RU2161983C1 - Method of treating chronic purulent rhinosinusites - Google Patents

Abstract

FIELD: otolaryngology. SUBSTANCE: on the first treatment day, single intravenous drop-by-drop infusion of 5 ng bataleukin per 1 kg body weight diluted with physiologic solution is administered (sequent days), bataleukin is administered topically in volume 3-4 ml with concentration 20 ng/ml until local inflammation features cease. EFFECT: enhanced treatment efficiency. 2 cl, 3 tbl

Description

 The invention relates to medicine, namely otorhinolaryngology, and can be used to treat chronic purulent rhinosinusitis.

 There is a method of treating chronic purulent rhinosinusitis that affects the state of local immunity of patients by introducing leukomass, plasma or serum into the affected sinus (Use of natural humoral and cellular factors of nonspecific protection in the treatment of chronic sinusitis in children. Lazarev V.N., Scriabin A.S. . // Bulletin of otorhinolaryngology. - 1998.- N1.-S.39-40).

The prototype of this invention is a method of treating patients with chronic purulent sinusitis (sinusitis) using heterogeneous alveolar macrophages (Use of heterogeneous alveolar macrophages for the treatment of patients with chronic sinusitis. Mishin VV, Trofimenko NP, Gritsenko LZ, Kuzmenko E. I. // Journal of ear, nose, and throat diseases. - 1992. - N 3. - P. 31-33), which is based on the ability of mononuclear phagocytes to eliminate foreign compounds and the production of cytokines that regulate other cellular fungi from the focus of inflammation. tion. A suspension of pork macrophages is introduced into the affected sinus in a volume of 2-3 ml at a concentration of 10 ⁶ -10 ⁷ / ml 4 times a day for 5 days.

 However, in this method there are a number of disadvantages: 1) the multiplicity of medical procedures, 2) foreign macrophages (pork) are used in the treatment process, which, when phagocytosis of pathogenic microorganisms in the focus of inflammation uncontrolledly synthesize cytokines of multidirectional action, 3) there is a risk of introduction into the diseased organ together with heterogeneous macrophages of foreign intracellular pathogens (viruses, etc.) from the animal.

 The technical result is an increase in the effectiveness of the treatment of chronic purulent rhinosinusitis due to stimulation of the own cells of the macrophage-phagocytic series of the immune system both at the systemic and local levels, reducing the duration of treatment.

 The treatment method is as follows: on the first day of treatment - betaleikin (recombinant interleukin -1β- permission of the Ministry of Health of the Russian Federation for clinical use No. 97/51/6) is diluted in physiological saline and administered intravenously drip at the rate of 5 ng / kg of patient weight, the following days - locally, in the affected sinus, after preliminary removal of purulent masses, betaleukin is diluted in physiological saline at a concentration of 20 ng / ml in a volume of 3-4 ml. The drug is administered daily until local signs of inflammation disappear. The course of treatment is from 3 to 6 days.

 The use of the proposed method of treatment in 15 patients with chronic purulent rhinosinusitis contributed to the rapid relief of the inflammatory process in the affected sinus: after the intravenous administration of betaleukin the next day in most patients (8 people), the amount of pus in the washings decreased sharply, which disappeared on the third day of treatment (excellent result), in some patients (5 people) a small amount of pus in the washings was observed until the fourth day of treatment (good result) and in two patients against the background of rashchenija amount of discharge from the sinuses maintained streaks occurred pus and edema and hyperemia of the nasal mucosa to the sixth day of treatment (a satisfactory result). In 86.7% of cases, the treatment outcome was rated as excellent and good. A satisfactory result was observed in cases when purulent rhinosinusitis was accompanied by hyperplastic growths of tissues that impaired the outflow of pus from the focus of inflammation. Surgical intervention in them contributed to the restoration of the outflow and the cessation of suppuration, the postoperative period was uneventful.

 Monitoring of immunological parameters characterizing the state of the macrophage-phagocytic link showed an increase in the functional activity of neutrophils both at the systemic (Table 1) and at the local level (directly in the focus of inflammation) (Table 2).

