PREBIOTICS AND NUTRITIONAL CORRECTION IN INTEGRATED THERAPY OF PATIENTS WITH PULMONARY TUBERCULOSIS AND COMORBID PROTEIN METABOLIC DISORDERS

Abstract

The purpose of the work is to study the effectiveness of prebiotics and nutritional correction as components of the integrated therapy of patients with pulmonary tuberculosis and protein metabolic disorders. 67 patients with pulmonary tuberculosis were examined and then divided into two groups: I group included 35 patients, who received standard antimycobacterial therapy in the intensive phase of the treatment in combination with prebiotic (lactulose) in a dose of 20 ml 3 times a day plus nutriological correction of metabolic disorders; the II group included 32 patients, who received standard antimycobacterial therapy. The control group consisted of 30 healthy individuals of comparable sex and age. In order to study the protein metabolism state, the content of certain substitutable amino acids (ornithine, aspartic acid, serine, glutamic acid, proline, glycine, alanine, cysteine, tyrosine, glutamine) and essential amino acids (lysine, histidine, arginine, threonine, valine, methionine, isoleucine, phenylalanine, leucine) and their total amount (mg per 100 ml of blood serum) were assessed. Results and discussion. It has been found that all patients in groups I and II, which were under our supervision before the treatment, had symptoms of intoxication and respiratory syndrome, the tuberculosis process in the lungs occupied more than three segments and single decaying and rupturing cavities prevailed. The patients with massive bacterial excretion dominated in both groups. Moreover, before the treatment, protein metabolic disorders were found out in both groups. They manifested by the imbalance of individual amino acids and led to a decrease in the total content of essential amino acids in 1,2 – 1,3 times, total content of substitutable amino acids in 1, 2 times that led to a decrease in total content of substitutable amino acids in patients of both groups in 1,2 – 1,3 in comparison with the control group. A comparative analysis of the effectiveness of prebiotics (lactulose) and nutritional correction of metabolic disorders in combination with antimycobacterial therapy in the TB patientsl with protein metabolic disorders showed that probiotics and dietary modifications contribute to improving protein metabolism.
 This has been evidenced by a significantly high (p <0,05) level of the total content of essential amino acids in blood serum, total content of substitutable amino acids and total content of amino acids (reliably reaching the level of indicators in healthy individuals) compared with the relevant indicators in the group of the patients receiving only antimycobacterial therapy. Probiotics and nutritional correction promote the rapid dynamics of the disappearance of respiratory syndromes and intoxication, promote cavity healing, and reduce the duration of treatment. Conclusions. The results of our research obtained convincingly suggest that prior to the beginning of treatment; all patients with pulmonary tuberculosis have protein metabolic disorders that require selecting a way to correct these disorders in order to increase the effectiveness of TB treatment. Antimycobacterial therapy during two months contributes to the positive dynamics of protein metabolism correction, but complete normalization of the amino acid composition in blood serum does not occur. Applying prebiotics (lactulose) and nutriological correction of metabolic disorders in combination with antimycobacterial therapy promotes the normalization of protein metabolism and increases the effectiveness of the TB treatment.