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Clinical Case of Pulmonary Hypertension Secondary to Chronic Obstructive Pulmonary Disease in the Patient with History of Pulmonary Tuberculosis 有肺结核病史的患者继发于慢性阻塞性肺病的肺动脉高压临床病例
Q4 Medicine Pub Date : 2023-12-24 DOI: 10.58838/2075-1230-2023-101-5-64-68
M. Moiseeva, N. V. Bagisheva, I. Viktorova, A. Mordyk
The article describes the follow-up over a clinical case of the patient with COPD, pulmonary hypertension (PH), and history of pulmonary tuberculosis. According to the guidelines, treatment of the patient with PH which developed due to bronchopulmonary pathology was focused on constant bronchodilator therapy to reduce hypoxemia and to achieve additional vasodilating effect on vessels of the pulmonary circulation, as well as on non-invasive high-flow oxygen therapy which inhibited the progression of PH (it prevented mortality).
文章介绍了对一名患有慢性阻塞性肺病、肺动脉高压(PH)和肺结核病史的患者的临床随访情况。根据指南,对因支气管肺部病变而出现 PH 的患者的治疗重点是持续使用支气管扩张剂治疗,以降低低氧血症,并对肺循环血管产生额外的血管扩张作用,同时使用无创高流量氧气治疗,以抑制 PH 的发展(防止死亡)。
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引用次数: 0
Efficacy of Various Approaches to Treatment of Patients with Isoniazid Resistant Pulmonary Tuberculosis 治疗耐异烟肼肺结核患者的各种方法的疗效
Q4 Medicine Pub Date : 2023-12-24 DOI: 10.58838/2075-1230-2023-101-5-26-30
I. Burmistrova, E. Vaniev, A. Samoylova, O. Lovacheva, I. A. Vasilyeva
The objective: to evaluate the efficacy of chemotherapy regimens for isoniazid resistant pulmonary tuberculosis (Hr-TB): short-course regimen consisting of 4 components (non-injection) and the regimen consisting of 5 components (standard regimen).Subjects and Methods. Medical records of 292 pulmonary tuberculosis patients with resistance to isoniazid were retrospectively studied. In 89 patients (Group A), the regimen containing rifampicin, pyrazinamide, ethambutol, and levofloxacin was used – a 4-component non-injection regimen (180±20 doses). In 203 patients (Group B), the regimen containing rifampicin, pyrazinamide, ethambutol, levofloxacin, and amikacin/kanamycin was used - a 5-component standard regimen (270 doses).Results. The efficacy of treatment of isoniazid resistant pulmonary tuberculosis was similar, while a short-term 4-component (non-injection) regimen is 4.5 times less expensive versus the standard 5-component regimen. Treatment success made 88.8% and 88.2% respectively, p>0.05.
目的:评估异烟肼耐药肺结核(Hr-TB)化疗方案的疗效:由4种成分组成的短程方案(非注射)和由5种成分组成的方案(标准方案)。对 292 名对异烟肼耐药的肺结核患者的病历进行了回顾性研究。89名患者(A组)采用了包含利福平、吡嗪酰胺、乙胺丁醇和左氧氟沙星的疗法--4种成分的非注射疗法(180±20次)。在 203 名患者(B 组)中,采用了包含利福平、吡嗪酰胺、乙胺丁醇、左氧氟沙星和阿米卡星/卡那霉素的 5 组标准方案(270 剂)。耐异烟肼肺结核的疗效相似,而短期 4 组分(非注射)疗法的费用是标准 5 组分疗法的 4.5 倍。治疗成功率分别为88.8%和88.2%,P>0.05。
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引用次数: 0
Tolerability of Tuberculosis Chemotherapy in Children 儿童结核病化疗的耐受性
Q4 Medicine Pub Date : 2023-12-24 DOI: 10.58838/2075-1230-2023-101-5-69-76
M. Lozovskaya, I. Y. Motov, G. A. Novik
The article presents the review of 61 publications. The topic is highly relevant due to the fact that clinical trials of drugs and chemotherapy regimens usually enroll adults, while children participate only in a small number of them. Often in clinical practice, anti-tuberculosis drugs are prescribed to children off-label. The frequency of adverse reactions in children varies widely depending on approaches to their reporting. The most severe and frequent adverse events are associated with liver injury. In recent years, clinical trials of fluoroquinolones, bedaquiline, and delamanid were run in pediatric patients with drug resistant tuberculosis demonstrating satisfactory tolerability and safety of these drugs.
