WAYS TO IMPROVE THE EFFECTIVENESS OF TREATMENT NEWLY IDENTIFIED PATIENTS DESTRUCTIVE PULMONARY TUBERCULOSIS
DOI: https://doi.org/10.29296/25877305-2022-02-01
Issue:
2
Year:
2022
Against the background of the improvement of the main epidemiological indicators in Russia over the
past decade, there has been no significant dynamics in the effectiveness of treatment of newly diagnosed
patients. According to the results of 2019, the healing of destructions was noted in 61,6%, and the
cessation of bacterial excretion – in 68,9% of patients. Along with an increase in the proportion of
resistant tuberculosis, issues of patients ‘ adherence to treatment, morphofunctional changes in the lung
tissue that reduce the flow of chemotherapy drugs to the lesion play a significant role in the low
efficiency of treatment of pulmonary tuberculosis. The pathogenetically based therapeutic technology
presented by the authors of the combined use of retrosternal lymphotropic chemotherapy and pneumoperitoneum
is aimed at creating effective inhibitory concentrations of chemotherapy drugs that suppress the pathogen in
conditions of altered lung tissue and increase the effectiveness of treatment. With the use of radionuclide
research methods, the strengthening of regional microcirculation of lung tissue against the background of
pneumoperitoneum, including with low-volume procedures, was proved. The obtained results of the application
of the proposed technology demonstrate an increase in the effectiveness of treatment of patients with newly
diagnosed destructive pulmonary tuberculosis according to the criterion of stopping bacterial excretion by
45,3%, healing of destructions – by 49,7%. The method can be used in the complicated course of infectious
pulmonary diseases of non-tuberculous etiology.
Keywords:
phthisiology
pulmonary tuberculosis
lung destruction in tuberculosis
retrosternal lymphotropic administration of drugs
therapeutic pneumoperitoneum
regional pulmonary perfusion
effectiveness of treatment of pulmonary tuberculosis
References:
- Osnovnye pokazateli po tuberkulezu po Rossii v 2015–2019 gg. FGBU «Tsentral'nyj NII organizatsii i informatizatsii zdravoohranenija» MZ Rossii: ofitsial'nyj sajt [Osnovnye pokazateli po tuberkulezu po Rossii v 2015–2019 gg. FGBU «Tsentral’nyi NII organizatsii i informatizatsii zdravookhraneniya» MZ Rossii: ofitsial’nyi sait (in Russ.)]. URL: https://last.mednet.ru/images/materials/CMT/tb_rf_osnovnye_pokazateli_2019.pdf
- Rusakova L.I., Punga V.V. Rasprostranennost' tuberkuleza s mnozhestvennoj lekarstvennoj ustojchivost'ju v nekotoryh regionah Rossijskoj Federatsii. Vestnik TsNIIT. 2018; 1: 41–51 [Rusakova L.I., Punga V.V. The prevalence of multidrug-resistant TB in some regions of the Russian Federation. Vestnik TsNIIT. 2018; 1: 41–51 (in Russ.)]. DOI: 10.7868/S2587667818010065
- Panova L.V., Ovsjankina E.S. Himioterapija tuberkuleza organov dyhanija s lekarstvennoj ustojchivost'ju MBT u detej starshego vozrasta i podrostkov:novye vyzovy – novye reshenija. Vestnik TsNIIT. 2021; 1: 58–64 [Panova L.V., Ovsyankina E.S. Chemotherapy in senior children and adolescents with drug-resistant pulmonary tb: new challenges – new solutions. Vestnik TsNIIT. 2021; 1: 58–64 (in Russ.)]. DOI: 10.7868/S2587667821010076
- Beljaeva E.N. Otsenka effektivnosti himioterapii pri tuberkuleze legkih s shirokoj lekarstvennoj ustojchivost'ju. Vestnik TsNIIT. 2017; 1: 42–3 [Belyaeva E.N. Evaluation of chemotherapy effectiveness in respiratory extensively drug resistant tuberculosis. Vestnik TsNIIT. 2017; 1: 42–3 (in Russ.)]. DOI: 10.7868/S2587667817010071
