Condition of the proteolytic system in patients with tuberculous pleurisy

Abstract

Recently, extrapulmonary forms of tuberculosis are increasingly common, which are not related to the pulmonary system. The largest proportion of extrapulmonary forms is pleural tuberculosis. This disease in case of delayed therapy can lead to prolongation of a specific process as a various forms of pulmonary tuberculosis and its extrathoracic localization.Objective — investigate the condition of the proteolytic system on the example of neutrophil elastase (NE) in patients with acute and chronic form of tuberculous pleurisy, including when combined with pulmonary tuberculosis. Identify possible pathogeneticconnections between the level of neutrophil elastase and chronic tuberculous pleurisy.Materials and methods. We observed 45 patients with tuberculous pleurisy, the main manifestation of which was the syndrome of pleural effusion of different localization. Patients were divided into two groups. In Group I, 26 (57.7 %) patients with acute course of tuberculous pleurisy were involved, in Group II, 19 (42.2 %) patients with chronic tuberculous pleurisy. The study of the proteolytic system was carried out by determining the activity of neutrophil elastase in the blood serum by spectrophotometric method. The control group consisted of 16 individuals (12 men and 4 women) who did not have the disease at the time of the study. The elastase level in this group averaged 75.0 nmol/(min · mL), it was considered normal.Results and discussion. In patients with an acute process during hospitalization, the level of neutrophil elastase ranged from 62.5 to 309.8 nmol/(min · mL) (on average — (160.8 ± 18.2) nmol/(min · mL), that is exceeded the norm by 2.1 times (p < 0.05)), in patients with chronic tuberculous pleurisy — from 183.4 to 351.6 nmol/(min · mL) (on average — (255.5 ± 15.5) nmol/(min · mL), that is, exceeded the norm by 3.4 times (p < 0.05)). Comparison of neutrophil elastase in acute and chronic tuberculous pleurisy revealed that in patients with a chronic specific process, its content was 1.6 times higher (p < 0.05).Conclusions. Researchers allowthat a significant increase in the level of neutrophil elastase, during hospitalization of a sick person, with chronic tuberculosis pleurisy may be a manifestation of both stimulation of the patient’s defenses against the tuberculosis process in general, and stimulation of productive proliferative processes on the one hand. On the other hand, it may be a specific marker of tuberculous pleurisy and a sign of its chronicity, which is a direct indication for surgical intervention.