In recent decades, the shift in priority in the treatment of patients with pulmonary granulomatosis in the direction of etiotropic therapy and reduced attention to the state of the macroorganism led to a decrease in the effectiveness of treatment. In modern conditions, when carrying out complex therapy for patients with tuberculosis and sarcoidosis, insufficient attention is paid to the state and dynamics of adaptation, resistance, homeostasis and reactivity of the organism. At the same time, the dynamics of these processes in patients is insignificant, the homeostatic balance of the organism is not restored, and the reactivity of the organism remains at the pathological level, with the predominance of paradoxical, hyporeactive and areactive types. This is due to the continuing influence on the regulatory centers of the vegetative system of not diagnosed, latent, ongoing tuberculosis intoxication. Undetected specific intoxication causes in patients activation of the sympathetic department, suppression of parasympathetic and development of dysfunction of the autonomic nervous system. Its dysfunction leads to a decrease in vascular supply of the organism, a high tension of anabolic processes, and a further change in the functional activity of both parts of this system when pathology develops. In addition, the emergence of vegetative dysfunction leads to a high consumption of plastic materials, energy resources, a decrease in the functional reserves of the body, a decrease and depletion of the body’s defense systems, its anti-inflammatory potential and the reactivity of the organism as a whole. These changes lead to an extension of the main course of treatment and the formation of expressed residual tubercular and sarcoidosis in the respiratory organs. To restore these disorders, it is necessary to carry out complex therapy with the inclusion of a personified appointment of activators of protective systems under the control of monitoring their effectiveness.

The search for available informative criteria for diagnosing the state and dynamics of the homeostatic equilibrium of the organism, which began at the end of the XIXth century, continues to the present. Scientific research establishes the priorities for the study of homeostasis in the clinic and its control over the supra-segmental regulatory centers of the autonomic nervous system. The proposed functional, instrumental, immunological, biochemical and hormonal methods for evaluating it in phthisiology for various reasons, including economic ones, cannot be used fully. The modern clinic needs accessible and informative criteria for homeostasis. The theoretical basis for their development was the doctrine of the general adaptation syndrome, which revealed the reaction of «stress» to extreme irritants. The subsequent discovery of changes in the body’s homeostasis to the effect of strong, medium strength, and weak stimuli has made it possible to identify three more types of adaptation reactions: the training reaction, the activation reaction, and the re-activation reaction. At the Department of Phthisiopulmonology of the FirstSt. PetersburgStateMedicalUniversity named after Acad. I.P. Pavlov proposed and tested new diagnostic criteria for homeostasis. They were developed on the basis of quantitative and qualitative characteristics of the formed elements of peripheral blood. Among them, in addition to these types of adaptive reactions of the body, leukocyte- lymphocyte index, indices of monocytogram, degree of disturbance of homeostasis and types of reactivity of the organism were introduced. These criteria allowed us to determine not only the state of homeostatic equilibrium of the organism, but also to assess the depth of its disturbance and the types of reactivity of the organism. Their use in daily clinical work provides an opportunity to monitor the course of the disease and carry out a personified correction by means of pathogenetic therapy.

The outcome of sarcoidosis of the respiratory system is closely linked to the state of homeostasis and reactivity. Monitoring their status is possible through immunological, biochemical and hormonal studies. Within common medical institutions re-executing these studies is not always possible for a number of reasons. Therefore, the research for the availability and informative criteria of homeostasis and reactivity state was initiated at the end of XIXth century and continues until now. At the Department of Phthisiopulmonology of the First St.-Petersburg state medical University Academy I. P. Pavlov. University, new accessible and informative diagnostic criteria for estimation the state of homeostatic balance of the organism are developed. They are based on research of the general adaptation syndrome and the discovery of antistress types of adaptive reactions of the organism. In this regard, based on the leukogram evaluation following diagnostic criteria were developed and tested: leukocyte-lymphocytic index, types of adaptive reactions, entropy and redundancy of formed elements of white blood cells, extent of disturbance of homeostasis, indices of proliferation and differentiation of monocytes and reactivity types. Unfortunately, in the pulmonology clinics, they are used today only in single cases. The monitoring of homeostasis and reactivity indicators in patients with respiratory system sarcoidosis had a high working performance. It is established that in sarcoidosis the best treatment effect with corticosteroids with minimal residual changes of respiratory system took place in patients with the appropriate type of reactivity and normal range of other indicators. Pathological reactivity of an organism, especially hyporeactive and areactive types, are always accompanied by formation of pronounced residual sarcoidosis changes in the respiratory tract, which is the basis for the subsequent exacerbation (recurrence) of sarcoidosis.

Fundamental research in the field of physiology revealed the important role of the state of homeostatic balance of the body in the emergence, development and outcome of human diseases, including granulomatous respiratory diseases- tuberculosis and sarcoidosis. To assess the homeostasis of the body in clinical conditions, various research methods are used - immunological, biochemical, hormonal and functional. However, in the daily work they can’t always be performed for technical and economic reasons. Proposed a new available diagnostics criterion of homeostasis based on the study of the quantitative and qualitative characteristics of the leukocytic formula of peripheral blood at the Department of videopornonoelia the First St. Petersburg state medical University Academy I. P. Pavlov. Among them types of adaptive reactions, leukocyte- lymphocytic index, entropy and redundancy of indicators of leukogram, monitorama blood, the degree of homeostasis and types of reactivity of an organism. During their approbation in the clinic high information content was revealed: more than 70% of the examined patients with tuberculosis of respiratory organs had defective types of adaptive reactions (intense), indices of proliferation and differentiation of monocytes were changed, and reactivity of the organism was characterized by pathological types (hyperreactive, paradoxical, hyporeactive and areactive). Treatment of patients with anti-tuberculosis drugs partially improved homeostasis, but its full recovery at the end of the main course of treatment did not occur. For better treatment in complex therapy, it is necessary to activate the body’s protective systems with the use of adaptogens (drugs, medicinal plants, physical factors: ultrasound, ultra-high-frequency inductothermy, alternating magnetic field on the regulatory centers of the suprasegmental apparatus of the autonomic nervous system). Monitoring of the state of homeostasis is most convenient to carry out using the proposed new available criteria for its evaluation.