Aim. To evaluate the efficacy of mechanical bacterial lysate on the prevention of infectious exacerbations of chronic obstructive pulmonary disease in patients with frequent exacerbations. Materials and methods. The study included patients (n=60) with frequent exacerbations of COPD (groups C and D according to the GOLD classification). All COPD patients were divided into two groups by blind method. The first group (n=30) received conventional therapy for COPD plus MBL (the course included 3 cycles of 10 days therapy with 20-day intervals between them). The second group of patients (control, n=30) received conventional therapy for COPD without MBL.We evaluated the severity of symptoms, frequency of recurrence of COPD exacerbations, readmissions, need for emergency care and changes in basic therapy of COPD. Evaluations were done on 10 days, 1, 3 and 6 months from the start of the study. Results. Adding of MBL to the therapy list of COPD resulted in a significant decrease of biomarkers of systemic inflammation and sputum purulence during compared to the control group. After 6 months of observation MBL group demonstrated statistically significant improvement of respiratory function, decrease in frequency of COPD exacerbations, needs for emergency medical service, reduced changes in basic therapy and hospitalization for exacerbation of COPD. Therapy with MBL showed a high degree of safety and low incidence of adverse events. Conclusion. The results of the study indicate that MBL may be used for the prevention of severe infectious exacerbations of COPD.
The objective: to study the effect of immunomodulators on markers of the acute inflammation phase in patients with mild community-acquired pneumonia (CAP).Subjects and methods. Patients (n = 64) with mild CAP (39.62 ± 9.82 years, CRB – 650.15 ± 0.04 scores) were enrolled in the study. The patients were divided into 2 groups: Group 1 (control) received only standard CAP therapy; in the other two groups, immunomodulators were prescribed simultaneously with standard therapy: in Group 2 – bacterial lysate (BL), in Group 3 – azoximer bromide (AB). In the patients, the blood levels of IL-6, TNF-α, C-reactive protein (CRP), lactoferrin were tested before treatment (day 1), and on days 13 and 60 of observation.Results. The initial levels of TNF-α, IL-6, CRP and lactoferrin in the patients were statistically significantly higher above normal ones. A significant decrease in the levels of TNF-α, IL-6, CRP was found in all patients on the 13th and 60th days of observation compared to the 1st day, the maximum reduction was observed in the patients receiving immunomodulators. The biggest decrease in the level of lactoferrin on the 60th day of observation was noted in the group of patients taking BL. The changes in the rate of TNF-α and IL-6 levels decrease on the 13th and 60th days were also statistically significantly more pronounced (compared to the control group). The changes in the rate of decreasing from the baseline on the 13th and 60th days in TNF-α in the BL Group made 44 [-64; -32]% and 85 [-89; -82]%; in the AB Group – 28 [-40; -20]% and 82 [-86; -80]%; in IL-6 in the BL group – 32 [-40; -18]% and 86 [-90; -85]%, in the AB group – 45 [-53; -38]% and 86 [-88; -84]%. In the control group, this parameter for TNF-α was 18 [-32; -8]% and 64 [-78; -56]%, for IL-6 – 11 [-20; -1]% and 75 [-81; -74]%.Conclusion. The addition of immunomodulators (BL, AB) to the therapy of patients with mild CAP results in statistically significant decrease in the blood levels of biomarkers of the acute inflammation phase on the 13th and 60th days.
Хроническая обструктивная болезнь легких (ХОБЛ) часто сочетается с другими заболеваниями, сущест венно ухудшающими прогноз [1, 2]. По данным экспертов [2, 3], хроническое персистирующее вос паление у больных ХОБЛ играет важную роль в по ражении эндотелия сосудов и развитии атеросклеро за, что, в свою очередь, способствует возрастанию сердечно сосудистой заболеваемости (ССЗ) и риска летальности. В последние годы наблюдается повы шенный интерес к изучению артериальной ригид ности (АР) стенки как показателя, характеризующего сосудистое ремоделирование [4]. Жесткость артерий изучена при артериальной гипертензии (АГ) [5] в сочетании с атеросклерозом [6], сахарном диабе те (СД) [7], АГ с сопутствующей ХОБЛ [8, 9], остео порозе [10], хронических заболеваниях почек, рев матоидном артрите, подагре [11]. Выявлено повы шение жесткости центральных артерий [12, 13] и при ХОБЛ. В исследованиях показаны значимое повы шение АР, связанное с тяжестью эмфиземы, ассоци ации гиперреактивности бронхов и толщины комп лекса интима-медиа (ТИМ) каротидной артерии, увеличения жесткости центральных артерий со сни жением соотношения объема форсированного выдо ха за 1 ю секунду (ОФВ 1 ) и форсированной жизнен ной емкости легких (ФЖЕЛ) (модифицированный индекс Тиффно) и интенсивностью процессов ремоделирования легочной артерии [14]. В работе РезюмеПри изучении особенностей ремоделирования и упругоэластических свойств крупных периферических (общих сонных -ОСА и бед ренных -ОБА) артерий выявлены взаимосвязи с гипоксией, маркерами системного воспаления у больных хронической обструктивной болезнью легких (ХОБЛ) и ХОБЛ в сочетании с артериальной гипертензией (АГ). В исследование были включены пациенты (n = 85) с ХОБЛ II-IV степени тяжести по GOLD (2011) (n = 60) и ХОБЛ в сочетании с АГ (n = 25). Структурно функциональное состояние пе риферических сосудов исследовалось путем измерения толщины слоя интима-медиа (ТИМ); рассчитывались индексы артериальной эластичности ОСА и ОБА. У больных ХОБЛ выявлены увеличение ТИМ, снижение эластичности и повышение упругости ОСА и ОБА по сравнению с контролем. АГ у больных ХОБЛ становится предиктором дальнейшего ремоделирования крупных периферических со судов на фоне гипоксии и системного воспаления. Ключевые слова: хроническая обструктивная болезнь легких, ремоделирование периферических сосудов, артериальная эластичность, упругость, гипоксия, системное воспаление. SummaryThe objective of this study was to investigate large peripheral vessel (the common carotid arteries (CAA) and common femoral arteries) remodeling and elastic properties to identify their relationships with hypoxia and markers of systemic inflammation in patients with chronic obstructive pul monary disease (COPD) and with co morbidity of COPD and arterial hypertension (AH). Methods. The study involved 60 patients with COPD (stage III-IV, GOLD 2011) including 25 patients with COPD + AH (n = 80). Structure and functional status of peripheral vessels were investigat ed by measuring the intima media thickness (TIM); artery elasticity indices were ...
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