The dissertation is devoted to the influence of the level of neutrophil elastase on the course of various forms of lung tuberculosis, depending on the sensitivity of the identified pathogen. 127 patients with various forms of pulmonary tuberculosis took part in the research, who were divided into 3 groups of subjects. The main group included 66 patients with pulmonary tuberculosis. The first comparison group consisted of patients with tuberculous pleurisy - 29 people. In the second comparison group, 32 patients with pulmonary tuberculosis combined with tuberculous pleurisy. Examination of patients was carried out according to generally accepted clinical research methods. General clinical (anamnesis, patient examination), radiological (examination X-ray of the chest in direct and lateral projections, computed tomography of the lungs, ultrasound), molecular genetics, microscopic and cultural methods for determining mycobacterium tuberculosis in sputum and the sensitivity of mycobacterium tuberculosis to antituberculosis drugs, immunological, laboratory (general and biochemical blood analysis, general urinalysis). Determination the state of the proteolytic system was determined by the activity of neutrophil elastase. Research of the endocrine system by the activity of estradiol. Statistical (parametric and non-parametric methods of varinational statistics using the Student-Fisher t-test). It was established that an increase in the level of elastase in the blood of patients with pulmonary tuberculosis and pleurisy of tuberculous genesis indicates the stimulation of the proteolytic system during the tuberculosis process. It was found that the increased level of elastase can be a differential diagnostic marker of tuberculous pleurisy. At the same time, it is possible that an increase in the activity of the proteolytic system is a sign of activation immunity system, as one of its links, in patients with pulmonary and pleural tuberculosis sensitive to antibacterial therapy. It was established that the level of elastase in these patients significantly exceeded the normal level in persons who did not have lung and pleural diseases at the time of the examination and in the past (control group 75 nmol/min•ml). In pulmonary tuberculosis, the level of NE was 1.6 times higher, and in patients with tuberculous pleurisy, it was 3.4 times higher than in the control group. At the same time, when pulmonary tuberculosis was combined with pleural tuberculosis, the level of elastase compared to the control group was slightly lower and exceeded it by 2.4 times. Therefore, the most active proteolytic system was in isolated pleural tuberculosis, and the pulmonary process significantly reduced this activity. In isolated pulmonary tuberculosis, the activity of the proteolytic system was even lower. The resistance of tuberculosis mycobacteria in patients with multidrug-resistant tuberculosis affected the proteolytic activity in an inhibitory way in the examined patients of all groups. In male patients with sensitive TB with preserved MBT sensitivity to antibacterial drugs, there was an increase in blood estradiol level to 0.27 nmol/l, which exceeds the norm by 2.5 times. With MRTB, an increase in estradiol to 0.44 nmol/l was found, which exceeds the norm by 3.5 times and indicates the involvement of additional reserves of the organism in the fight against tuberculosis infection, since it is known that estradiol stimulates immunity. In female subjects among patients with sensitive TB with preserved MBT sensitivity, there was a decrease in the level of estradiol to 0.2 nmol/l, by 2.1 times, which may indicate inhibition of the body's defenses, while in MRTB there was an increase in the level of estradiol by 1, 4 times - up to 0.6 nmol/l, which is a consequence of the tension of the body's protective forces in order to overcome the tuberculosis infection. Therefore, a decrease in estradiol provokes diseases in men and women. However, in severe forms of tuberculosis such as MDR-TB, the level of estradiol increases. The given data deepen the understanding of the pathogenesis of pulmonary tuberculosis. The results of the study demonstrate that high levels of neutrophil elastase (more than 110.0 nmol/min*ml) are a marker of the tuberculosis process in the lungs and pleural cavity, which can be used in the differential diagnosis of the etiology of pleural effusion. A low level of elastase (less than 75,0 nmol/min*ml) and estradiol can be a prognostic criterion for the transformation of sensitive pulmonary tuberculosis into its resistant forms. Low numbers of neutrophil elastase and estradiol can be markers of resistance mycobacterium tuberculosis even before the results of bacteriological studies are obtained. Determination of the level of elastase and estradiol in the blood can be used to assess the course of a specific process, namely its subsequent positive or negative course.