文章对 61 篇出版物进行了综述。由于药物和化疗方案的临床试验通常以成人为对象,而儿童只参与其中的一小部分,因此该主题具有高度相关性。在临床实践中,抗结核药物经常在标签外开具给儿童。儿童出现不良反应的频率因报告方式不同而有很大差异。最严重和最常见的不良反应与肝损伤有关。近年来,在耐药性结核病儿童患者中开展了氟喹诺酮类、贝达喹啉和地拉那米的临床试验,结果表明这些药物的耐受性和安全性令人满意。
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引用次数: 0
Specific Features of Pulmonary Tuberculosis Patients Treatment with Interferon-Gamma Depending on the Nature of the Tissue Inflammatory Reaction 根据组织炎症反应的性质使用干扰素-γ 治疗肺结核患者的具体特征
Q4 Medicine Pub Date : 2023-12-24 DOI: 10.58838/2075-1230-2023-101-5-51-58
I. F. Shlyk, D. Kudlay, E. Kampos, N. Nikolenko, I. M. Franchuk
The objective: to evaluate effectiveness of treatment of infiltrative pulmonary tuberculosis patients with exudative or productive types of the tissue inflammatory reaction when additional immunotherapy with recombinant IFN-γ is used.Subjects and Methods. 127 infiltrative tuberculosis patients were enrolled in the study, of them 66 had an exudative type of the inflammatory reaction (2 Groups OG-1 and GS-1 were formed), 61 had a proliferative type (2 Groups OG-2 and GS-2 were formed). Patients from OG-1 and OG-2 Groups additionally received different regimens with recombinant interferon-γ.Result: Comprehensive treatment of infiltrative tuberculosis including intramuscular administration (according to a certain regimen) of recombinant IFN-γ contributes to achievement of pronounced positive changes of clinical and radiological symptoms in patients with both exudative and productive types of the tissue inflammatory reaction. In the groups treated with recombinant IFN-γ, restoration of the cellular immune response, cellular cooperation, normalization of the cytokine profile and increased phagocytosis activity were confirmed by the results of laboratory tests.
目的:评估在使用重组 IFN-γ 进行额外免疫治疗时,对具有渗出型或增殖型组织炎症反应的浸润性肺结核患者的治疗效果。研究共纳入了 127 名浸润型肺结核患者,其中 66 名患者属于渗出型炎症反应(分为 OG-1 和 GS-1 两组),61 名患者属于增殖型炎症反应(分为 OG-2 和 GS-2 两组)。OG-1组和OG-2组的患者还接受了重组干扰素-γ的不同治疗方案:结果:浸润性肺结核的综合治疗,包括肌肉注射重组 IFN-γ(按照一定的方案),有助于渗出型和生产型组织炎症反应患者的临床和放射学症状发生明显的积极变化。在接受重组 IFN-γ 治疗的组别中,细胞免疫反应的恢复、细胞间的合作、细胞因子谱的正常化以及吞噬活性的增强均得到实验室检测结果的证实。
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引用次数: 0
The Role of IL-23 in the Development of Th17 Lymphocytes in Pulmonary Tuberculosis Patients IL-23 在肺结核患者 Th17 淋巴细胞发育中的作用
Q4 Medicine Pub Date : 2023-12-24 DOI: 10.58838/2075-1230-2023-101-5-45-50
T. Kononova, O. Urazova, V. Serebryakova, S. Chumakova, O. A. Vasilyeva, A. E. Sanina
The objective: to evaluate the role of IL-23 in the development of Th17 lymphocytes in patients with different clinical and pathogenetic forms of pulmonary tuberculosis.Subjects and Methods. 