RU2290199C1 - Method for treating chronic inflammatory diseases of small pelvic organs of chlamydeous etiology - Google Patents

Abstract

FIELD: medicine, gynecology.

SUBSTANCE: one should carry out basic antibioticotherapy and immunocorrection, moreover, as an immunocorrector it is necessary to apply affinoleukin preparation as submucous injections into uterine cervix. A single dosage of affinoleukin corresponds to 1.0 U once during 2 d. Therapy course consists of 10 injections. The innovation provides regional activation of T-lymphocytes' transition from immature forms into mature ones associated with mucous membranes of urogenital tract and, thus, efficient chlamydial elimination.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to gynecology, and can be used to treat chronic urogenital chlamydial infections.

A known method of treating chronic inflammatory diseases of the pelvic organs of chlamydial etiology, which includes, in addition to basic antibiotic therapy, also immunocorrection (Remezov A.P., Neverov V.A., Semenov N.V. "Chlamydial infections (clinic, diagnosis, treatment). ”St. Petersburg. - 1995, p. 32-34).

Disadvantages: lack of effectiveness, long periods of treatment, a high frequency of relapses.

The invention is aimed at solving problems: improving the effectiveness of treatment and prevention of relapse.

Effect: expanding the range of products for the treatment of chronic inflammatory diseases of the pelvic organs of chlamydial etiology.

These tasks are achieved due to the use of the drug “Affinoleukin” in a single dose of 1.0 unit against the background of basic antibiotic therapy as a unit dose, administered once every 2 days regionally by submucous injection into the cervix by 10.

The drug “Affinoleukin” (license No. 15/0006-L / 02) is produced by the BIOMED NGO, Perm, and is a complex of low molecular weight proteins obtained from human leukocytes lyophilized by glycine. The drug is used to treat chronic and persistent viral, bacterial and fungal infections.

There are no regional data on the methodology for the treatment of chronic inflammatory diseases of the pelvic organs of chlamydial etiology with this drug.

The method is as follows: a patient receiving antibacterial therapy (basic), including doxycycline monohydrate and clarithromycin, probiotics, conduct a course of injections into the cervix with the drug affinoleukin in a single dose of 1.0 unit. 1 time in 2 days with the number ten.

Examples of specific performance.

Example 1. Patient L., 25 years old, turned to the GDC with complaints of periodic pain in the lower abdomen, radiating to the lower back, more often disturbing during menstruation, sometimes in the middle of the cycle; copious discharge from the genital tract. Gynecological history - menarche - at 13 years old, the cycle is 28 days, of which 7-8 days are monthly, they are accompanied by pain, plentiful. Sex life from 18 years, consistent monogamy (2 partners). Pregnancy never came. Sexually transmitted infections have a history of negating. On examination: the external genitalia are formed correctly, the walls of the vagina are clean, covered with a milky coating. On the mirrors - the cervix is uterine, the external pharynx of the cervical canal is irritated: the mucous membrane is uneven, the vascular pattern is pronounced, there is a gray coating. In a bimanual examination, the uterus of normal size and consistency, anteversio, anteflexio, with the displacement of the isthmus to the left, painful sensations arise. Area of appendages: on the right is the ovary of normal size, dense, painful. On the left, the ovary is normal, dense, painful, a cord is determined, sensitive to palpation.

When ultrasound - the uterus is in the position of anteversio, anteflexio, along the axis of the pelvis, dimensions 56 * 47 * 42 mm, M - echo: 7 mm, there is a fracture of the basement membrane - endometrium, right ovary 32 * 21 mm; left ovary 32 * 27 mm. Conclusion - signs of chronic endometritis, chronic bilateral adnexitis.

Complete blood count: red blood cells - 3.8 * 10 ¹² / l, hemoglobin - 126 g / l, white blood cells - 5.8 * 10 ⁹ / l, eosinophils - 1%, stab - 21%, segmented - 61%, lymphocytes - 19%, erythrocyte sedimentation rate - 4 mm / h.

