative tuberculosis S1, 2 of the right lung in the phase of disintegration, the office+. Chronic obstructive bronchitis in the acute stage.

The patient had received treatment according to the claimed method. Treated under intensive phase standard anti-TB therapy - streptomycin 1 g, isoniazid 0.6 g, rifampicin 0.6 g, pyrazinamide 1.5 g, multivitamins, vitamin B6. From the first day of treatment the patient additionally daily for 3 months had injected the drug Wobenzym 1 tablet 2 times a day, 30 minutes before meals, 2 times a week, a rate of 24 procedures performed inhalation solution of 350 mg drug Hexose in 10 ml of water for injection. Further treatment was performed according to standard mode.

After 4 months the patient was performed control tests:

Radiograph and CT - S1, 2 right Legkov the area limited pneumosclerosis, infiltrative changes resorbed, fragmentirovana pockets of small and medium caliber, medium intensity, degradation in the lung tissue are not defined.

Blood analysis: hemoglobin - 134 g/l, erythrocytes - 4,2×1012/l, leucocytes - 5,6×109/l, eosinophils - 1%, stab neutrophils - 5%, segmented neutrophils - 65%, lymphocytes - 26%, monocytes - 3%, ESR - 8 mm/hour.

Two analyses of sputum smears by microscopy method - BACILLI not found.

Two sputum - culture growth of the office no.

Mantoux test with 2 Tu - 11 mm

Sample preparation Diaskintest 7 mm

Fibrocolonoscopia - found a cure endobronchitis.

As a result of treatment according to the claimed method was achieved positive dynamics. The patient's condition has improved, infiltrative changes resorbed, and the destruction of closed, reached abacillation and cure chronic obstructive bronchitis. In satisfactory condition of the patient was discharged to continue treatment of pulmonary tuberculosis in the outpatient setting.

Example 2: the patient L., 26 years old, medical history, No. 774/23, was admitted for inpatient treatment in state "TB clinical hospital" of the Rostov region on the occasion of disseminated pulmonary tuberculosis in the phase of infiltration and decay, office+associated nonspecific bronchitis. the status of the patient at admission: the phenomenon of tuberculosis intoxication expressed, the power is low, the temperature is increased to 37.8°C. complaints of cough with the release of large amounts of sputum, weakness, sweating, decreased appetite, weight loss. Auscultation: in easy listening vesicular hard touch of the breath, all the way down - scattered dry rales. BH - 26 in 1 minute, AD - 115/60 mm Hg, PE - 74 in 1 minute.

Survey data at entry:

The radiographs and tomograms in the upper lobes of both lungs focal shadows, blending in infiltration, low-intensity, without distinct outlines, some with small plots of destruction, the roots of the lungs infiltrated, not structural.

Blood analysis: hemoglobin - 124 g/l, erythrocytes - 3,6×1012/l, leukocytes, and 9.6×109/l, eosinophils - 0%, stab neutrophils - 7%, segmented neutrophils - 67%, lymphocytes - 21%, monocytes - 5%, ESR - 26 mm/hour.

Analysis of sputum smear method of direct microscopy - KUM found: 6-12 in the field of view.

The sputum gave rise to 5 colonies of the office.

Mantoux test with 2 Tu - 19 mm

Sample preparation Diaskintest 12 mm

Fibrocolonoscopia - revealed nonspecific diffuse catarrhal endobronchitis.

Based on the survey data the patient was diagnosed with disseminated pulmonary tuberculosis in the phase of infiltration and decay, ILO+, nonspecific bronchitis.

The patient was assigned to l is an increase according to the claimed method. Treated under intensive phase standard anti-TB therapy - streptomycin 1 g, isoniazid 0.6 g, rifampicin 0.6 g, pyrazinamide 1.5 g, multivitamins, vitamin B6. From the first day of treatment the patient additionally daily for 3 months had injected the drug Wobenzym 1 tablet 2 times a day, 30 minutes before meals, 2 times a week, a rate of 24 procedures performed inhalation solution of 350 mg drug Hexose in 10 ml of water for injection. Further treatment was performed according to standard mode.

After 4 months the patient was performed control tests:

The radiographs and tomograms in the upper lobes of both lungs diffuse pneumosclerosis, pockets of small and medium caliber, medium intensity, with clear contours and destruction are not defined, the structural roots of the lungs.

Blood analysis: hemoglobin - 136 g/l, erythrocytes - 4,2×1012/l, leukocytes is 6.4×109/l, eosinophils - 1%, stab neutrophils - 6%, segmented neutrophils - 65%, lymphocytes - 24%, monocytes - 4%, ESR - 8 mm/hour.

Two analyses of sputum smears by microscopy method - BACILLI not found.

Two sputum - culture growth of the office no.

Mantoux test with 2 Tu - 12 mm

Sample preparation Diaskintest 5 mm

Fibrocolonoscopia - found a cure nonspecific endobronchitis.

As a result of treatment agreement is but the claimed method was achieved positive dynamics. The patient's condition has improved, infiltrative changes resorbed, and the destruction of lung tissue were closed, decreased the number and size of lesions, achieved abacillation and cure of bronchitis, lung catarrhal phenomena were not heard. In a satisfactory condition the patient was discharged to continue TB treatment in the outpatient setting.

Under our supervision there were 22 patients with pulmonary tuberculosis with concomitant non-specific bronchitis, which were divided into two groups with different ways of conducting therapy. By sex, age, prevalence of tuberculous changes in the lungs, the presence of decay and bacteria formed the groups were homogeneous. Patients of the main group of 11 people received treatment according to the present method, the patients in the comparison group, in the amount of 11 people who received treatment according to the standard modes of TB treatment. The results of the treatment were assessed after 4 months in terms of closing cavities collapse, resorption of infiltration, conversion. Comparative analysis of results of treatment of these two groups of patients are presented in the table.

Table
Show is whether the effectiveness of treatment in patients of the two groups
The monitoring groupResorption of infiltration
abs./%
The closing of the cavernous
abs./%
Abacillation
abs./%
The main group91010
(n=11)81,8%90,9%90,9%
The comparison group (n=11)455
36,4%45,5%45,5%

As can be seen from the data given in the table, the patients of the main group, who were treated according to the claimed method, the effectiveness of treatment than patients in the comparison group that received treatment according to the standard modes of TB treatment: in terms of resorption infiltration - 2.2 times, closing cavernous - 2.0 times, abacillation - 2.0 times.

Thus, the claimed method of treatment of pulmonary tuberculosis patients with concomitant n the specific bronchitis can significantly improve the effectiveness of treatment in terms of resorption of infiltration, closing cavities of decay and conversion.

The method of treatment of pulmonary tuberculosis patients with concomitant non-specific bronchitis, providing TB treatment according to the standard modes, characterized in that from the first day of treatment the patient additionally daily for 3 months, injected the drug Wobenzym 1 tablet 2 times a day 30 minutes before meals, 2 times a week course of 24 procedures perform the inhalation solution of 350 mg drug Hexose in 10 ml of water for injection.



 

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