165 pulmonary tuberculosis patients were examined. Venous blood was used for tests. Mononuclear leukocytes were isolated by centrifugation and monocytes were extracted and transformed into dendritic cells. The concentration of IL-23 in the supernatants of culture suspensions of dendritic cells was determined by ELISA. Immunophenotyping of Th17 lymphocytes (CD4+CD161+IL-17A+ cells) was performed by flow cytometry. Real-time PCR was used to determine the expression of the RORC2 transcription factor gene in lymphocytes.Results. In patients with infiltrative drug susceptible and drug resistant pulmonary tuberculosis against the background of normal production of IL-23 by dendritic cells, an increase in blood level of Th17 lymphocytes and the level of mRNA of the RORC2 transcription factor gene was registered. The course of disseminated pulmonary tuberculosis (regardless of drug susceptibility and resistance) is associated with pronounced decrease in the concentration of IL-23 in vitro and the absence of response from Th17 lymphocytes.
目的:评估IL-23在不同临床和发病形式的肺结核患者Th17淋巴细胞发育过程中的作用。165 名肺结核患者接受了检查。检测采用静脉血。离心分离单核白细胞,提取单核细胞并将其转化为树突状细胞。树突状细胞悬浮培养液上清液中的 IL-23 浓度由 ELISA 法测定。通过流式细胞术对 Th17 淋巴细胞(CD4+CD161+IL-17A+ 细胞)进行免疫分型。采用实时 PCR 检测淋巴细胞中 RORC2 转录因子基因的表达。在树突状细胞正常产生 IL-23 的背景下,浸润性易感和耐药肺结核患者血液中 Th17 淋巴细胞水平和 RORC2 转录因子基因 mRNA 水平均有所上升。播散性肺结核的病程(不论对药物的敏感性和耐药性)与体外 IL-23 浓度的明显降低和 Th17 淋巴细胞无反应有关。
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引用次数: 0
Many years of experience of spontaneous pneumothorax treatment within one medical center 一个医疗中心多年来治疗自发性气胸的经验
Q4 Medicine Pub Date : 2023-12-24 DOI: 10.58838/2075-1230-2023-101-5-20-25
A. V. Mikheev, S. N. Trushin
The objective: to analyze results of surgical treatment of the patients with spontaneous pneumothorax.Subjects and Methods. Medical records of patients with spontaneous pneumothorax (SP) who were treated in Surgical Thoracic Department of Ryazan Regional Clinical Hospital from 1998 to 2021 were retrospectively analyzed. The article describes the experience of treatment of 738 cases of spontaneous pneumothorax within one medical center. The evolution of tactics and principles of surgical treatment over a 23-year period is presented. The incidence of spontaneous pneumothorax and efficacy of different surgical options were analyzed. The recurrence of spontaneous pneumothorax was recorded in the following cases: after pleural cavity drainage – in 19.7%, after videothoracoscopic resection of bullous parts of the lung in combination with subtotal parietal pleurectomy – in 2.1%.
目的:分析自发性气胸患者的手术治疗结果。回顾性分析了 1998 年至 2021 年在梁赞地区临床医院胸外科接受治疗的自发性气胸(SP)患者的病历。文章介绍了一家医疗中心治疗 738 例自发性气胸的经验。文章介绍了 23 年间手术治疗策略和原则的演变。分析了自发性气胸的发病率和不同手术方案的疗效。自发性气胸复发的病例如下:胸膜腔引流术后--19.7%,视频胸腔镜肺大泡切除术联合胸膜旁次全切除术后--2.1%。
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引用次数: 0
Long-term Follow-up of Family Nidus of Tuberculosis Infection 肺结核家庭感染巢的长期随访
Q4 Medicine Pub Date : 2023-12-24 DOI: 10.58838/2075-1230-2023-101-5-59-63
A. V. Kukurika, L. Parolina
The article presents a long-term follow-up of a family nidus of tuberculosis infection demonstrating the incidence among adult contacts including 6 years after taking off the register of dispensary follow-up.