- Tihonova L.Ju., Sokolova V.V., Tarasjuk I.A. i dr. Opyt primenenija preparata Bedakvilin u bol'nyh tuberkulezom s mnozhestvennoj lekarstvennoj ustojchivost'ju vozbuditelja v Amurskoj oblasti. Tuberkulez i bolezni legkih. 2018; 96 (6): 45–50 [Tikhonova L.Yu., Sokolova V.V., Tarasyuk I.A. et al. Experience of treatment of multiple drug resistant tuberculosis patients with Bedaquiline in Amur Region. Tuberculosis and Lung Diseases. 2018; 96 (6): 45–50 (in Russ.)]. DOI: 10.21292/2075-1230-2018-96-6-45-50
- Stavitskaja N.V., Fel'ker I.G., Zhukova E.M. i dr. Mnogofaktornyj analiz rezul'tatov primenenija bedakvilina v terapii MLU/ShLU-tuberkuleza legkih. Tuberkulez i bolezni legkih. 2020; 98 (7): 56–62 [Stavitskaya N.V., Felker I.G., Zhukova E.M. et al. The multivariate analysis of results of bedaquiline use in the therapy of MDR/XDR pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2020; 98 (7): 56–62 (in Russ.)]. DOI: 10.21292/2075-1230-2020-98-7-56-62
- Batyrshina Ja.R., Petrenko T.I. Faktory, assotsiirovannye s preryvanijami kursa polihimioterapii u bol'nyh tuberkulezom s mnozhestvennoj i shirokoj lekarstvennoj ustojchivost'ju vozbuditelja. Tuberkulez i bolezni legkih. 2015; 93 (6): 26–7 [Batyrshina Ya.R., Petrenko T.I. Faktory, assotsiirovannye s preryvaniyami kursa polikhimioterapii u bol’nykh tuberkulezom s mnozhestvennoi i shirokoi lekarstvennoi ustoichivost’yu vozbuditelya. Tuberculosis and lung diseases. 2015; 93 (6): 26–7 (in Russ.)].
- Bogorodskaja E.M. Bol'nye tuberkulezom: motivatsija k lecheniju. Tuberkulez i bolezni legkih. 2009; 86 (2): 3–10 [Bogorodskaya E.M. Patients with tuberculosis: motivation for treatment. Tuberculosis and lung diseases. 2009; 86 (2): 3–10 (in Russ.)].
- Bogorodskaja E.M., Sterlikov S. A., Borisov S. E. Otkaz ot lechenija – osnovnaja prichina nizkoj effektivnosti lechenija bol'nyh tuberkulezom. V kn.: pod red. M.I. Perel'mana. Mat-ly Vseros. soveschanija gl. vrachej i ruk. org.-metod. otdelov protivotuberkuleznyh uchrezhdenij RF,
- Sterlikov S.A., Testov V.V. Effektivnost' lechenija bol'nyh tuberkulezom s mnozhestvennoj lekarstvennoj ustojchivost'ju vozbuditelja, zaregistrirovannyh v 2010 g. Tuberkulez i bolezni legkih. 2014; 91 (3): 12–7 [Sterlikov S.A., Testov V.V. The efficiency of treatment in multidrug-resistant tuberculosis patients registered in 2010. Tuberculosis and Lung Diseases. 2014; 91 (3): 12–7 (in Russ.)].
- Homenko A.G. Tuberkulez. M.: Meditsina, 1996; 493 s. [Khomenko A.G. Tuberkulez. M.: Meditsina, 1996; 493 s. (in Russ.)].
- Homenko A.G., Chukanov V.I., Korneev A.A. Effektivnost' himioterapii tuberkuleza legkih s lekarstvenno-ustojchivymi mikobakterijami. Problemy tuberkuleza. 1996; 6: 42–4 [Khomenko A.G., Chukanov V.I., Korneev A.A. Effektivnost’ khimioterapii tuberkuleza legkikh s lekarstvenno-ustoichivymi mikobakteriyami. Problemy tuberkuleza. 1996; 6: 42–4 (in Russ.)].
- Shprykov A.S., Sutjagina D.A. Hronichekaja tabachnaja intoksikatsija kak faktor snizhenija kontsentratsii antibiotikov pri lechenii tuberkuleza legkih i vnebol'nichnoj pnevmonii. Tuberkulez i bolezni legkih. 2019; 97 (1): 70–1 [Shprykov A.S., Sutyagina D.A. Chronic intoxication with tobacco as a factor reducing concentration of antibiotics when treating pulmonary tuberculosis and community-acquired pneumonia. Tuberculosis and Lung Diseases. 2019; 97 (1): 70–1 (in Russ.)]. DOI: 10.21292/2075-1230-2019-97-1-70-71
- Ponomarenko T.M., Sychev D.A., Chikalo A.O. i dr. Sistema tsitohroma R450 v legkih: rol' v patogeneze zabolevanij i farmakokinetike lekarstvennyh sredstv. Farmakokinetika i farmakodinamika. 2012; 1: 25–8 [Ponomarenko T.M., Sychev D.A., Chikalo A.O. et al. Sistema tsitokhroma R450 v legkikh: rol’ v patogeneze zabolevanii i farmakokinetike lekarstvennykh sredstv. Pharmacokinetics and Pharmacodynamics. 2012; 1: 25–8 (in Russ.)].
