TREATMENT OF INFILTRATIVE PULMONARY TUBERCULOSIS WITH THE APPLICATION OF LOW-INTENSITY LASER RADIATION: CHARACTERISTICS OF THE CYTOKINE PROFILE, IMMEDIATE AND LONG-TERM RESULTS
Abstract
Reduced efficiency of chemotherapy of tuberculosis in recent years, the presence of side effects of TB drugs makes it relevant to the application of non-pharmacological pathogenetic methods for increasing the effectiveness of treatment. One of them is laser therapy. The development of the tuberculous process depends on the condition of protective forces of organism, virulence of mycobacteria and duration of their persistence in the body. A broad range of immune cells and cytokines produced by them, carry out the control of Mycobacterium tuberculosis.
The aim of this work is to study the peculiarities of the dynamics of the cytokine profile of patients with infiltrative pulmonary tuberculosis in which treatment was applied the laser therapy, the immediate and long-term results of their treatment.
Materials and methods. There have been examined patients with infiltrative pulmonary tuberculosis: the main group - 34 patients, who underwent the laser therapy, the control group - 25 patients without laser therapy. There have been studied the concentration of interferon-γ, tumor necrosis factor-α and interleukine-8 before treatment and in dynamics during therapy after 1.5 months, 2.5-3 months and before discharge. Assessment of immediate results of treatment have been conducted at the hospital stage according to the criteria of cessation of discharge and closing of disintegration cavities. Long-term results of treatment have been studied in 46 patients (27 patients of the main group and 19 patients of the control group) over the five-year period.
The results and discussion. In both groups of patients the initial concentration of interferon-γ, tumor necrosis factor-α and interleukine-8 in plasma were increased. On the background of treatment was determined by the decrease in the level of cytokinemia. The more pronounced decrease in the level of studied cytokines was observed in patients of the main group: interferon-γ from 65.3±7.5 pg/ml to 22.5±2.0 pg/ml (p<0.05), tumor necrosis factor-α from 4.0±0.3 pg/ml to 2.7±0.1 pg/ml (p<0.05), interleukin-8 from 28.9±3.3 pg/ml to 18.4±2.9 pg/ml (p<0.05) in comparison with the control group: interferon-γ from 65.5±13.4 ng/ml to 32.3±4.1 pg/ml (p<0.05), tumor necrosis factor-α from 3.7±0.4 pg/ml to 3.1± pg/ ml (p>0.05), interleukin-8 from 29.5±3.7 pg/ml to 23.7±2.5 pg/ml (p>0.05). At the hospital stage in the main group the positive effect of the treatment with cessation of discharge and closing of disintegration cavities there was achieved in 28 patients (82.4%) and 15 patients (60.0%) in the control group, which is almost 1.4 times less. The average time of cessation of bacterial excretion was 1.6±0.1 month in the main group and 2.4±0.3 per month in the control group, p<0.05. The average time of closure of decay cavities was 3.9±0.3 per month in the main group and 5.0±0.4 month in the control group, p<0.05. Clinical cure was achieved in 23 patients (85.2%) of the main group and in 13 patients (68.4%) in the control group. The small residual changes have developed in 16 patients (69.6%) of the main group and 6 (46.2%) patients in the control group. Chronic course of tuberculosis was observed in 2 patients (7.4%) of the main group and 3 patients (15.7%) in the control group. Two cases of relapse of tuberculosis process were identified: 1 patient (3.7%) of the main group and 1 patient (5.3%) in the control group.
Conclusion. The use of laser therapy in complex TB treatment contributes to a more pronounced reduction of cytokinemia. The concentration of the studied cytokines in the serum after the second course of laser therapy and at discharge from the hospital approached indices in healthy individuals. The cessation of discharge, closure of disintegration cavities and the clinical cure of tuberculosis occurred more frequently and earlier in patients of the main group, it was formed less pronounced residual changes.
References
2. Григорьева Е.А. Медико-социальные аспекты выявления, течения и лечения инфильтративного туберкулеза легких в период эпидемического неблагополучия: автореф. дис. … канд. мед. наук: 14.00.26 – фтизиатрия Новосибирск, 2008. 24.
3. Галкин В.Б. и др. Динамика распространенности туберкулеза с множественной лекарственной устойчивостью. Туберкулез и болезни легких. 2017; Т. 95, 3: 5-12.
4. Васильева И.А. и др. Заболеваемость, смертность и распространенность как показатели бремени туберкулеза в регионах ВОЗ, странах мира и в Российской Федерации. Часть 1. Заболеваемость и распространенность туберкулеза. Туберкулез и болезни легких. 2017; Т. 95, 6: 9-21.
5. Васильева И.А. и др. Заболеваемость, смертность и распространенность как показатели бремени туберкулеза в регионах ВОЗ, странах мира и в Российской Федерации. Часть 2. Смертность от туберкулеза. Туберкулез и болезни легких. 2017; Т. 95, 7: 8-16.
