SU1725117A1 - Method for prognostication of toxic and allergic complications secondary to chemotherapy of tuberculosis - Google Patents

Abstract

The invention relates to medicine, in particular to phthisiology, and can be used to predict the possibility of the occurrence of allergic and toxic reactions during chemotherapy of tuberculosis. The purpose of the invention is to improve the accuracy of the method. Patient's serum is dialyzed through a semi-permeable membrane. The dialysate prdverganet gel chromatographic separation on columns filled with sephadex determines the amount of low molecular weight substances with a molecular weight of 300 daltons, characterized by an absorption maximum at 236 nm and 292 nm, and with a decrease in the content of this fraction to 30.2% and lower than baseline, predict the possibility of toxic and allergic reactions. The method allows with a 100% accuracy to predict toxic and allergic reactions during chemotherapy of tuberculosis. w o

Description

The invention relates to medicine, namely phthisiology, and can be used to predict the occurrence of toxic and allergic reactions during chemotherapy of tuberculosis.

The purpose of the invention is to improve the accuracy of the method.

The method is carried out as follows.

Serum is separated from the blood of a patient obtained from a peripheral vein prior to the prescription of antibiotic therapy and in the dynamics of its implementation by one of the known methods. Serum is dialyzed through a semipermeable membrane for 17–20 hours to separate large molecular components against a 5–10-fold volume of a 0.14 M sodium chloride solution, pH 7.2-7.4, at a temperature of 2-4 ° C. All further operations on the treatment of serum dialysate are carried out at 2-4 ° C. The dialysate is collected, concentrated, for example, by weathering under a fan in cellophane paper to the initial volume of blood serum and subjected to gel chromatographic separation on columns filled with a sec. G-15 fadex and stabilized with a 0.14 M sodium chloride solution, pH 7.2-7 ,four. The columns are portion-wise using an collector for collecting fractions and collecting eluent (5–15 ml in a sample), which is analyzed at a wavelength of 280 nm on an SF spectrophotometer - 16, recording the profile of the curve of elimination and gel chromatogram. Take samples

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The individual gel-chromatogram peaks, which are included in the individual peaks, are combined and analyzed in ultraviolet radiation in the range of 220–330 nm in order to reveal the absorption maximums of each peak in the cuvettes with a layer thickness of 10 mm. The comparison solution is demineralized water.

The quantitative content within the gel chromatogram of the fraction of low molecular weight substances eluted from the columns in the elution volume of 5.0-6.0 Y0 (where Y0 is the free volume of the column) and characterized by maximum absorption at 236 nm and 292 nm is used to predict the development of complications toxic and allergic in patients with tuberculosis in the appointment of antibiotic therapy. With a decrease in its content in dialysate, the serum of tuberculosis patients in the dynamics of specific antibiotic therapy to 30.2% and below (up to trace amounts) of the initial amount predict the possibility of the development of toxic and allergic complications.

Example 1. Patient P. was admitted to the hospital for cirrhotic tuberculosis of the lower lobe of the left lung, BC (+). The content of the fraction of low molecular weight substances in the serum upon admission is 47.7%.

Treatment with phthivazide 0.5 x 3, ethambutol 1.2 once. Tolerability of drugs throughout the entire course of antibiotic therapy is satisfactory. No complications of a toxic-allergic nature were noted. The content of the fraction of low molecular weight substances in the course of treatment course varied from 45.3 to 50.9%.

L p and m e r 2. Patient S. was admitted to the clinic for the first time detected infiltrative tuberculosis of the upper lobe of the left lung in the disintegration phase, BK (+). The content of the fraction of low molecular weight substances in the dialysate of the blood serum upon admission is 52.4%.

