RU2026680C1 - Method of treating acute pneumonia progressing against background of allergopathology in adults - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: this method prescribes intranasally administering thymogen 48 to 72 h after start of cure in dose of 100 mcg during seven days. EFFECT: disclosed method allows relieving disease, preventing allergic complications and undertaking cure both in hospital and ambulatory conditions. 1 tbl

Description

 The invention relates to medicine, specifically to methods for treating patients with acute pneumonia.

Known methods for the prevention of allergic complications in patients with acute pneumonia occurring against the background of allergopathology, antihistamines - blockers of H ₁ histamine receptors, however, the presence of side properties of drugs of this group, including the "paradoxical" effect, the ability to thicken sputum and thereby worsen its rheological properties, limit their use for the treatment of bronchopulmonary patients in our country, abroad, this group of drugs for this purpose is not used at all.

In practice, long-acting drugs are also used - blockers of H ₁ -histamine receptors - zadit and ketotifen, but the lack of an immunostimulating effect in them causes the fact that this method of treatment is not widespread.

 Such drugs as gordoks, trasilol, kontrikal - a group of antiprotease drugs - are quite effective, but the intravenous route of administration, the risk of complications, including allergies themselves, are deficient, due to the fact that they are not produced by domestic companies, and also their immunostimulating effect, led to virtually no possibility of their use in wide clinical practice.

 Closest to the proposed method for the treatment of patients with acute pneumonia occurring against the background of allergopathology is a method of treatment with sodium cromoglycate preparations. In the country, cromolin-sodium-intal is used to correct allergic reactions. Its action is that it inhibits the release of mediating substances from mast cells, preventing allergic complications in patients. The drug does not have an immunostimulating effect, while in acute pneumonia, many patients develop immunological deficiency. Intal is not produced by domestic firms; it is purchased in small quantities and is severely deficient in our country.

 The basis of the invention is the task of improving the quality of treatment, namely, preventing the development of allergic complications in acute pneumonia in patients with background allergopathology.

The essence of the invention is that in the complex of treatment of patients with acute pneumonia occurring against the background of allergopathology, thymogen is included - a thymus preparation that has both anti-mediator and immunostimulating activity. Thymogen is administered intranasally at 100 mcg daily for 7 days. Timogen is a synthetic peptide-glutamyl-tryptophan (C ₁₆ H ₂₀ N ₃ O ₅ ). The immunoactive dipeptide was isolated by high performance liquid chromatography from the natural preparation of thymus thymalin. Thymogen stimulates the reaction of cellular and humoral immunity, as well as non-specific resistance. It was discovered a new, still unknown property of thymogen - anti-mediator, that is, the ability of the drug to prevent mast cell degranulation and thereby have an anti-allergic effect on the body. The use of these two properties of the drug allows you to achieve a persistent clinical effect and reduce the hospital bed in acute pneumonia.

 The lack of information in the patent and scientific literature on the method of simultaneous antiallergic and immunostimulating treatment of acute pneumonia in patients with allergic pathology in general and thymus drug with thymogen in particular indicates the compliance of the claimed technical solution with the criterion of "Novelty".

 The proposed method for the treatment of acute pneumonia in patients with allergopathology has a "significant difference". The authors found an unknown early property of thymogen to prevent degranulation of rat mast cells with serum from an allergic patient and the associated clinical anti-mediator effect. The authors also did not find the use of thymogen in patients with acute pneumonia by its well-known immunostimulating property with respect to the parameters of non-specific resistance and specific reactivity, the suppression of which occurs in patients with acute pneumonia. Thus, the use of thymogen as a simultaneous immunostimulating and anti-mediator therapy is not obvious to a specialist. The use of thymogen allowed to achieve a reduction in treatment time by 4.2 days.

 The proposed method meets the criterion of "industrially applicable", as it successfully passed clinical trials in the clinic of field therapy and the garrison military hospital in Tomsk.

 A method of treating patients with acute pneumonia occurring against the background of allergopathology is carried out as follows: in the acute period of the disease (for 2-3 days of the patient’s stay in the hospital) with anti-mediator and immunostimulating goals, thymogen for 7 days is included in the treatment. A daily dose of 100 mcg is intranasal.

 Evidence of a beneficial effect.

 To assess the specific effect of thymogen, the effect of other drugs was also studied.

