UA69010A - Method for medical rehabilitation of women with chronic urogenital chlamydiosis - Google Patents

Abstract

The method for the medical rehabilitation of women with the chronic urogenital chlamydiosis comprises the use of Thymogen and Manax at the average therapeutic doses. In addition, Glutargin is used.

Description

Description of the invention

The invention relates to the field of medicine, namely to gynecology. 2 The relevance of the problem of the invention is due to the fact that at present chronic urogenital chlamydia (CHCH) is one of the most common sexually transmitted diseases. This is due to the fact that in the modern conditions of the environment and human life, with a significant spread of secondary immunodeficiency states, these diseases tend to grow, especially among women of childbearing age. Infections caused by chlamydia are the most common bacterial sexually transmitted diseases. 70 HCV is characterized by a significant number of long-term and recurrent forms, which is largely associated with the presence of resistant forms of chlamydia to existing antibacterial drugs, and, especially, with the development of immunodeficiency. Therefore, a special place after the treatment is occupied by the medical rehabilitation of patients with HCV.

There is a method of medical rehabilitation of women with HCV by repeated administration of antibacterial drugs, mainly antibiotics of the tetracycline series in courses of 2-3 weeks with intervals between the administration of drugs from 3 to 6 months (Chlamydia. Clinic, diagnostics, treatment // Methodical recommendations. - M., 1996. -20 p.).

However, this method is not effective enough, as it does not contribute to the normalization of immunity, and therefore secondary immunodeficiency states remain in women with HCV, which causes a high possibility of relapses of this disease.

There is also a well-known method of medical rehabilitation of women with HCV through the administration of thymus drugs, for example, thymalin or tactivin in repeated courses for 5-10 days in a row, with intervals between the administration of the drug from 3 to 6 months, which helps to increase immunity indicators (Skripkin Y.K., Pashinyan M. .G. Opiate treatment of patients with urogenital chlamydia // Obstetrics and Gynecology. -2000. -Mo2. -P. 50-52).

This method is also not effective enough, its drawback is that the thymus drugs must be injected for a long time in repeated courses, and this, in turn, increases the possibility of infection of patients with viruses "hepatitis B and C.

Therefore, a method of medical rehabilitation of women with CHD was proposed, in which the thymus drug - thymogen and the drug of plant origin - manax are administered (Declaratory patent Mo59725 A IPC AbIKZ5/78,

Ab1K35/26 - Ukraine. - Method of medical rehabilitation of women with chronic urogenital chlamydia. - o

Published on September 15, 2003. Bul. Mob). -

This method is the most effective of the existing ones, so it was chosen as a prototype. The shortcomings of the prototype include the fact that some patients relapse after treatment. at

The task of the invention was to increase the effectiveness of the existing method of medical rehabilitation of women with HCV and o) to reduce the likelihood of recurrence in the future.

This task is achieved by additional administration to women for the medical rehabilitation of women with HCV of the domestic drug glutargin, which helps to accelerate the elimination of manifestations of both infectious and so-called "metabolic" intoxication, and in clinical terms - ensures the achievement of long-term and full remission of the disease. Glutargin is a new domestic drug, which according to its chemical structure is a dipeptide of two amino acids: I-arginine and I-glutamic acid, which has antioxidant, hepatoprotective and detoxifying effects, normalizes protein, carbohydrate and lipid metabolism. An important mechanism of action of glutargin c is that it significantly reduces the level of ammonia, which it binds and converts into non-toxic substances - urea and glutamate, and also eliminates the syndrome of "metabolic" intoxication.

Our proposal regarding the additional inclusion of glutargin in the complex of medical rehabilitation of women with HCV is based on the pattern first established by us in experimental conditions and then confirmed in clinical conditions, which consists in the summation and mutual potentiation of the pharmacological action of thymogen, manax, and glutargin in their joint use introduction in terms of normalizing indicators of immunological homeostasis and restoration (Ce) of the functional activity of the liver parenchyma, which contributes to a significant increase in natural anti-infective resistance and prevents the activation of chlamydia in the presence of persistent infection, and in clinical terms contributes to a long-term full remission of the disease and prevention of the development of relapses of HCV. - 2 0 The clinical-pathogenetic effect of joint administration of thymogen, manax and glutargin significantly exceeds the simple summation of the effects of these drugs. Previously, glutargin was not used for the medical rehabilitation of women with HCV.

