Shtepa O. Optimization of treatment of patients with lower respiratory tract infections with concomitant hypertension, taking into account the activity of inflammation.

Object of the study: lower respiratory tract infections (community-acquired pneumonia of mild course, infectious exacerbation of chronic obstructive pulmonary disease) with concomitant arterial hypertension. Objective: to optimize treatment and improve the diagnosis of lower respiratory infections in patients with concomitant arterial hypertension, taking into account the etiologic factor, the values of the markers of the surfactant protein D, C-reactive protein. Methods of investigation: general clinical, x-ray, spirographic studies, microbiological examination of sputum with the definition of infectious agents, biochemical blood test with determination of the concentration of C-reactive protein (C-RP) markers and surfactant protein D (SP-D), biostatistical methods. Scientific novelty of the results. In the thesis, scientific data on the informativeness of the generally accepted diagnostic techniques for the acute infectious process of the lower respiratory tract in patients with CAP and AE COPD were refined. For the first time in the Dnepropetrovsk region, a retrospective and prospective analysis of the incidence and etiologic structure of respiratory pathogens in patients with LRTI was conducted, the level of resistance of the detected strains was determined, and the results of the retrospective and prospective stages were compared. Data on the properties of pulmonary surfactant in the implementation of local immunity from changes in SP-D levels acting as a key regulator of alveolar macrophage functions, which are responsible for the development of immunological reactivity in lung diseases with an inflammatory component, are supplemented. The diagnostic value of SP-D and C-RP markers for the first time is shown depending on the presence of concomitant arterial hypertension (AH), the interrelations of markers among themselves are analyzed and the influence of AH on the activity of inflammation is established. For the first time, the effectiveness of supplementing the standard curative program with pathogenetic therapy with the use of the preparation of phosphatidylcholine in patients with CAP of mild course and infectious exacerbation of COPD has been proved to reduce the activity of the inflammatory process and restore the stability of the surfactant system.