 A comparison of the immunostimulatory (in vivo) and anti-mediator (in vitro) effects of thymogen with the prototype is shown in the table.

 As can be seen from the table, thymogen has the greatest simultaneous anti-mediator and immunostimulating activity.

PRI me R 1. Patient S. (medical history N 57), 35 years old, was admitted to the hospital 4.01.90, on the fifth day of the disease with a diagnosis of direction: acute left-sided pneumonia. Acutely ill, when there was a general malaise, cough with sputum, fever, body temperature rose to 38.5 ° ^C. After two days, the patient's condition worsened, body temperature rose to 39.6 ^{° C,} there were pains in the left side of the chest, worse with a deep breath. At the initial examination (fifth day of illness) in the hospital, the general condition is moderate. The body temperature of 39.0 ^C. The complaints of pain in the left chest, increasing with deep breathing and coughs, cough with muco-purulent sputum, fever, shortness of breath on exertion, general weakness, headache. Objectively: the skin is pale, hot. Pulse - 104 beats in 1 min. HELL -105/60 mm Hg The number of breaths - 29 in 1 min. The left half of the chest lags behind in the act of breathing. Above the left lung, blunting of percussion sound in the subscapular region. Auscultatory on the left in the subscapular area against the background of weakened vesicular breathing crepitating wheezing, pleural friction noise. From other organs without changes. A history of intolerance to penicillin and citrus fruits.

 The diagnosis was made: croupous left-sided pneumonia with a localization of 9.10, DN II art. Prescribed treatment: antibiotics, detoxification agents, cardiovascular analeptics, expectorant drugs, bronchodilators. Against the background of the therapy, there was no change in the patient's condition - increased body temperature and changes in the lungs persisted. On the fourth day of treatment, a change in antibiotics was carried out taking into account the sensitivity and antibiotic of microflora isolated from sputum. Within 3-4 days there was a slight positive dynamics, but then the patient's condition worsened again. Shortness of breath intensified, pronounced dullness of percussion sound began to be determined up to the angle of the left scapula, auscultation in the left subscapular region, vesicular breathing became sharply weakened, wheezing was not heard, tachycardia and increased body temperature persisted. X-ray in the pleural cavity of the left lung revealed fluid. After pleural puncture with fluid removal and correction of treatment, the patient's condition began to improve. On the eleventh day of treatment, body temperature returned to normal. Auscultatory changes in the lungs disappeared on the twentieth day, and percussion changes on the twenty-sixth day of treatment. It was discharged after recovery on February 9, 1990 (bed-day - 36), however, the pleural adhesion in the left lung was preserved radiologically. The final diagnosis: croupous left-sided pneumonia with a localization of 9.10, DN II st. Parapneumonic left-sided exudative pleurisy.

A blood test from 5.01.90 g. Hb - 130 g / l, Er. - 4.3x10 ¹² / l, lake. - 10.8x10 ⁹ / l, s - 55%, p - 4%, e - 1%, m - 3%, l - 37%, ESR - 60 mm / h.

 Leukocyte intoxication index (LII) - 1.44; lymphocytic index (LI) - 0.63.

From 4.02.90, Hb - 133 g / l, Er. - 4.3x10 ¹² / l, Lake. - 3.4x10 ⁹ / l, s - 53%, p - 2%, e - 5%, m - 3%, l - 37%, ESR - 13 mm / h. LII - 1.17; LI - 0.70.

 Immunological analysis from 5.01.90 g.

 T-lymphocytes - 29%, T-helpers - 19%, T-suppressors - 10%, B-lymphocytes - 12%, IgA - 4.0 g / l, IgM - 1.04 g / l, IgL - 15, 6 g / l, CEC - 75 units opt.pl., rat mast cell degranulation test - positive reaction with citrus allergens: orange - 70%, with intimal - 50%, with thymogen - 10%, lemon - 60%, s intimal - 40%, with thymogen - 10%.

 Immunological analysis of 4.02.90,

 T-lymphocytes - 35%, T-helpers - 15%, T-suppressors - 20%, B-lymphocytes - 22%, IgA - 1.83 g / l, IgM - 1.15 g / l, IgL - 9, 2 g / l, CEC - 86 units of opt.pl., rat mast cell degranulation test - positive reaction with citrus allergens: orange - 70%, with intimal - 30%, with thymogen - 10%, lemon - 50%, s intimal - 30%, with thymogen - 10%.