- Junusbaeva M.M., Borodina L.Ja., Bilalov F.S. i dr. Effektivnost' lechenija tuberkuleza s shirokoj lekarstvennoj ustojchivost'ju u patsientov s raznym genotipom po genam fermentov biotransformatsii CYP2B6 i NAT2. Tuberkulez i bolezni legkih. 2020; 98 (6): 40–6 [Yunusbaeva M.M., Borodina L.Y., Bilalov F.S. et al. Efficacy of treatment of extensive drug resistant tuberculosis in patients with different genotypes in the biotransformation enzyme genes of CYP2B6 and NAT2. Tuberculosis and Lung Diseases. 2020; 98 (6): 40–6 (in Russ.)]. DOI: 10.21292/2075-1230-2020-98-6-40-46
- Position statement on innovative clinical trial design for development of new TB treatments. World Health Organization, 2021; 12 p.
- Erohin V.V., Zemskova Z.S. Sovremennye predstavlenija o tuberkuleznom vospalenii. Problemy tuberkuleza. 2003; 3: 11–21 [Erokhin V.V., Zemskova Z.S. Sovremennye predstavleniya o tuberkuleznom vospalenii. Problemy tuberkuleza. 2003; 3: 11–21 (in Russ.)].
- Bondarev I.M. Ustrojstvo dlja vvedenija poroshkoobraznogo lekarstvennogo veschestva. Opisanie izobretenija k avtorskomu svidetel'stvu №628930, A.61 M 13/00. UDK 615.473 9(088.8), 1978 [Bondarev I.M. Ustroistvo dlya vvedeniya poroshkoobraznogo lekarstvennogo veshchestva. Opisanie izobreteniya k avtorskomu svidetel’stvu №628930, A.61 M 13/00. UDK 615.473 9(088.8), 1978 (in Russ.)].
- Homenko A.G., Omarov T.O., Kaminskaja G.O. i dr. Effektivnost' primenenija naruzhnogo lazernogo obluchenija v kompleksnom lechenii bol'nyh tuberkulezom legkih s soputstvujuschim bronhoobstruktivnym sindromom. Problemy tuberkuleza. 1991; 8: 32–5 [Khomenko A.G., Omarov T.O., Kaminskaya G.O. et al. Effektivnost’ primeneniya naruzhnogo lazernogo oblucheniya v kompleksnom lechenii bol’nykh tuberkulezom legkikh s soputstvuyushchim bronkhoobstruktivnym sindromom. Problemy tuberkuleza. 1991; 8: 32–5 (in Russ.)].
- Aminova G.G. K voprosu o funktsional'noj morfologii kornej limfaticheskoj sistemy. Arhiv anatomii. 1972; 63 (9): 33–41 [Aminova G.G. K voprosu o funktsional’noi morfologii kornei limfaticheskoi sistemy. Arkhiv anatomii. 1972; 63 (9): 33–41 (in Russ.)].
- Casley-Smith J. Comparative fine structure of the microvasculature and endothelium. In: Adv. Microcirc. Vascular endothelium and Basement Membranes. Ed. by B.M. Altura. Basel: Karger, 1980; r. 1–44.
- Levin Ju.M. Prakticheskaja limfologija. Problemy funktsional'noj limfologii. Novosibirsk, 1982; s. 121–3 [Levin Yu.M. Prakticheskaya limfologiya. Problemy funktsional’noi limfologii. Novosibirsk, 1982; s. 121–3 (in Russ.)].
- Levin Ju.M. Limfologicheskie printsipy i metody terapii. Klinicheskaja limfologija. M., 1985; s. 125–6 [Levin Yu.M. Limfologicheskie printsipy i metody terapii. Klinicheskaya limfologiya. M., 1985; s. 125–6 (in Russ.)].
- Levin Ju.M., Bujanov V.M., Danilov K.Ju. i dr. Limfotropnaja antibiotikoterapija. Hirurgija. 1987; 1: 72–6 [Levin Yu.M., Buyanov V.M., Danilov K.Yu. et al. Limfotropnaya antibiotikoterapiya. Khirurgiya. 1987; 1: 72–6 (in Russ.)].
