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CNAA / Theses / 2005 / July /

Clinical and biochemical research of the level of intoxication in patients with lung tuberculosis and nontuberculosis lung diseases


Author: Adriana Niguleanu
Degree:doctor of medicine
Speciality: 14.00.26 - Phtisiopneumology
Year:2005
Scientific adviser: Valeriu Djugostran
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Phthisiopneumology "Chiril Draganiuc"
Scientific consultant: Serghei Ghindă
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Phthisiopneumology "Chiril Draganiuc"
Institution:
Scientific council:

Status

The thesis was presented on the 5 July, 2005
Approved by NCAA on the 22 September, 2005

Abstract

Adobe PDF document0.40 Mb / in romanian

Thesis

CZU 616-002.5/-059:612.017.1:577.1/07

Adobe PDF document 1.27 Mb / in romanian
116 pages


Keywords

lung tuberculosis, nonspecific lung diseases, endogen intoxication, middle molecules, leucocytar indexes of intoxication, natural resistence and immunoreactivity, phagocytic activity of leucocytes, treatment

Summary

This prospective study is based on a dynamic and complex (clinical, biochemical, immunological, X-ray and instrumental) research the peculiarities of the syndrom of endogen intoxication of 422 patients with different clinical forms of lung tuberculosis and nonspecific lung diseases from 17 to 69 years old. The comparison group is composed of 71 practically healthy persons.

The available for all medical establishments improved method of EI essessment by means of spectrophotometrical determination of middle molecules in biological liquids and the simplified integral index of intoxication (area under the spectrophotometrical curb) have been perfected and applied into practice. This objective quantitative method is more sensible compared to leucocytes indices of intoxication and other clinical and laboratory indices.

The administration of Izoniazid by standard DOTS program (the refference group) was substituted by indirect endolymphatic introduction (the main group). The monitoring of intoxication parameters showed the decrease of the concentration of middle molecules in patients with infiltrative lung tuberculosis in both groups, but it stays above the physiological indices. Thus on the ending of the intensive therapy the intoxication persists. This data proves the necessity of modification at the stage of intensive treatment of the standard therapy by means of detoxication methods: for example – enterabsorbtion method, as the most available and pathogenetically well grounded.

The application of the treatment with lymphotropical introduction of Isoniazid in infiltrative lung tuberculosis (main group) ensures a more vivid therapeutical effect. It was stated that the frequency of full resorbtion of infiltration and disappearance of distruction cavities without residual fibrous alterations significantly increases. The present result is obtained due to sanation of lymphatic structures and improvement of humoral transport in the affected zone.

When analyzing the obtained results of the area and extentions of middle molecules in patients with tuberculosis and non-tuberculosis, lungs the possibility of the differential diagnosis of these pathologies was not revieled. Thus, the specificitation of the studied test is low, while the sensificity of the test is vivid. But, the authentical difference of data in patients with bronchial asthma and bronchitis has been established. More, in bronchial asthma the level of middle molecules is extremely high, fact which indicates to the necessity of the intensive detoxicative therapy.

The modifications of the immune reactivity and natural resistance correspond to various levels of EI in patients with lung tuberculosis. The low level of middle molecules correspond to normal indices of the immune reactivity and natural resistance, the middle level (21,5 u.c.) – to the activation and the high level of middle molecules (25,2 u.c.) - to the oppression of these protective forces of organism.

On the basis of correlative and regressional comparison of MM and immunological data the equations for determination of RBTL, phagocitar number were proposed with the precision of 0,2%-2,4%.