The thesis covers solution of the urgent question of Phthisiology, improvement of the efficacy of treatment of drug-susceptible and drug-resistant pulmonary tuberculosis by means of studying the dynamics of carbohydrate and lipid metabolism and vitamins B1 and B12 levels during the treatment with first-line and second-line antituberculosis drugs.
According to the results of the study, it was found that 38 (31.6%) patients had a disorder of carbohydrate metabolism in the form of insulin resistance (IR), which at the statistical level (p < 0.05) was associated with severe disease (bilateral lesions pulmonary parenchyma, the presence and massiveness of bacterial excretion). For this category of patients, significantly higher indicators of TC (4.82 mmol/L vs. 4.85 mmol/L in the group of patients without carbohydrate metabolism disorders), LDL (3.2 mmol/L vs. 2.5 mmol/l in group of patients without carbohydrate metabolism disorders) and AI (3.86 units versus 2.95 units in the group of patients without carbohydrate metabolism disorders), (p <0.05) are characteristic. We found the relationship between the severity of NDTB of the lungs and the degree of manifestation of metabolic disorders. Thus, the increase in the volume of lesions from one lobe of the lungs to total bilateral lesions was accompanied by an increase in the median glycosylated hemoglobin from 4.8% to 7.1%, respectively (p < 0.05).
For the first time it was established that development of polyneuropathy in patients with NDTB of lungs is associated with the negative dynamics of vitamin B12 against a background of treatment of II-line anti-TB drugs.
To determine the motor and sensory conductivity, the following parameters were evaluated: motor nerve conduction velocity (MNCV), terminal motor latency (TML), sensor nerve conduction velocity (SNCV), terminal sensory latency (TSL).
It is recommended to use in the continuation phase a three-component pyrazinamide treatment regimen in patients with drug-susceptible tuberculosis in which at the end of the intensive phase of treatment an increase in fasting glucose and/or postprandial glucose is recorded in order to compensate for disorders of carbohydrate metabolism in such patients. In order to detect early disorders of the peripheral nervous system and prevent the development of polyneuropathy against a background of the use of linezolid, in patients who were prescribed this drug in the treatment regimens, to recommend electroneuromyography of the lower extremities, determination of vitamin B12 before treatment and 30 days of therapy, and correction of vitamin B12 deficiency if necessary.
After completion of the main course of chemotherapy, it is recommended to remonitor the lipid profile of patients with multidrug-resistant tuberculosis, in whom treatment with II-line drugs was accompanied by hypercholesterolemia and dyslipoproteinemia, and, if necessary, to prescribe pathogenetic treatment to reduce the future cardiovascular risks.
It is recommended to prescribe additional pathogenetic treatment in the form of intravenous infusions of xylitol solution in patients with pulmonary tuberculosis who have insulin resistance index over 2.7 in order to improve the course of the disease and increase the effectiveness of their treatment.
The results of the study significantly supplemented the arsenal of the knowledge about the dynamics of carbohydrate and lipid metabolism, as well as the level of vitamins B1 and B12 during the treatment with I-line and II-line anti-TB drugs in patients with pulmonary tuberculosis. According to the materials of thesis, a declaratory patent for a utility model № 131150 U, IPC G01N33 / 48 (2006.01) was obtained.