文章介绍了对一个结核病家庭感染源的长期跟踪调查,结果显示了成人接触者的发病率,包括从诊疗所跟踪登记册中删除 6 年后的情况。
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引用次数: 0
Inhalation Surfactant Therapy within Comprehensive Treatment of HIV-Infected Patients with Multiple Drug Resistant Tuberculosis 吸入表面活性剂在hiv感染合并多重耐药结核病患者综合治疗中的应用
Q4 Medicine Pub Date : 2023-10-27 DOI: 10.58838/2075-1230-2023-101-1s-32-38
E. M. Zhukova, N. V. Stavitskaya, E. Yu. Pushkareva, O. A. Smolentseva
The objective: to evaluate the main eff ects of surfactant inhalations during the intensive phase of chemotherapy with the regimen containing bedaquiline and linezolid in HIV-infected patients with multiple drug resistant tuberculosis. Subjects and Methods. A single-center, open-label, controlled prospective cohort study was conducted. 80 patients with MDR-TB/HIV were enrolled in the study and randomized into two groups: ST+ Group included 40 patients who in addition to anti-tuberculosis therapy containing bedaquiline and linezolid during the intensive phase received inhalation of the suspension of Surfactant-BL according to a certain regimen. The course of 28 inhalations took 2 months, the total dose of surfactant was 700 mg. ST- Group included 40 patients who received anti-tuberculosis therapy only. To assess the severity of respiratory symptoms in patients, we used our own scoring. All patients also received antiretroviral therapy. Results. In the ST+ Group versus ST- Group, there was a decrease in the severity of tuberculosis clinical manifestations and timing of their relief, higher frequency of cavity healing by 21.2%, and faster sputum conversion by 28.6%. These rates are higher than in ST- Group and this is a short period of 10 weeks. None of the patients developed adverse reactions to surfactant inhalations. Patients tolerated well the combination of surfactant therapy, MDR TB chemotherapy containing bedaquiline and linezolid, and ART.
目的:评价表面活性剂吸入对hiv感染合并多重耐药结核病患者在贝达喹啉和利奈唑胺联合化疗强化期的主要作用。研究对象和方法。进行了一项单中心、开放标签、对照前瞻性队列研究。80例MDR-TB/HIV患者被纳入研究,随机分为两组:ST+组40例患者在强化期除贝达喹啉和利奈唑胺抗结核治疗外,按一定的方案吸入surfactanet - bl悬浮液。28次吸入疗程2个月,表面活性剂总剂量为700 mg。ST组包括40例仅接受抗结核治疗的患者。为了评估患者呼吸道症状的严重程度,我们使用了自己的评分方法。所有患者还接受了抗逆转录病毒治疗。结果。与ST-组相比,ST+组结核病临床表现的严重程度和缓解时间有所降低,腔愈合频率高21.2%,痰转化速度快28.6%。这些比率高于ST组,这是10周的短时间。所有患者均未出现吸入表面活性剂的不良反应。表面活性剂治疗、含贝达喹啉和利奈唑胺的耐多药结核病化疗以及抗逆转录病毒治疗联合用药耐受性良好。
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引用次数: 0
Immediate and postponed results of resection interventions in pulmonary tuberculosis patients with local inflammatory changes in the bronchial tree 支气管树局部炎症改变的肺结核患者的即时和延迟切除干预的结果
Q4 Medicine Pub Date : 2023-10-27 DOI: 10.58838/2075-1230-2023-101-1s-26-31
Zh. A. Laushkina, S. V. Sklyuev, D. V. Krasnov, D. A. Skvortsov, N. V. Stavitskaya
The objective: to study the frequency and nature of postoperative complications, immediate and postponed results of resection interventions in pulmonary tuberculosis patients depending on the presence and pathomorphological parameters of local infl ammatory changes in the bronchial tree. Subjects and Methods. 147 pulmonary tuberculosis patients who underwent pulmonary resection were enrolled in the prospective cohort study. Main Group ( n =49) included patients with local infl ammatory changes in the bronchi before surgery; Comparison Group ( n =98) included patients with no infl ammatory changes in the bronchi. Results. The presence of local infl ammatory changes in the bronchial tree detected by bronchoscopy, did not have a signifi cant impact on the development of complications during surgical treatment - neither on their number nor on structure. The incidence of complications of resection interventions depends on severity of tuberculosis lesions in the lung.