PRI me R 2. Patient O. (medical history N 783), 35 years old, was admitted to the hospital 12.12.90, on the tenth day of illness with a diagnosis of direction: acute left-sided pneumonia. Acutely ill, when, after exposure to cold, appeared weakness, cough, initially dry, the second day of the disease with the release of muco-purulent sputum, increased body temperature to 38.9 ° ^C. On the sixth day of illness there was a pain in the left side of the chest when coughing or take a deep breath. At the initial examination (on the tenth day of the disease) in the hospital, the general condition is moderate. The body temperature - 38,5 ^° C Complaints of cough with muco-purulent sputum, pain in the left side of the chest by coughing and deep breathing, fever, moderate sweating, dizziness. Objectively: pulse - 98 beats per 1 min, BP = 100/60 mm Hg. Art., the number of breaths - 28 in 1 min. The left half of the chest lags slightly in the act of breathing. Percussion on the left in the axillary region is dull. Auscultatory on the left in the lower sections weakened vesicular breathing, against which in the subscapular region moist finely bubbling rales, in the axillary region there is a section of crepitating rales. From other organs without changes. A history of citrus intolerance. The patient was diagnosed with croupous left-sided pneumonia with a localization of 2.6.7, DN II tbsp. Prescribed treatment: antibiotics, cardiovascular analeptics, expectorant drugs. From the second day of treatment, thymogen was prescribed 100 μg intranasally for 7 days. On the third day of treatment, the patient's condition became satisfactory - body temperature decreased to normal numbers, chest pain decreased. On the eighth day of treatment, the patient did not show complaints, with an objective examination of the lungs, no changes were detected. In treatment, the antibiotic and thymogen were canceled, the patient continued to receive physiotherapeutic procedures and exercise therapy. Discharged on recovery December 28, 1990 (bed-day - 16).

 Blood test from 12.13.90 g.

Gem. - 153 g / l, er. - 4.5x10 ¹² / l, lake. - 7.0x10 ⁹ / l, s - 68%, p - 3%, e - 1%, m - 8%, l - 20%, ESR - 52 mm / h. LII -2.23; LI - 0.32.

From 12/27/90 gem. - 150 g / l, er. - 4.5x10 ¹² / l, lake. - 4.6x10 ⁹ / l, s - 48%, p - 1%, e - 1%, m - 5%, l - 45%, ESR - 8 mm / h, LII - 1.04; LI - 0.84.

 Immunological analysis dated 13.12.90. T-lymphocytes - 25%, T-helpers - 2%, T-suppressors - 23%, B-lymphocytes - 13%, IgA - 1.3 g / l, IgM - 0.6 g / l, IgL - 5.52 g / l, CEC - 86 units opt.pl., rat mast cell degranulation test - positive reaction with citrus allergens (orange, lemon) - 60%, with intal - 40%, s thymogen - 20%.

 Immunological analysis from 12.27.90

 T-lymphocytes - 49%, T-helpers - 34%, T-suppressors - 15%, B-lymphocytes - 18%, IgA - 2.5 g / l, IgM - 1.48 g / l, IgL - 12, 3 g / l, CEC - 95 units opt.pl., rat mast cell degranulation test - positive response to citrus fruits (orange, lemon) - 40%, with intimal - 30%, with thymogen - no degranulation.

 The extracts from the case histories of moderate to severe form of croupous pneumonia treated with thymogen and treated according to the usual scheme illustrate the nature of the course of the disease with various treatment methods. It was shown that the patient with the use of thymogen has a fast positive dynamics in the course of the disease, and, conversely, in the patient treated in the traditional way, the disease lasted longer and with complications.

 The use of thymogen caused anti-mediator and immunostimulating effects, as a result of which a positive effect in treatment was achieved.

 Thus, based on the above examples and the table, we can conclude that the proposed method for the treatment of acute pneumonia in patients with allergopathology with a thymus thymogen preparation has a new higher therapeutic effect, which will be obtained by using the invention in comparison with the prototype, since it is achieved simultaneously anti-mediator and immunostimulating effects.

Claims (1)

 METHOD OF TREATMENT OF ACUTE PNEUMONIA IN ADULTS, PROCESSING ON THE BACKGROUND OF ALLERGOPATOLOGY, including the introduction of drugs, characterized in that they inject intranasally thymogen at 100 mcg for 7 days.

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