The claimed method is carried out as follows. After treatment and achieving an unstable remission of the disease, women suffering from HCV are prescribed a course of medical rehabilitation, which includes the administration of 59 thymus preparations - thymogen in medium therapeutic doses (10 Ωkg once a day intramuscularly) during 5-10 days in a row, manax inside 39mg twice a day for 20-30 days in a row and additionally glutargin 0.5-0.75g (2-3 tablets) inside 3 times a day for 15-20 days in a row. If necessary, courses of medical rehabilitation for HCV can be repeated 2-3 times a year. Our clinical experience shows that in most cases the achieved immunocorrective effect when using a combination of thymogen, manax and bo glutargin lasts for 5-6 months, and therefore it is enough to conduct 1-2 courses of medical rehabilitation during 1 year of dispensary supervision.

When developing the stated method of medical rehabilitation of women with CHD, we examined 2 groups of women aged 20-38 with this pathology, of which the main group - 47 women and the comparison group - 45 women. Both groups were randomized according to the duration of the disease, its severity and the frequency of relapses during the last year of dispensary supervision. The diagnosis of HCV was established according to the data of the anamnesis, clinical examination and was confirmed by the detection in the blood serum of women by the ELISA method of antibodies, class (YAM specific to the causative agent of chlamydia, in diagnostically significant titers.

The dynamics of clinical and some laboratory parameters were studied in all examined patients in both groups. At the same time, it was established that before the start of treatment, the same clinical symptoms were observed in both groups, namely, general weakness, malaise, low-grade fever, dysuric manifestations, pain in the lower abdomen. During the gynecological examination, the presence of edema and hyperemia of the cervix and discharge of a mucous or muco-purulent nature from the cervical canal was established in the examined patients.

The main group of women was treated using the claimed method (with additional administration of glutargin), and the 7/0 comparison group - using the known prototype method (without the use of glutargin).

As a result of clinical observations, it was established that the inclusion of glutargin in the complex of medical rehabilitation of women with CHD ensures the acceleration of the normalization of the clinical condition of patients, the faster achievement of stable clinical remission, and the reduction of the number of relapses of the disease in comparison with patients of the comparison group. Indeed, pain in the lower abdomen in women of the main group disappeared on average 4,150.2 days earlier, dysuric manifestations - by 3,540.2 days, general weakness - by 3.2-0.2 days, malaise - by 3.4x0.2 days , increased fatigue - by 3.4-40.15 days, low-grade fever - by 4.9-0.25 days earlier than in patients of the comparison group (Р«0.05) (table 1). » rehabilitation of women with chronic obstructive pulmonary disease according to clinical indicators (Met) 11110101 klinichnipokavnii 0 Main group (p-47) Comparison group (p45)| R - y " about zo - about 91.5x396 77,822,596 Ge")

The duration of preservation of swelling and hyperemia of the cervix was reduced when using the declared x-ray method by 5.5-40.3 days, secretions from the cervical canal - by 6.7-0.3 days (Р«0.05). In general, clinical remission in sick women of the main group was achieved in 6.9:0.3 days, that is, 1.9 times earlier than in women in the comparison group (P «0.01). According to the data of dispensary supervision during 1 year, in the main group, 43 women (91.55390) achieved long-term full remission, while in the comparison group - 35 women (77.8x2.590).