- Zhdanov D.A. Obschaja anatomija i fiziologija limfaticheskoj sistemy. M., 1952; 335 s. [Zhdanov D.A. Obshchaya anatomiya i fiziologiya limfaticheskoi sistemy. M., 1952; 335 s. (in Russ.)].
- Ravich-Scherbo V.A. O fiziologicheskom retrogradnom limfotoke endotorakal'noj oblasti. Sb. «Retrogradnyj limfotok v endotorakal'noj oblasti». Voronezh, 1940; s. 5–18 [Ravich-Shcherbo V.A. O fiziologicheskom retrogradnom limfotoke endotorakal’noi oblasti. Sb. «Retrogradnyi limfotok v endotorakal’noi oblasti». Voronezh, 1940; s. 5–18 (in Russ.)].
- Rusznyák I., Földi M. Physiologie und Pathologie des Lymphkreislaufes. Budapest, 1957; 836 p.
- Kuprijanov V.V., Borodin Ju.I., Karaganov Ja.L. i dr. Mikrolimfologija. M.: Meditsina, 1983; 287 s. [Kupriyanov V.V., Borodin Yu.I., Karaganov Ya.L. i dr. Mikrolimfologiya. M.: Meditsina, 1983; 287 s. (in Russ.)].
- Gubkina M.F. Himioterapija tuberkuleza legkih u podrostkov s primeneniem regional'nogo limfotropnogo metoda lechenija. Dis. … kand. med. nauk. M., 1996; 187 s. [Gubkina M.F. Khimioterapiya tuberkuleza legkikh u podrostkov s primeneniem regional’nogo limfotropnogo metoda lecheniya. Dis. … kand. med. nauk. M., 1996; 187 s. (in Russ.)].
- Firsova V.A., Gubkina M.F. Obosnovanie primenenija regional'noj limfotropnoj terapii pri lechenii tuberkuleza u podrostkov. Problemy tuberkuleza. 1996; 6: 47–50 [Firsova V.A., Gubkina M.F. Obosnovanie primeneniya regional’noi limfotropnoi terapii pri lechenii tuberkuleza u podrostkov. Problemy tuberkuleza. 1996; 6: 47–50 (in Russ.)].
- Shtefko V.G. Patologicheskaja anatomija limfogennyh faz tuberkuleznogo protsessa legkih. Voprosy patologicheskoj anatomii i kliniki limfogennyh faz tuberkuleznogo protsessa. M., 1937; s. 6–31 [Shtefko V.G. Patologicheskaya anatomiya limfogennykh faz tuberkuleznogo protsessa legkikh. Voprosy patologicheskoi anatomii i kliniki limfogennykh faz tuberkuleznogo protsessa. M., 1937; s. 6–31 (in Russ.)].
- Bagdasarjan T.R. Effektivnost' primenenija pnevmoperitoneuma v kompleksnom lechenii bol'nyh destruktivnym tuberkulezom legkih s lekarstvennoj ustojchivost'ju mikobakterij tuberkuleza. Avtoref. diss. … kand. med. nauk. M., 2008; s. 23 [Bagdasaryan T.R. Effektivnost’ primeneniya pnevmoperitoneuma v kompleksnom lechenii bol’nykh destruktivnym tuberkulezom legkikh s lekarstvennoi ustoichivost’yu mikobakterii tuberkuleza. Avtoref. diss. … kand. med. nauk. M., 2008; s. 23 (in Russ.)].
- Sigaev A.T., Amansahedov R.B., Kazho R.M. i dr. Otsenka sostojanija mikrotsirkuljatsii v legkih u bol'nyh s tuberkulemami v do- i posleoperatsionnom periode. Vestnik TsNIIT. 2019; 1: 68–76 [Sigaev A.T., Amansakhedov R.B., Kazho R.M. et al. Evaluation of blood microcirculation in the lungs of patients with tuberculomas in the pre- and post-operative period. Vestnik TsNIIT. 2019; 1: 68–76 (in Russ.)]. DOI: 10.7868/S2587667819010072
- Shaklein I.A. Pnevmoperitoneum pri tuberkuleze legkih. Tuberkulez organov dyhanija. T. 2. Kn. 2. M., 1959; s. 223–41 [Shaklein I.A. Pnevmoperitoneum pri tuberkuleze legkikh. Tuberkulez organov dykhaniya. T. 2. Kn. 2. M., 1959; s. 223–41 (in Russ.)].
- Klinicheskie rekomendatsii. Tuberkulez u vzroslyh [Klinicheskie rekomendatsii. Tuberkulez u vzroslykh (in Russ.)]. URL: https://cr.minzdrav.gov.ru/schema/16_1