Імуномодулювальні особливості сучасних пробіотичних препаратів у комплексному лікуванні жінок репродуктивного віку з хламідійною інфекцією у нижньому відділі статевих органів

Abstract

The aim of the study: assessment of influence of complex treatment of chronic recurrent chlamydial cervical infection with probiotics of various forms of the use on the immune status and the vaginal microbiocenosis in women of reproductive age. Materials and methods. The study surveyed 87 women of age from 18 to 35 years, from which 67 patients of recurrent chlamydial cervicitis, which (according to the protocol) were eligible for inclusion. The control group included 20 gynecologicaly healthy women. All surveyed women were representative by age and data of the obstetric-gynecologic and somatic anamnesis. In accordance with the objectives of the study, all patients with chlamydia infection (CHI) before the appointment of therapy were randomized into two groups matched for age, symptoms and duration of the inflammatory process. The I (main) group included 35 patients who underwent complex therapy. Part of therapy included drugs Sumamed 250 mg (1 capsule) 1 time a day for 5-7 days according to the scheme: 1st day – 1 g (4 capsules) with the 2nd -3rd day – 500 mg per day (2 capsules) and 4th – 7th day – 250 mg per day (1 capsule). Topically applied combination of reparative, anti-inflammatory and antimicrobial drug Depantol in the form of suppositories – appointed standard one vaginal suppository twice a day for 10 days. Later was appointed eubiotic Lacto® 2 capsules 3 times a day during 3 weeks. The II group included 32 patients (comparison group) who underwent treatment involving Sumamed and Depantol, but with the subsequent appointment of local eubiotiks (1 vaginal suppository at night) – 10 days. Results. The results of the survey of women of reproductive age with chronic recurrent chlamydial cervicitis during colposcopic study found a high frequency of cervical pathologies, namely, inflammatory changes – 100%, ectopia prismatic epithelium – 32.8%, the true erosion – 19.4%, that in 5.9% cases was combined with leukoplakia, and dysplasia – 16.4%, which correlated with cytological examination (ASCUS – 68.6%, LSIL – 25.5%, HSIL and 2.9%). Most women with CHI noted deep violations of microbiocenosis of the vagina with a predominance of opportunistic pathogenic bacteria: Peptostreptococcus – in 43.3%, Corynebacterium – in 56.7%, epidermal staph in 65.7% and gardnerellas – in 74.6%, candida – in 46.3% of cases. Patients with CHI were stated a lack of interferon Genesis – reduction of IFN-a 1.4-fold and IFN-g – 1.8 times. Conclusion. The complex therapy of chronic recurrent chlamydial cervicitis in women of reproductive age was conducted by the developed algorithm with the inclusion of oral probiotic Lacto® contributed to the increase of parameters of nonspecific resistance of the organism in 88% of cases, which was reflected in the reduction of titers of specific IgM 1.4-fold, IgG – 1.8 times, raising the level of lysozyme in cervical mucus – 1.5 times and sIgA – 1.2 times, the restoration of cytokine profile and normalization of microbiocenosis of the vagina in 76.4% of women. Key words: probiotics, immunity, cytokines, T-lymphocytes, microbiocenosis, Saccharomyces, Bifidobacterium, antibiotic-associated diarrhea, chlamydial infection, efficiency.