Therefore, the inclusion of glutargin in the complex of medical rehabilitation of women with HCV contributes to the acceleration of the achievement of stable clinical remission of the disease and increases the number of women with full clinical remission of the disease lasting one year or more. The influence of glutargin on the dynamics of some immunological indicators in medical rehabilitation was also studied (table 2). Before the start of treatment in both groups, there were similar shifts in immunological indicators, which were characterized by T-lymphopenia (a decrease in the total number of 15 CsOoZ'-lymphocytes), a decrease in the number of СО4 "cells and a decrease in the СО4/СО8 ratio, an increase

Ц concentration of CYC in blood serum (see Table 2). se) and - 50 rehabilitation of women with HCV on some immunological indicators (Met) "munological indicators Norm. (Main corpse (pat Group of comparison 1-45) R. "2 so3 9 69.22 BOB 17 BT and weight Bo 16 50, 05 sora 9 4B, bzh1.6 З0.3 1.3 З0.5 14 20.1 59 452 from "оо в" sov 9 22510 20.5 -10 20.7 10 50 22310 lav hol sryusov 2,050,05 140 - 003 142 50.03 »01 in 1965 0.04 151003 0.01

CIC, g/l 1.88:0.05 311-011 Zp OT »01 tat p0o8 283 DOV ho 65 in the denominator - for 28-30 days from the beginning of medical rehabilitation;

P was calculated between the baseline and comparison group scores

After the completion of the course of medical rehabilitation, sick women of the main group, who received the declared method of medical rehabilitation with the help of glutargin, noted a clear positive dynamics of the studied laboratory indicators, namely, the elimination of T-lymphopenia, an increase to the norm in the number of T-helpers (СО4-) and immunoregulatory of the ХОО4/СО8 index, a decrease in the CIC level to the upper limit of the norm.

In the comparison group, which received medical rehabilitation according to the known prototype method, the positive dynamics of the studied indicators was significantly less. Therefore, T-lymphopenia, a decrease in the number of circulating T-helpers (СО45), and the immunoregulatory index of srasov remained in the majority of sick women in this group of patients, and the concentration of CYC was probably increased. So, the declared method of medical rehabilitation of women with HCV is pathogenetically justified, since its use helps to eliminate secondary immunodeficiency.

Thus, the use of the declared method of medical rehabilitation of women with HCV is clinically effective and pathogenetically justified, as it contributes to the normalization of clinical and immunological indicators. The use of glutargin does not cause unwanted side effects, it is well tolerated by patients. The conditional economic effect of the declared method of medical rehabilitation of women with CHD amounted to about UAH 182. for 1 woman. Clinical experience has shown that the use of glutargin has no contraindications, it is well tolerated and does not cause any side effects, including allergic reactions, so it can be recommended for widespread use in gynecological practice.

Example 1

Patient N., 32 years old, has been suffering from HCV for the past 7 years, and has been examined many times on an outpatient basis and in a hospital. He complains of general weakness, malaise, increased fatigue, low fever, dysuric manifestations, pain in the lower abdomen, discharge from the genital tract. During examination in mirrors, swelling of the vaginal part of the cervix, hyperemia around the external uterine opening, and serous-purulent secretions from the cervical canal were found. Antibodies to chlamydia in diagnostically significant titers were detected in the patient's blood serum using the ELISA method and the diagnosis of chlamydia was confirmed. The patient underwent a course of treatment according to the generally accepted method. Then medical rehabilitation was prescribed in accordance with the "claimed method", namely the introduction of the thymus drug - thymogen in medium therapeutic doses (10 Ωmg once a day intramuscularly) for 5 consecutive days, manax inside 9 Ωg 2 times a day for 20 consecutive days and additionally glutargin inside 0.5 g (2 tablets) 3 times a day for 15 days in a row. Under the influence of the prescribed medical rehabilitation, both the general condition of the patient and her well-being gradually improved. Indeed, the pain in the lower abdomen disappeared on the 5th day from the beginning of medical rehabilitation, dysuric manifestations - on - b day, general weakness - on the 4th day, malaise - also on the 4th day, increased fatigue - on the 5th day, o subfebrility - on the 6th day, swelling and hyperemia of the cervix - for 7 days, discharge from the cervical canal - for 8 days, the time to achieve clinical remission was 8 days. Gee)