目的:研究支气管树局部炎性改变的存在和病理形态学参数对肺结核患者术后并发症的发生频率和性质、切除干预的即时和延迟结果的影响。研究对象和方法:147例接受肺切除术的肺结核患者被纳入前瞻性队列研究。主组(n =49)为术前支气管局部炎性改变患者;对照组(n =98)为支气管无炎性改变的患者。结果。支气管镜检查发现支气管树存在局部炎性改变,对手术治疗期间并发症的发生没有显著影响——无论是在数量上还是在结构上。手术并发症的发生率取决于肺结核病变的严重程度。
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引用次数: 0
Evaluation of effectiveness of transcranial mesodiencephalic modulation within comprehensive treatment of pulmonary tuberculosis patients with various comorbidities 经颅中间脑调节综合治疗多种合并症肺结核的疗效评价
Q4 Medicine Pub Date : 2023-10-27 DOI: 10.58838/2075-1230-2023-101-1s-39-44
O. A. Serov, O. A. Smolentseva
The objective: to study the impact of transcranial mesodiencephalic modulation on eff ectiveness of comprehensive treatment of pulmonary tuberculosis patients with various comorbidities. Subjects and Methods. 48 patients who received standard regimens of anti-tuberculosis chemotherapy participated in the study; the patients were divided into two groups. In Group 1, patients additionally underwent sessions of mesodiencephalic modulation (MDM), while in Group 2, no MDM was administered. Results. Two months after the start of the study, in Group 1, positive radiological changes were recorded more often – in 91,7% (22/24), in Group 2, positive changes were observed in 62,5% (15/24) of patients ( p =0,047; χ2); the same pattern was observed with positive changes of laboratory rates – 91,7% (22/24) versus 66,7% (16/24), ( p =0,033; χ2), respectively. In patients of Group 1 compared to Group 2, symptoms of tuberculosis and comorbid conditions fully disappeared or became less intensive in 79,2% (19/24) versus 41,7% (10/24), ( p =0,009; χ2). In Group 1, adverse drug reactions were registered in 16,7% (4/24), in Group 2 – 43,5% (10/24), ( p =0,05; χ2).
目的:探讨经颅中间脑调节对合并多种合并症肺结核患者综合治疗效果的影响。对象与方法:48例接受标准抗结核化疗方案的患者参与研究;患者被分为两组。在组1中,患者额外进行了中间脑调节(MDM)治疗,而在组2中,不进行MDM治疗。结果。在研究开始两个月后,在第1组中,阳性放射学改变记录的频率更高,为91.7%(22/24),在第2组中,62.5%(15/24)的患者观察到阳性变化(p =0,047;χ2);在实验室检出率的阳性变化中观察到相同的模式- 91.7%(22/24)对66.7% (16/24),(p = 0.033;分别χ2)。与第2组相比,第1组患者的结核病症状和合并症完全消失或减轻的比例分别为79.2%(19/24)和41.7% (10/24),(p =0,009;χ2)。1组药物不良反应发生率为16.7%(4/24),2组为43.5%(10/24),差异有统计学意义(p = 0.05;χ2)。
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引用次数: 0
期刊
Tuberculosis and Lung Diseases
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