RU2464034C2 - Method of treating tuberculosis complicated by intolerance to chemotherapy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to phthisiology, and may be used for treating tuberculosis complicated by intolerance to chemotherapy. That is ensured by prescribing the product "Cedar Proteins" 15.0 g of powder dissolved in boiled water 150.0-200.0 ml once a day 1.5-2 h after breakfast for 21 days with underlying standard anti-tuberculosis chemotherapy.

EFFECT: use of the given method of treating provides improving tolerance to the anti-tuberculosis therapy and reducing the symptoms of tuberculous intoxication.

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Description

The invention relates to medicine, namely pulmonology, TB, can be used to treat tuberculosis complicated by intolerance to chemotherapy.

It is known that the etiotropic drugs used to treat patients with tuberculosis are essentially antimetabolites and can have an additional negative effect on various vital processes of the body, in which there are already initial impairments to resistance and metabolism. Tuberculosis intoxication, the presence of destructive changes lead to protein loss in conditions of reduced intake by alimentary route.

Obviously, treatment of tuberculosis patients is possible only with adequate and timely correction of metabolic disorders, immune reactivity, antitoxic liver function and antioxidant defense system.

Complaints made by patients with tuberculosis are associated with symptoms of specific intoxication, due to the general effect of MBT toxins and tissue breakdown products on various functional systems of the body (Mishin, 2007).

The restoration of impaired metabolism is possible by the appointment of a special diet with a high fat content, which will create favorable conditions for the development of reparative processes, the equalization of body mass deficiency (V. Mishin, 2007).

More affordable by the method of application and low cost may be natural herbal preparations.

As an additional nutrient for the complex treatment of tuberculosis patients with the aim of improving the tolerance of chemotherapy and the effect on intoxication syndrome, a well-known medicine product made from the pine nut kernel “Cedar Proteins” can be used, which contains a vitamin-mineral complex that is unique in qualitative and quantitative composition combination with valuable protein, lipid and carbohydrate components, a balanced combination of which is certainly useful for patients erkulezom.

A known method of producing a product from a pine nut kernel "Method for producing a product of" Cedar Proteins "from a cake of pine nut" (No. 2229658 dated 07/27/2008, authors Vyazovaya EA, Lyashenko MV), the resulting product can be used in medicine as a source of essential amino acids, for the rehabilitation of postoperative patients, against the background of the use of antibiotics and to maintain normal intestinal microflora, athletes against the background of intensive training to increase endurance, to improve the well-being of elderly people, without specifying the dosage and duration NOSTA reception capabilities application tuberculosis.

The well-known product "Preventive product, dietary supplement, perfume and cosmetic product based on powder of pine nutshell and the method of its production" (RF Patent No. 2236154 from 09/20/04, authors Vetrov IV, Popov A.A.). This product is used as a therapeutic and prophylactic product in the form of bakery products, as a general strengthening agent for metabolic disorders, as a natural source of dietary fiber to normalize the functions of the gastrointestinal tract and in the manufacture of perfumes and cosmetics, and there is no indication of the use of the drug in tuberculosis , the dosage of the product as a source of dietary fiber is not indicated.

However, these methods do not consider the use of the product "Cedar Proteins" in phthisiology to stop the symptoms of tuberculosis intoxication and treat tuberculosis.

The closest analogue is a way to reduce side effects in the treatment of pulmonary tuberculosis (Patent No. 2314113, 01/10/2008), which uses the drug "Populin", which is an aqueous extract of aspen bark and hodgepodge, on the background of anti-tuberculosis therapy, which reduces and prevention of hepatotoxic effects of anti-TB drugs. However, there is no data on the use of the drug to improve tolerance to anti-tuberculosis therapy and reduce the symptoms of tuberculosis intoxication and pine nut does not include pine nut.

The aim of the invention is to increase the effectiveness of the treatment of tuberculosis complicated by intolerance to chemotherapy, with the aim of improving the tolerance of anti-TB chemotherapy and relieving symptoms of tuberculosis intoxication.

The goal is achieved by adding as a supplementary nutrition against the background of anti-tuberculosis therapy of patients with tuberculosis the product "Cedar Proteins" 15.0 g of powder, dissolved in 150.0-200.0 ml of boiled water for 21 days.

