Galan I. Nutritional correction of protein metabolism as a method of secondary prevention in patients with pulmonary tuberculosis

The dissertation is devoted to solving the scientific problem of hygiene and phthisiology to improve the effectiveness of treatment and secondary prevention of the development of complications in patients with new pulmonary TB cases by including nutritive correction of protein metabolism in the standard treatment regimen with antimycobacterial drugs. Comparative assessment of indicators of protein metabolism in patients with new pulmonary TB cases indicates that before starting treatment, regardless of the clinical form of the TB process, they have common features: a significant decrease (p <0.05) in the total amount of amino acids due to reducing the total amount of nonessential and essential amino acids and significant (p <0.05) increased ammonia level in serum compared to healthy individuals. At the next stage, a relationship was established between the severity of changes in protein metabolism and the extension of tuberculous process in the lungs. The most significant protein metabolism disorders and amino acid composition of serum were found in patients with disseminated tuberculosis – increase in 2.7 times of ammonia level (p <0.05), decrease in 1.3 times in the total amount of amino acids, in the total amount of essential amino acids, in the total amount of the essential amino acids by reducing the level of almost all essential and nonessential amino acids. In patients with infiltrative tuberculosis, less pronounced, but significant, changes in the amino acid composition of serum were recorded. The smallest changes are observed in focal tuberculosis. Also studies have shown that the prescription of standard antimycobacterial therapy has a positive effect on certain indicators of protein metabolism, but does not provide a full normalization of metabolic processes. Based on scientific research priority clinical indicators were identified for the inclusion of nutritional correction of protein metabolism in the complex treatment of patients with new TB cases in order to prevent its complications. A differentiated approach to the formation of the diet of patients with tuberculosis is proposed taking into account the stage of development of the tuberculous process and the general condition of the body for nutritional correction of immunopathological and metabolic processes, in accordance with the links of pathogenesis, biologically active compounds were isolated and a group of products with the highest level of these biologically active compounds was recommended. It was found that the use of nutritional correction of protein metabolism made it possible to minimize the time of disappearance of intoxication and respiratory syndromes, increase the frequency of healing of decay cavities in the lungs at the time of completion of treatment, increase the rate of healing of decay cavities in the lungs at the time of completion of treatment, to get a pronounced positive effect on the biochemical parameters of blood and the state of protein metabolism, to reduce the average length of hospital stay for patients in the complex treatment of patients with infiltrative new TB cases. Based on our research results scheme of secondary prevention of complications in patients with new pulmonary TB cases was substantiated and introduced into the practice of specialized institutions by nutritional correction of protein metabolism.