ПОВЫШЕНИЕ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ БОЛЬНЫХ ОСТРОПРОГРЕССИРУЮЩИМ ИНФИЛЬТРАТИВНЫМ И ДИССЕМИНИРОВАННЫМ ТУБЕРКУЛЕЗОМ ЛЕГКИХ С ПОМОЩЬЮ КОРРЕКЦИИ СОДЕРЖАНИЯ НЕОПТЕРИНА И RANTES

Abstract

Objective: to improve effectiveness of treatment for acute progressive destructive infiltrative or disseminated pulmonary TB using individualized pathogenetic therapy based on neopterin and RANTES levels in blood serum. Materials and methods. We studied neopterin and RANTES levels in 36 patients with infiltrative or disseminated TB with lung cavities and acute progression at the time of diagnosis, 37 patients without signs of acute progression, and 30 healthy donors. Results. Neopterin and RANTES levels were higher in patients with signs of acute progression of destructive pulmonary TB; they were referred to diagnostic criteria for acute progressive course of TB at neopterin levels more than 26.5 nmol/L and RANTES levels more than 83 387 pg/mL. Low levels of neopterin (less than 9.6 nmol/L) were in patients with advanced acute progressive pulmonary TB and severe comorbidities; it was prognostically unfavourable as well as at RANTES levels more than 83 387 pg/mL. Neopterin and RANTES levels were decreasing at slow rates in patients with acute progression of TB at the time of diagnosis. Administration of gamma-D-glutamyl-tryptophan sodium to patients with high levels of neopterin and glutamyl-cysteinyl-glycine disodium to patients with low levels of neopterin fostered recovery of neopterin and RANTESlevels by the 6th month of treatment in patients with acute progressive TB; it correlated with positive treatment outcomes and cure within 24–36 months in 87% of patients vs 19% of patients, which did not receive personalized pathogenetic therapy. Conclusion. The study demonstrated effectiveness of individualized immunotherapy in the treatment for acute progressive pulmonary TB. Keywords: TB, neopterin, RANTES, acute progressive TB, immunotherapy