During the laboratory examination of patient N., it was established that before the start of the course of medical rehabilitation, she had T-lymphopenia (5195 CSO), a decrease in the number of T-helpers (3296 СО45), as well as the СО4/СО8 ratio (1.51 ), an increase in the level of CIC (2.87g/l). After the completion of the medical rehabilitation course, the number of HCV cells increased to 6,795, CO4 increased to 4,595, and the immunoregulatory index of SOA/SOV increased to 1.91. At the same time, the concentration of CIC decreased to 2.05 g/l. Dispensary supervision for 1 year after the "rehabilitation" course made it possible to establish the patient's satisfactory state and well-being, there were no complaints from the genitourinary system. c Example 2 :c» Patient A., 29 years old, has been suffering from HCV for 10 years. He complains of general weakness, malaise, periodically occurring pain in the lower abdomen, discharge from the cervical canal, frequent and painful urination. It is known from the anamnesis that the patient was treated for a long time in a gynecological hospital for cervical erosion,

FU 15, however, the treatment had no effect. During the examination, it was found that the cervix is swollen, there is erosion on the front lip of the cervix, muco-purulent discharge from the cervical canal. (Se) Patient A. underwent a clinical and laboratory examination, during which an increase in the level of specific antibodies to chlamydia in blood serum was determined by the ELISA method, which allowed to confirm the diagnosis of urogenital chlamydia. - After the completion of the generally accepted treatment, a set of rehabilitation measures was carried out in accordance with the declared method, namely, the administration of the thymus preparation - thymogen in medium therapeutic doses (10 Ωmg once a day) for 10 consecutive days, Manax inside 9 Ωg 2 times a day for 3 consecutive days and additionally glutargin 0.75 g (Z tablet) internally Z times a day for 20 days in a row.

Under the influence of the prescribed medical rehabilitation, the patient's general condition and well-being improved. Pain in the lower abdomen 59 disappeared on the 6th day from the beginning of medical rehabilitation, dysuric manifestations - on the 5th day, the general in. weakness - for the 4th day, malaise and increased fatigue - for the 5th day, low fever - for the 6th day, swelling and hyperemia of the cervix - for the 7th day, discharge from the cervical canal - for the 8th day, the time to achieve clinical remission was 8 days.

During the laboratory examination of patient A., it was established that before the beginning of the course of medical rehabilitation, the patient had significant changes in the immune system, namely T-lymphopenia (5090

COSx), a decrease in the number of T-helpers (3096 СО4), as well as the СО4/СО8 ratio (1.52), an increase in the level of CIC (2.77g/l). After the completion of the medical rehabilitation course, the number of SOZh cells increased to 6995, SOJ - to 4590, therefore the immunoregulatory index СО4/СО8 increased to 1.96, that is, to the norm. At the same time concentration

CIC decreased to 2.07 g/l. Dispensary supervision within 1 year after the medical rehabilitation allowed 65 to establish the patient's satisfactory condition and well-being, there were no complaints from the genitourinary system.

Thus, the declared method of medical rehabilitation of women with HCV has significant advantages over the known prototype method. It is useful for medical practice, the use of glutargin has no contraindications, the drug is well tolerated and does not cause any side effects, including allergic reactions, therefore

Can be recommended for widespread use in gynecological practice.

Claims (2)

Formula of the invention 70 1. The method of medical rehabilitation of women with chronic urogenital chlamydia, which includes the administration of thymogen and manax in medium therapeutic doses, which differs in that glutargin is additionally administered. 2. The method according to claim 1, which is characterized by the fact that glutargin is administered internally in 0.5-0.75 g (2-3 tablets) times a day for 15-20 days in a row. Official bulletin "Industrial Property". Book 1 "Inventions, useful models, topographies of integrated microcircuits", 2004, M 8, 15.08.2004. State Department of Intellectual Property of the Ministry of Education and Science of Ukraine. « «c) «- «c) (o) (Se) - with . and? (o) se) («c) - 50 (42) 60 b5