 As can be seen from the data table. 1, in patients during treatment, activation of the phagocytic and adhesive activity of neutrophils in the bloodstream was noted.

 According to the table. 2, in the process of treatment, neutrophils located directly in the inflammatory focus are also activated. The activation peak occurs on the 3rd day of treatment and coincides in terms with a sharp decrease in the signs of the inflammatory process (purification of washings from purulent masses and cessation of nasal discharge).

 Example.

 Patient Shaimordanova A.I. entered the ENT department of the Clinical Hospital named after G.G. Kuvatova October 25, 1999 (medical history N 111432) with complaints of difficulty in nasal breathing, purulent discharge from the nose, headaches, weakness. Sick from October 2, from October 5 to 12, was in hospital treatment, where the usual treatment was carried out - washing of the paranasal sinuses with dioxidine. She was admitted to hospital again on October 25th. Examination results: radiological - bilateral dimming of the maxillary sinuses and frontal sinus on the right. Objectively, with anterior rhinoscopy, the nasal mucosa is pale pink, with a bluish tinge, swollen, after anemia the mucosa is reduced, in the middle nasal passage is a strip of pus. When puncture obtained viscous pus in the amount of 5 ml, anastomoses passable.

 Diagnosed with bilateral chronic suppurative pansinusitis. The treatment was prescribed according to the proposed methodology. On October 26, betaleukin was injected intravenously in 500 ml of physical. solution at the rate of 5 ng / kg of weight, on the following days - October 27, 28, 29 - after preliminary washing of the sinuses, locally betaleukin, diluted in physical. a solution of 20 ng / ml in a volume of 3-4 ml.

 On the first day after treatment, the patient notes an improvement, the lavage fluid from the sinuses is slightly stained with blood, there are small clots of pus. On the second day, he feels well, the wash liquid is unclear. On the third day, the washings from the sinuses are clean, the catheter is removed.

 The results of the study of the functional state of macrophage-phagocytic cells isolated from blood and wash fluid are presented in tables 3 and 4.

 According to the table. 3, in the patient Shaimordanova A.I. during treatment, stimulation of the functional activity of neutrophils and monocytes located in the vascular bed was noted. In this case, the peak activation of the phagocytic and microbicidal ability of macrophages was observed on the 2nd day of treatment - after intravenous administration of betaleukin. The peak of neutrophil stimulation was observed against the background of the completion of signs of the disease (after treatment). The adhesion ability of macrophage-phagocytic cell cells increased by the end of treatment.

 As can be seen from the table. 4, in the patient Shaimordanova A.I. during treatment, stimulation of the phagocytic and microbicidal activity of neutrophils located in the inflammatory focus was noted, while the adhesive ability of the cells decreased.

 Thus, we observed positive clinical dynamics (improvement of well-being on the second day of treatment, quick purification of washings from the sinuses from pus on the third day from the start of treatment) against the background of improved functional parameters of the macrophage-phagocytic link of the immune system at the systemic and local levels. Already on the second day of treatment, an increase in phagocytic activity and bactericidal activity of neutrophils and monocytes was noted, and by the end of treatment, the indicators of cell adhesion increased. The above indicates a positive immunostimulating effect of this drug on its own cells of the immune system.

 Betaleukin treatment (a combination of intravenous and topical administration) was carried out in 15 patients with chronic purulent rhinosinusitis. The results of clinical and laboratory monitoring of patients showed its high efficiency. A positive result was obtained in all cases, of which in 86.7% of cases the treatment result was assessed as excellent and good (treatment duration from 3 to 4 days). Immunological indicators characterizing the state of the macrophage-phagocytic link of the immune system of patients during treatment showed an increase in the functional activity of neutrophils at both the systemic and local levels (directly in the focus of inflammation).

Claims (1)

 A method for the treatment of chronic purulent rhinosinusitis by local action on the affected sinus of the nose, characterized in that on the first day of treatment, betaleukin is administered intravenously dropwise, diluted in physiological solution at the rate of 5 ng / kg of the patient’s weight, and on the following days it is administered locally at the rate of 20 ng / ml in a volume of 3-4 ml until local signs of inflammation disappear.

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