The dissertation contains theoretical substantiation and proposals for the practical solution of the scientific problem of optimizing and predicting the effectiveness of pathogenetic treatment of alcoholic patients with newly diagnosed pulmonary tuberculosis based on the assessment of radiological, inflammatory, immunological parameters and the state of the system oxidative stress antioxidant protection. their prognostic value in assessing the effectiveness of therapy.
To achieve the goal of the study, a comprehensive clinical examination of 109 patients with FDPTB aged 20 to 50 years was conducted. The median age was 37.00 years. To solve the tasks among the examined patients, depending on the level of alcohol consumption, 3 groups of patients were formed. The first group included 34 patients with FDPTB and low alcohol consumption, the mean age was 37.09 ± 8.44 years, group 2 included patients who consumed alcohol with a health risk (mean age 37.14 ± 8.61 years). ). Group 3 included patients who abused alcohol or had a possible alcohol dependence (mean age 33.90 ± 9.05 years). The control group consisted of 20 relatively healthy individuals who did not drink alcohol or who received 5 or less points on the AUDIT test, with a mean age of 36.91 ± 6.05 years.According to the study design, patients in each of the groups (1, 2, 3) were divided into two subgroups depending on the treatment regimen (L1 and L2), which they received during the 2 months of the intensive phase of anti-TB therapy. Subgroup L1 included patients receiving standard four-component therapy (isoniazid + rifampicin + pyrazinamide + ethambutol). Patients of subgroup L2 in addition to standard therapy received antioxidant drugs according to the developed scheme: selenium and vitamin E drugs in doses of 250 mg and 200 mg, respectively, once a day at the same time with anti-TB drugs.
Results. When analyzing the general clinical indicators and assessing the level of quality of life in the studied patients, it was found that in patients with FDPTB with an increase in alcohol intake, lower BMI (p <0.01); increase in the number of complaints (p <0.05), in particular for general weakness (p <0.05), cough with sputum (p <0.01) and shortness of breath (p≤0.01). Also, with increasing alcohol consumption, the severity of the intoxication syndrome increased: increase in body temperature (p <0.05), ESR (p <0.05) and C-reactive protein (p <0.01). The tendency to decrease the quality of life depending on the level of alcohol consumption was determined (p1-2 = 0.06, p2-3 <0.01, p1-3 <0.01).
The group of patients who abused alcohol, compared with the groups of patients with low and health-threatening consumption, differed by 2.11 (p <0.01) times and 1.27 (p = 0.12) times more cases with bacterial excretion according to the results of microscopic examination of sputum, 2.71 (p <0.01) times and 1.74 (p = 0.01) times more patients with common forms of TB, 2.55 (p <0.01 ) times and 1.36 (p = 0.07) times the frequency of destructive processes in lung tissue. Continuation of IF treatment to 90 doses was required in 16.1% of patients who abused alcohol and 6.82% of patients who consumed alcohol in moderation.