Biochemical analysis of blood: total protein - 61 g / l, bilirubin - 15.2 mmol / l, glucose - 4.2 mmol / l, C-reactive protein - neg.

Immune status: white blood cells in the peripheral blood 5.8 * 10 ⁹ / l, CD-3 - 64%, CD-4 - 32%, CD-8 - 31%, CD-20 - 5%, phagocytosis index - 1.2 .

Chlamydia test: PCR - positive, determination of antigen in a smear from the cervical canal by PIF reaction - positive, serum antibody level - Ig A 1:32, Ig G 1: 512.

The study of blood serum for antibodies to infections: CMV - 72%, HSV - 68%, rubella - 98%, toxoplasmosis - Ig M and Ig G were not found. Histological examination of scrapings from the cervical canal: chronic cervicitis (proliferative inflammation). Smears for ureaplasmas and mycoplasmas (UIF) are negative.

Based on the medical history (absence of pregnancy), complaints (algodismenorrhea, pain), objective data (ultrasound, histological examination), laboratory results (high titers of antibodies to chlamydia in blood serum and determination of antigenic structures of chlamydia in smears), the diagnosis was made: chronic endometritis, chronic bilateral salpingoophoritis, chronic cervicitis of chlamydial etiology, algodismenorrhea.

Basic therapy was carried out: doxycycline monohydrate, clarithromycin, probiotics (hilak-forte), eubiotics (bifiform). "Affinoleukin" is prescribed in single doses of 1.0 unit, 1 time in two days in the form of submucosal injections into the cervix, with a course of 10 injections. There were no side effects and complications during the treatment with “Affinoleukin”.

Markers of chronic urogenital chlamydial infection 1 month after treatment: Ig A - 1/8, Ig G - 1/32 ("serological scar"), no chlamydial antigen in smears, PCR - negative. Immune status (one month after treatment): white blood cells in the peripheral blood 6.8 * 10 ⁹ / l, CD-3 - 70.1%, CD-4 - 51%, CD-8 - 26%, CD-20 - 11 %, phagocytosis index - 4.4.

The woman was left in the dispensary: normalization of the menstrual cycle occurred, there was no chlamydial infection during the year after treatment.

Example 2. Patient L., 28 years old, turned to the GDC with complaints of pain in the lower abdomen, accompanied by a feeling of heaviness, intense during menstruation and in the middle of the cycle; copious discharge from the genital tract. Gynecological history - menarche - at 12 years old, the cycle is 26 days, of which 7-8 days are monthly, they are accompanied by pain, plentiful. Sexual life since 19 years, consistent monogamy (2 partners). Pregnancies: 1 - miscarriage in the period of 5-6 weeks at the age of 23 years, 2 - proceeded physiologically, first urgent delivery through the natural birth canal at the age of 26 years, 3 - laparoscopy due to ectopic pregnancy in the left fallopian tube, Fitz-Hugh symptom Curtis, tubectomy on the left. Sexually transmitted infections have a history of negating. On examination: the external genitalia are formed correctly, the walls of the vagina are clean, covered with a milky coating. On the mirrors - the cervix is cylindrical, clean, covered with a milky coating. In a bimanual examination, the uterus of normal size and consistency, anteversio, anteflexio, with the displacement of the isthmus to the left, painful sensations arise. Area of appendages: on the right is the ovary of normal size, dense, painful. On the left is determined a cord sensitive to palpation.

When ultrasound - the uterus is in the position of anteversio, anteflexio, along the axis of the pelvis, size 62 * 49 * 37 mm, M - echo: 11 mm, there is a fracture of the basement membrane - endometrium, right ovary 32 * 21 mm; the left ovary is not detected. Conclusion - signs of chronic endometritis, chronic bilateral adnexitis.

Complete blood count: red blood cells - 3.9 * 10 ¹² / l, hemoglobin - 117 g / l, white blood cells - 7.2 * 10 ⁹ / l, eosinophils - 1%, stab - 27%, segmented - 65%, lymphocytes - 21%, erythrocyte sedimentation rate - 7 mm / h.