Treatment was started with three drugs: ethambutol, rifamycin and ftivazid in moderate therapeutic doses. After 10 days, the content of the fraction of low molecular weight substances in the dialysate of the blood serum was 33.4%, and after 4 weeks it decreased to 9.2%. After 6 weeks from the start of antibiotic therapy, the patient developed an erythematous rash on the skin of the forearms and lower legs. In this case, a decrease in the content of the fraction of low molecular weight substances in the patient’s serum dialysate preceded the clinical manifestation of an allergic reaction to antibacterial therapy with these drugs.

Specific anti-tuberculosis

The treatment was supplemented with desensitizing agents (suprastin, calcium gluconate) for 4 weeks. This led to the disappearance of medicinal dermatosis and a significant improvement in well-being.

0 patient, as well as allowed to complete a course of antibacterial therapy in full, a control study of the dialysate content of the blood serum fraction of low molecular weight substances in a patient with a high blood pressure showed that its level was restored to 38.8%.

Example 3. Patient B. was admitted to the clinic for the first time diagnosed disseminated pulmonary tuberculosis in

0 phase decay, BC (+). The content of the fraction of low molecular weight substances in the dialysate of the blood serum upon receipt of 48.5%.

Started treatment with ftivazidom 0.5 x 3, 1.2 ethambutol once. After 2 non-

5%, the content of the fraction of low molecular weight substances in serum dialysate was 17.9%. After 9 weeks from the start of the course of antibiotic therapy, the patient developed headaches associated with

0 taking anti-TB drugs. The content of the fraction of low molecular weight substances in the dialysate of the blood serum was determined at the level of the sensitivity of the method of its detection (2%).

5 The presence of a toxic complication of antibacterial therapy was confirmed by the results of a study of the function of the hepatobiliary system: the time to achieve maximum accumulation of bengal rosus.

0 iodine lengthened to 35.10 minutes, the half blood purification period from the radiopharmaceutical was reduced to 18.05 minutes, the relative hepatic clearance decreased to 3.75%, the secretion index decreased

5 to 67.90%.

After a three-day break, treatment with these antibacterial drugs was resumed. Additionally, symptomatic remedies are prescribed,

0 including etymzol. The manifestations of a toxic side reaction to antibacterial therapy disappeared, which allowed it to continue in full. The content of the fraction of low molecular weight

5 substances in the serum dialysate at discharge of the patient 42.8%,

Example 4. Patient P. was admitted to the hospital for the first time diagnosed infiltrative pulmonary tuberculosis in the phase of disintegration, BC (+), Relative content

fractions of low molecular weight substances in the dialysate of the blood serum upon receipt of 56.6%.

Started treatment with ftivazidom 0.5 x 3 and ethambutol 1.2 times. After 5 weeks from the start of antibiotic therapy, the patient developed unpleasant sensations in the epigastric region, pain in the right hypochondrium. The relative content of the fraction of low molecular weight substances in the blood serum dialyate at this time decreased to 30.2%. The presence of a toxic complication of antibacterial therapy in a patient is confirmed by the following data from the study of the functional state of the hepatobiliary system: the time to achieve maximum accumulation of bengal rose i13135.20 min; the half-purification period for the isotope is 17.32 min; relative hepatic clearance of 3.68%; secretion index is 68.43%. After a three-day break and the appointment of symptomatic agents, treatment with antibacterial drugs was resumed. The manifestations of the toxic complication of anti-tuberculosis therapy disappeared. Relative

the content of low molecular weight fractions in serum dialysate after 2 weeks was 62.1%.

A total of 38 patients with tuberculosis were examined. During the course of chemotherapy, toxic and allergic reactions were predicted with an accuracy of 100%.

Claims (1)

Formula for gaining A method for predicting toxic and allergic complications in chemotherapy of tuberculosis by examining the tissue of the body, so that, in order to improve the accuracy of the method, the patient before and during the treatment period In serum dialysate chromatography, the quantitative content of the fraction of low molecular weight substances is determined with a molecular weight of 300 daltons and absorption maxima at 236 nm and 292 nm and with a decrease in the content of this fraction to 30.2% or less qualities predict the development of toxic and allergic complications.