Clinical approval of intra-peritoneal instilation of recombinant human granulocyte colony-stimulating factor for the treatment of acute peritonitis

Abstract

To conduct a preliminary evaluation of the clinical use of recombinant human granulocyte colony-stimulating factor (G-CSF) for the treatment of acute peritonitis (AP).Material and methods. 20 patients. The causes of AP were perforated gastroduodenal ulcers – 7, colon perforation – 7, acute appendicitis – 3, small bowel perforation – 2, one case each of mesenteric thrombosis and uterine perforation. Diffuse AP was detected in 4 (20%) patients, generalized – in 16 (80%). The 1st, control, group and the 2nd, experimental groupб included 10 patients each. Similar basic treatment was used in both groups. Patients of the 2nd group at the end of the operation were injected intraperitoneally with a solution of G-CSF with 0.9% NaCl (5 μg/1 ml) at a dose of 10 μg per 1 kg of body weight. After the operation, the amount of glucose (AG), creatinine (AC) in blood plasma, prothrombin index (PI), nuclear index (NI), stress index (SI), leukocyte intoxication index (LII), neutrophil-lymphocyte index (NLI), neutrophil-mononuclear index (NMI), lymphocyte-monocyte index (LMI), immunological reactivity index (IRI).The results. NI in the 2nd group increased after a day (p<0.01), then prevailed almost all the time. SI after a day in both groups was almost not different. On the 3rd day, the SI in the 1st group significantly increased, and in the 2nd group, it decreased. Later there were opposite changes. After a day, LII decreased in both groups. After 3 days, LII decreased in the 1st group (p<0.05). In the 2nd group, after 3 days, LII increased significantly (p<0.01) and decreased after 7 days. NLI indicators changed similarly. In the 1st group, NMI significantly (p<0.05) decreased after 3 days and remained low. NMI significantly prevailed in the 2nd group, increased (p<0.01) after 5 days. In the 1st group, LMI decreased all the time. In the 2nd group, LMI increased (p<0.01) after 2 days, decreased after 3 days, and increased (p<0.05) after 5 days. IRI in the 1st group, after it increased for 3-5 days, then decreased. In the 2nd group, IRI changed like LMI. AG in the 1st group prevailed all the time. In the 1st group, AC increased for 5 days, in the 2nd group - it constantly decreased. PI in the 1st group decreased for 5 days, in the 2nd group it normalized after 3 days, then increased.Conclusions. 1. According to the complex of integral evaluation criteria, in patients with AP who underwent intraperitoneal instillation of G-CSF solution, signs of adequate functioning of cellular components of immune protection were found after the operation. 2. According to the complex of biochemical criteria, signs of an early reduction in the manifestations of intoxication and recovery of kidney and liver function were found in such patients. 3. The results of clinical approbation indicate the possibility and perspective of using this method of treatment for patients with AP.