Biochemical analysis of blood: total protein - 72 g / l, bilirubin - 11.5 mmol / l, glucose - 3.9 mmol / l, C-reactive protein - neg.

Immune status: peripheral blood leukocytes 7.2 * 10 ⁹ / l, CD-3 - 59%, CD-4 - 29%, CD-8 - 35%, CD-20 - 7%, phagocytosis index - 2.4 .

Chlamydia test: PCR - positive, determination of antigen in a smear from the cervical canal by PIF reaction - positive, serum antibody level - Ig A 1:16, Ig G 1: 128.

The study of blood serum for antibodies to infections: CMV - 67%, HSV - 53%, rubella - 81%, toxoplasmosis - Ig M and Ig G were not found.

Histological examination of scrapings from the cervical canal: chronic cervicitis (proliferative inflammation). Smears for ureaplasmas and mycoplasmas (UIF) are negative.

Based on the medical history (absence of pregnancy), complaints (algodismenorrhea, pain), objective data (ultrasound, histological examination, Fitz-Hugh-Curtis symptom), laboratory results (high titers of antibodies to chlamydia in blood serum and determination of antigenic structures of chlamydia in smears) was diagnosed with chronic endometritis, chronic adnexitis, chronic cervicitis of chlamydial etiology, algodismenorrhea.

Basic therapy was carried out: doxycycline monohydrate, clarithromycin, probiotics (hilak-forte), eubiotics (bifiform). "Affinoleukin" is prescribed in single doses of 1.0 unit, 1 time in two days in the form of submucosal injections into the cervix, with a course of 10 injections. There were no side effects and complications during the treatment with “Affinoleukin”.

Markers of chronic urogenital chlamydial infection 1 month after treatment: Ig A - neg., Ig G - 1/32 ("serological scar"), no chlamydial antigen in smears, PCR - negative. Immune status (one month after treatment): peripheral blood leukocytes 7.2 * 10 ⁹ / L, CD-3 - 74.0%, CD-4 - 48.5%, CD-8 - 21%, CD-20 - 14%, phagocytosis index - 6.8.

The woman was left at the dispensary: normalization of the menstrual cycle occurred, one year after treatment of exacerbations of chlamydial infection, there was a normal uterine pregnancy.

The study included 60 women with chronic inflammatory diseases of the pelvic organs of chlamydial etiology who contacted the Perm City Consultative and Diagnostic Center (MUZ “MSCh No. 9 named after M. Tver”). In accordance with the introduction of the drug "Affinoleukin" 60 patients were divided into 2 groups. The first group received the drug "Affinoleukin" in the form of submucosal injections into the cervix, 1.0 unit, number 10, once every two days. The second group received the drug "Affinoleukin" subcutaneously, 1.0 unit, number 10, once every two days.

The control group consisted of 20 patients with chronic inflammatory diseases of the pelvic organs of chlamydial etiology, who received basic and pathogenetic therapy.

Groups were formed by random sampling.

When comparing the course of the disease in patients who received the drug "Affinoleukin" regionally (submucosal injections in the cervix), subcutaneously (shoulder region), and patients in the control group, the results are shown in Table 1.

During clinical trials, patients were monitored to identify possible side effects of the drug "Affinoleukin". In no case of the use of the drug allergic complications, there were no reactions to the drug.

Thus, the application of the proposed method for the treatment of chronic inflammatory diseases of the pelvic organs of chlamydial etiology significantly reduces the number of relapses, chronic infections. In patients treated with the drug "Affinoleukin" locally, at an earlier date, the pain syndrome, signs of inflammation disappear.

Claims (1)

A method for the treatment of chronic inflammatory diseases of the pelvic organs of chlamydial etiology, including basic antibiotic therapy and immunocorrection, characterized in that the drug affinoleukin is used as a immunocorrector by submucous injections into the cervix in a single dose of 1.0 unit, once every two days, course 10 injection.