Table 1 Chemical, vitamin-mineral and amino acid composition of the product "Cedar Proteins" (wt.%, G / 100 g of product) Fats, including phospholipids 18.0-21.0 1.8-2.5 Vegetable proteins 38.0-45.0 Carbohydrates 18.0-25.0 Water 2.0-4.0 Other substances up to 100% Vitamin B1 (mg / 100 g) 1.14 Vitamin B2 (mg / 100 g) 37.0 Vitamin B5 (mg / 100 g) 437.4 Vitamin PP (nicotinamide) (mg / 100 g) 10.3 B (g / 100 g) 0.004 Ca (g / 100 g) 0.05 Cu (g / 100g) 0.004 Fe (g / 100 g) 0.012 I (g / 100 g) 0.01 K (g / 100 g) 1.36 Mg (g / 100 g) 0.47 Mn (g / 100 g) 0.02 Na (g / 100 g) 0.005 P (g / 100 g) 1.31 S (g / 100 g) 0.60 Se (g / 100 g) 0.002 Si (g / 100 g) 0.01 Zn (g / 100 g) 0.014 Asparagine (g / 100 g) 9.6 Threonine (g / 100 g) 4.8 Serine (g / 100 g) 3.6 Glutamine (g / 100 g) 20.4 Proline (g / 100 g) 4.4 Glycine (g / 100 g) 4.1 Alanine (g / 100 g) 4.5 Valine (g / 100 g) 4.9 Methionine (g / 100 g) 0.4 Isoleucine (g / 100 g) 3.8 Leucine (g / 100 g) 6.8 Tyrosine (g / 100 g) 4.5 Phenylalanine (g / 100 g) 4.2 Histidine (g / 100 g) 2.8 Lysine (g / 100 g) 3.7 Arginine (g / 100 g) 17.2

The treatment is carried out according to the following scheme: against the background of the intensive phase of chemotherapy, the product “Cedar Proteins” 15.0 g, dissolved in 150.0-200.0 ml of boiled water, is connected once a day after 1.5-2 according to the standard or individualized regimen hours after breakfast for 21 days, a second course is possible.

To prepare additional nutrition, dissolve 15.0 g of the cedar protein product powder in 150.0-200.0 ml of boiled water. Take once a day after 1.5-2 hours after breakfast. The duration of taking the product "Cedar Proteins" is 21 days. Repeated courses of admission are possible. The product is highly soluble in water, in dissolved form it is a suspension of a whitish color with a pleasant nutty odor.

Method effectiveness

The use of additional nutrition through the use of the product "Cedar Proteins" was studied in 40 patients with various forms of pulmonary tuberculosis and extrapulmonary localization. The main group consisted of 25 people, the control group consisted of 15 people. Patients of both groups were comparable in the clinical forms of tuberculosis, the presence of symptoms of tuberculosis intoxication, anti-tuberculosis therapy was carried out in accordance with the drug sensitivity of the office standard chemotherapy regimens. 30% of patients received treatment according to the I chemotherapy regimen, 10% - the IIB regimen, 60% - the IV chemotherapy regimen. Patients of the main group took Cedar Proteins as a food product once a day - 1.5-2 hours after breakfast, 15.0 g of powder dissolved in 150-200 ml of boiled water. In the control group, patients of the control group received a placebo as a food product (a mixture of maltose with milk powder - 7.0 g, dissolved in 200.0 ml of boiled water).

Upon admission, symptoms of tuberculous intoxication were observed in most patients - 88%, of which 8 (32%) patients noted a significant decrease in body weight - by 15-24 kg, complained of a decrease in appetite for more than 1 month 88% of patients.

As a result of taking the product “Cedar Proteins” against the background of the intensive phase of anti-tuberculosis chemotherapy, subjectively all patients of the main group noted improvement in well-being, which was expressed in the disappearance of symptoms of intoxication - the appearance of appetite, the disappearance of nausea, weight gain. Significant improvement in chemotherapy tolerance (lack of severity in epigastrium, nausea after taking tablet anti-TB drugs) was noted by 100% of patients in the main group, digestion was normalized by the majority of subjects in the main group - up to 80%, and no adverse reactions were observed when taking anti-TB drugs. There were no cases of withdrawal of anti-TB drugs while taking Cedar Proteins. In the control group, patients showed no improvement in chemotherapy tolerance - nausea and epigastric discomfort persisted.

When measuring body weight before taking the product "Cedar Proteins", a decrease in body weight was detected in all patients - during the illness, weight loss was different - from 3-4 kg to 24 kg before admission to the hospital. After the intake of the product “Cedar Proteins” was completed, more than 80% of patients showed weight gain from 1 to 6 kg and body weight averaged 53.6 ± 1.6 kg before treatment and 57.8 ± 1.7 kg after treatment (p <0.05), 20% of patients retained their original weight. In the control group, the weight gain was a maximum of 2.5 kg.

