Роль глюкокортикостероїдів в лікуванні рецидивів туберкульозу легень в Полтавській області

Abstract

В роботі визначалася роль глюкокортикостероїдів (ГКС) в лікуванні рецидивів туберкульозу легень в Полтавській області. Встановлено, що ГКС покращують переносимість хіміотерапії, сприяють прискоренню розсмоктування явищ інфільтрації в легеневій тканині, чим покращують біодоступність хіміопрепаратів в зони патологічного процесу і забезпечують підвищення частоти закриття каверн та абацилювання. Призначення ГКС під час лікування вперше діагностованого туберкульозу (ВДТБ) не прямим шляхом сприяє зменшенню вірогідності виникнення рецидивів в подальшому у цих хворих, за рахунок підвищення ефективності лікування ВДТБ; В работе определялась роль глюкокортикостероидов (ГКС) в лечении рецидивов туберкулеза легких в Полтавской области. Установлено, что ГКС улучшают переносимость химиотерапии, содействуют ускорению рассасывания явлений инфильтрации в легочной ткани, чем улучшают биодоступность химиопрепаратов у зоны патологического процесса и обеспечивают повышение частоты закрытия каверн и абациллирования. Назначение ГКС во время лечения впервые диагностированного туберкулеза (ВДТБ) не прямым путем содействует уменьшению вероятности возникновения рецидивов в дальнейшем у этих больных, за счет повышения эффективности лечения ВДТБ; A research aim was determination of role of corticosteroids in treatment of patients with relapses of tuberculosis lung in the Poltava region. Material and research methods. Under our supervision was 145 patients with the relapses of tuberculosis lung which got antituberculosis therapy in the conditions of therapeutic separations of the Poltava regional clinical antituberculosis dispensary. Depending on the mode of treatment patients were up-diffused on two groups. In a basic group entered 61 patient, which got a chemotherapy on a two category with setting of corticosteroids on a chart (20 mg through a day, in the morning, during 2 months with abolition of preparation without the decline of dose). In control group was 84 patients which got only antituberculosis drags. All patients voluntarily agreed to participating in scientific research. Efficiency of treatment was determined after a dynamics to normalization of blood values, stopping of exсretion of the micobacterium tuberculosis (MBT), resolving of infiltration and focal changes or by their compression and cicatrization of cavities. Results of research and their discussion. For the patients of basic group during all course of treatment the best bearableness of antituberculosis drags was marked, by-reactions were observed in 7 (11,48%) patients and there were they mainly after completion the intensive phase of treatment (when the reception of corticosteroids ceased). In the first 3 months of treatment by-reactions on antituberculosis drags had only 3 (4,92%) patients of basic group . In a control group by-reactions were marked more frequent (16,67%) and all of them were in the first 3 months of treatment. For the first 2 months of treatment blood values was normalized in the 49,09% of patients of basic group and only for the 38,89% (р>0,05) persons of control group which testifies to adaptive and disintoxication operate corticosteroids. For the first 3-4 months efficiency of treatment in a basic group arrives at 67,21%, while in control she folds 45,24% (р<0,05), that is the certificate of positive role of corticosteroids in treatment of relapses of tuberculosis. Infiltration changes in the lungs of basic group resolved not only quicker but also greater amount of patients. For 3-4 months of treatment cavities were closed in 64,29% of patients of basic and 56,14% (р>0,05) patients of control group. Such results ground to consider that corticosteroids does not have a direct influence on МBТ and on speed of cicatrization of cavities, but they show a positive effect by the acceleration of resolving of the used for setting fire infiltration and improvement of bioavailability of antituberculosis drags. Setting of corticosteroids in treatment of the first diagnosed tuberculosis of lung assists (to the not lines by a way, but due to the increase of efficiency of treatment of the first diagnosed tuberculosis of lung) diminishing to authenticity of origin of relapses in future for these patients. So among selected by us patients with the relapses of tuberculosis lung only 33,33% patients were accepted by corticosteroids during treatment concerning the first diagnosed tuberculosis of lung, while majority (66,67%, р<0,05) did not accept. Conclusions. Research results showed that corticosteroids was the important factor of nosotropic therapy of patients with the relapses of tuberculosis lung, which has the expressed antiinflammatory action which assists the acceleration of resolving of infiltration in pulmonary tissue (67,21% of patients of basic group, against 45,24% (р<0,05) – in control for the first 3-4 months of treatment), what improves bioavailability of antituberculosis drags in the areas of pathological process and provides the increase of frequency of closing of cavities and stopping of excretion of MBT. On a background the reception of corticosteroids the patients of basic group have the best bearableness of antituberculosis drags, especially in the period of intensive phase of treatment which is the important constituent of increase of efficiency of treatment of patients with the relapses of tuberculosis lung. Setting of corticosteroids during treatment of the first diagnosed tuberculosis of lung to the not lines assists diminishing to authenticity of origin of relapses a way in future for these patients, due to the increase of efficiency of treatment of the first diagnosed tuberculosis of lung.