6. Иванова Д.А., Борисов С.Е. Спектр и факторы риска нежелательных побочных реакций при лечении впервые выявленных больных туберкулезом. Туберкулез и болезни легких. 2017; Т. 95, 6: 22-29.
7. Левкина М.В. Лазеротерапия в комплексном лечении инфильтративного туберкулеза легких (экспериментально-клиническое исследование): дис. … канд. мед. наук: 14.00.26; 14.00.51. СПб., 2007. 109.
8. Нечаева О.Б. Эпидемиологическая ситуация по туберкулезу среди лиц с ВИЧ-инфекцией в Российской Федерации. Туберкулез и болезни легких. 2017; Т. 95, 3: 13-19.
9. Шкарин А.В., Белоусов С.С., Аникина О.А. Уровень цитокинов в плазме крови у больных активным инфильтративным туберкулезом легких. Проблемы туберкулеза. 2008; Т. 86, 8: 34-38.
References
1. Voronkova O.V., Urazova O.I., Serebriakova V.A. Strukturno-funktsionalnye svoistva limfotsitov krovi u bolnykh lekarstvenno-ustoichivym tuberkulezom legkikh [Structural and functional properties of blood lymphocytes in patients with drug-resistant pulmonary tuberculosis]. Meditsinskaia immunologiia. 2006; Vol. 8, 2-3: 254-255 [in Russian].
2. Grigorieva E. A. Mediko-sotsialnye aspekty vyiavleniia, techeniia i lecheniia infiltrativnogo tuberkuleza legkikh v period epidemiologicheskogo neblagopoluchiia [Medical and social aspects of the identification, course and treatment of infiltrative pulmonary tuberculosis in the period of epidemic ill-being]. Extended abstract of candidate' s thesis. Novosibirsk, 2008. 24 [in Russian].
3. Galkin V.B., Sterlikov S.A., Balasaniants G.S., Yablonskii P.K. Dinamika rasprostranennosti tuberkuleza s mnozhestvennoi lekarstvennoi ustoichivostiu [Changes in the prevalence of drug resistance tuberculosis]. Tuberkulez i bolezni legkich. 2017; Vol. 95, 3: 5-12 [in Russian].
4. Vаsilievа I.A., Belilovskii E.M., Borisov S.Ye., Sterlikov S.A. Zabolevaemost, smertnost i rasprostranennost kak pokazateli bremeni tuberkuleza v regionakh VOZ, stranakh mira i v Rossiiskoi Federatsii. Chast 1. Zabolevaemost i rasprostranennost tuberkuleza [Incidence, mortality and prevalence as indicators of tuberculosis burden in WHO regions, countries of the world and the Russian Federation. Part 1. Tuberculosis incidence and prevalence]. Tuberkulez i bolezni legkich. 2017; Vol. 95, 6: 9-21 [in Russian].
5. Vаsilievа I.A., Belilovskii E.M., Borisov S.Ye., Sterlikov S.A. Zabolevaemost, smertnost i rasprostranennost kak pokazateli bremeni tuberkuleza v regionakh VOZ, stranakh mira i v Rossiiskoi Federatsii. Chast 2. Smertnost ot tuberkuleza [Incidence, mortality and prevalence as indicators of tuberculosis burden in WHO regions, countries of the world and the Russian Federation. Part 2. Tuberculosis mortality]. Tuberkulez i bolezni legkich. 2017; Vol. 95, 7: 8-16 [in Russian].
6. Ivаnovа D.A., Borisov S.Ye. Spektr i factory riska nezhelatelnykh pobochnykh reaktsii pri lechenii vpervyie vyiavlennych bolnykh tuberkulezom [Profile and risk factors of adverse reactions in new tuberculosis cases receiving treatment]. Tuberkulez i bolezni legkich. 2017; Vol. 95, 6: 22-29 [in Russian].
7. Levkina M.V. Lazeroterapiia v kompleksnom lechenii infiltrativnogo tuberkuleza legkikh (eksperimentalno-klinicheskoie issledovaniie) [Laser therapy in the complex treatment of infiltrative pulmonary tuberculosis (experimentally-clinical research)]. Candidate' s thesis. Saint Petersburg, 2007. 109 [in Russian].
8. Nechaieva O.V. Epidemiologicheskaia situatsiia po tuberkulezu sredi lits s VICh-infektsiiei v Rossiiskoi Federatsii [Tuberculosis epidemic situation among HIV positive people in the Russian Federation]. Tuberkulez i bolezni legkich. 2017; Vol. 95, 3: 13-19 [in Russian].
9. Shkarin A.V., Belousov S.S., Anikina O.A. Uroven tsitokinov v plazme krovi u bolnykh aktivnym infilrativnym tuberkulezom legkikh [Levels of cytokines in plasma in patients with active infiltrative pulmonary tuberculosis]. Problemy tuberkuleza. 2008; Vol. 86, 8: 34-38 [in Russian].