In the main group, there was a tendency to an increase in glucose levels after taking the product "Cedar Proteins" - 5.979 ± 1.733 mmol / L before treatment and 6.04 ± 1.119 mmol / L after 1 month.

The dynamics of the levels of protein fractions in the process of taking the product "Cedar Proteins" tends to increase, but without reaching normal indicators, the tendency to normalize the ratio of albumin to globulin - albumin was 52.5% before taking and 55.4% after a month of taking the product " Cedar Proteins. " In the control group, the indicators of total blood protein after taking a placebo were higher than in the main group - 81.89 ± 7.314, but the ratio of albumin to globulin did not normalize, it was 54% / 46% before cedar protein intake and after 1 month, respectively and 49% / 51%.

In the study of lipoprotein levels in the main group, a slight increase was noted. In the main group after the use of “Cedar Proteins”, a significant increase in triglycerides was detected - 0.547 ± 0.058 mmol / L and after 1 month 0.715 ± 0.064 mmol / L (p <0.05) and VLDL - 0.247 ± 0.023 mmol / L before administration and 0.317 ± 0.028 mmol / L after 1 month (p <0.05).

Clinical example.

Patient K., 54, disabled, was admitted on 10/30/2007. Identified during a physical examination as FLG +. Prior to this, for 1.5 years he noted complaints of pain and difficulty in moving in the right knee joint. Upon admission, the condition is closer to satisfactory, complained of a temperature increase of up to 37.4 ° C, night sweating, weight loss of 24 kg during the year, pain in the right knee joint, inability to move in the knee joint. In the OAK of 10.31.2007: red blood cells 4.2, hemoglobin 134, white blood cells 9.7, s / I 68.0, lymphocytes 21.0, ESR 37 mm / h. In a sputum under microscopy of a smear 3 times KUM were not found. The sputum culture on the Office is negative. On the Rg-mm of the chest organs from 11/05/07, a group of focal shadows without signs of decay is determined on the right in the upper lobe, the roots of the lung are not expanded. An X-ray examination of the right knee joint revealed unevenly narrowed joint space, uneven articular ends of the bones, foci of destruction in the medial condyle of the tibia, contact destruction of the femur, shadow of the paraarticular sore abscess with sequesters. In the department of extrapulmonary tuberculosis, the diagnosis was made: tuberculosis drives the arthritic phase on the right, focal tuberculosis in / lobe of the right lung in f. infiltration, office.

Given the double localization of tuberculosis, the PB was prescribed a chemotherapy regimen, immobilization of the knee joint. From the beginning of treatment, the product “Cedar Proteins” was additionally prescribed at a dose of 15.0 g dissolved in 150.0-200.0 ml of boiled water, once a day 1.5-2 hours after breakfast for 21 days. 2 months after admission, an operation was performed - arthrotomy.

As a result of the use of “Cedar Proteins” as an additional nutrition against the background of an intensive phase IIB, the chemotherapy regimen by the end of the first week of treatment showed symptoms of tuberculous intoxication - normalization of temperature, sweating significantly decreased. There is an increase in weight of +5 kg. The chemotherapy regimen prescribed by IIB with 6 anti-TB drugs is satisfactory, nausea and severity were not observed in the epigastrium.

When x-ray control, there is a positive dynamics in the upper lobe of the right lung. On the roentgenogram of the right knee joint - sclerosis of bone tissue, there is an increase in the clarity of contours, compaction of soft tissues.

The patient was discharged in satisfactory condition, with a weight gain of 15 kg for further outpatient treatment at the place of residence.

Thus, the use of the product “Cedar Proteins” as an additional nutrition against anti-tuberculosis therapy significantly increases the tolerability of treatment, allowing for full chemotherapy, including in the presence of concomitant pathology of the gastrointestinal tract, contributes to the disappearance of symptoms of tuberculous intoxication, improves well-being, promotes weight gain in patients with various clinical forms of tuberculosis.

Claims (1)

A method of treating tuberculosis complicated by intolerance to chemotherapy, characterized in that tuberculosis patients against the background of standard anti-tuberculosis chemotherapy regimens are additionally prescribed the product “Cedar Proteins” at a dose of 15.0 g, dissolved in 150.0-200.0 ml of boiled water, once every 1.5-2 hours a day after breakfast for 21 days.