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12Таблица 3.
Показатели биохимического исследования крови у больных, принимавших препарат №1В (М ± т)
Показатель Ед. изм. Норма Результат до лечения (n = 50) Результат после лечения (n = 50)
Общий белок г/л 65-85 71,49±0,99 78,86±1,41
Билирубин общий мкМ/л 5-21 18,5±1,98 15,7±1,13
Холестерин общий мМ/л 0-5,2 5,90±0,20 4,85±0,13
АСТ ед/л до 40 31,5±2,83 23,8±1,70
АЛТ ед/л до 40 36,15±3,54 24,70±1,70
Щелочная фосфатаза ед/л 53-128 136,70±13,72 81,05±6,08
а-амилаза ед/л 25-125 84,35±6,22 67,60±4,04
Креатинин мкМ/л 62-115 107,0±9,33 79,65±2,97
Мочевина мМ/л 2,1-7,1 6,85±0,31 5,70±0,18
Триглицериды мМ/л 0-1,71 1,57±0,16 1,27±0,07
ГГТ ед/л <32 28,95±1,13 24,65±0,99
Глюкоза мМ/л 3,89-5,83 5,40±0,16 4,85±0,14
Таким образом, прием препарата №1В внутрь по 7 капель, при растворении в 50 мл кипяченой воды комнатной температуры, 2 раза в сутки за 20 минут до еды утром и вечером в течение 14 дней в комплексном лечении взрослых больных гриппом, свидетельствует о выраженной эффективности препарата при заболевании гриппом.
На фоне приема препарата №1В, у пациентов титр РНК вируса гриппа не выявляется уже на 2 сутки терапии. Эти данные наряду с результатами доклинического исследования препарата свидетельствуют о прямом специфическом действии препарата №1В на вирус гриппа.
Применение препарата №1В в комплексном лечении больных гриппом существенно облегчает тяжесть заболевания, сокращает период лихорадки, уменьшает выраженность катарального и интоксикационного синдромов. Наиболее отчетливо это наблюдается в течение первых 1 -2 суток от начала
лечения, в период разгара болезни. Именно влияние препаратов на тяжесть течения и выраженность симптомов является одной из наиболее важных задач противовирусной терапии.
Препарат №1В не вызывает нежелательных побочных эффектов, хорошо переносится, не вызывает привыкания и обладает возможностью длительного назначения.
Выводы.
Препарат №1В при клиническом изучении при назначении внутрь показал высокую эффективность при комплексном лечении взрослых больных гриппом.
Список литературы
1. Плетнев, В.В. Капли Плетнева, обладающие противовирусным и иммуномодулирующим эффектами // Патент РФ на изобретение. - 2014. - N 2553308.
АНАЛ1З ДИНАМ1КИ ЗМ1Н ОСНОВНИХ КЛШ1ЧНИХ ПОКАЗНИК1В У ХВОРИХ НА ГЕНЕРАЛ1ЗОВАНИЙ КАТАРАЛЬНИЙ Г1НГ1В1Т З ХРОН1ЧНИМ ТА ЗАГОСТРЕНИМ ПЕРЕБ1ГОМ П1Д ВПЛИВОМ ПРОВЕДЕНОГО ЕТАПНОГО Л1КУВАННЯ
Шостенко А.А.
ДВНЗ «Буковинський державний медичний утверситет», кафедра стоматологи дитячого в1ку, асистент
ANALYSIS OF THE DYNAMICS OF CHANGES IN THE MAIN CLINICAL PARAMETERS IN PATIENTS WITH GENERALIZED CATARRHAL GINGIVITIS WITH CHRONIC AND EXACERBATED FLOW UNDER THE INFLUENCE OF STAGE THERAPY
Shostenko A.
HSEE "Bukovinian state medical university", department of pediatric dentistry, assistant
Анотащя
У статп наведеш результати отриманих змш клшчних показнишв у 82 хворих на генералiзований катаральний пнпвгг з рiзним клшчним перебпюм. Об'ективний стан порожнини рота та ясен встановлю-вали на основi наступних теспв: спрощеного шдексу ппени (OHI - S), iндексу кровоточивосп Мюллемана, Коуела, пашлярно-марпнально-альвеолярного iндексу (РМА). Розроблена та впроваджена комплексна те-рапiя, що передбачае використання професiйних гiгieнiчних заходiв, протизапальних, антибактерiальних, iмуномоделюючих препаратiв та пробютишв на рiзних етапах лiкування, яка позитивно впливае на динамо змiн клiнiчних показник1в генералiзованого катарального пнпвиу.
Abstract
The article presents the results of the obtained changes in clinical parameters in 82 patients with generalized catarrhal gingivitis with different clinical courses. The objective state of the oral cavity and gums was established on the basis of the following tests; simplified hygiene index (OHI - S), Mullemann, Cowell's bleeding index, papillary-marginal-alveolar index (PMA). Complex therapy has been developed and implemented, which involves the use of professional hygienic measures, anti-inflammatory, antibacterial, immunomodulating drugs and probi-otics at different stages of treatment, which positively influences the dynamics of changes in the clinical indicators of generalized catarrhal gingivitis.
Ключовi слова: катаральний пнпвгг, iмунокорегуюча терашя, пародонт, запалення.
Keywords: catarrhal gingivitis, immune-correcting therapy, periodontium, inflammation.
The most common periodontal pathology at a young age is catarrhal gingivitis, as evidenced by numerous epidemiological studies of domestic and foreign authors [1,2,3,].
A particular concern to the dental community is the tendency of chronic inflammation in the tissues of the gums to frequent exacerbations, which exacerbate the clinical manifestations of catarrhal gingivitis and require the expansion of an arsenal of drug treatment, which is not always successful [4,5]. It is necessary to recognize that professional hygienic interventions and local antibacterial therapy with chlorhexidine-contain-ing agents are the basis of traditional treatment of the disease to date, which is not always effective, especially in patients with acute disease. This leads to necessary research for ways that increase the effectiveness of traditional (basic) therapy of generalized catarrhal gingivitis.
The purpose of the study is to comprehend the clinical results of complex therapy in patients with generalized catarrhal gingivitis, chronic and acute course.
Materials and methods of research. The study involved 82 patients ages 19 to 31 years old, women -44 (54.7%), men - 38 (45.3%). As research has shown, 33 patients were diagnosed with chronic course of the disease (group I). While,49 were diagnosed with acute (group II).
The establishment of the diagnosis and differential diagnosis of this disease was based on generally accepted national classifications of inflammatory diseases of periodontal tissues. The study involved patients with confirmed clinical and radiological diagnosis of generalized catarrhal gingivitis and had no history of somatic diseases. All patients received informed consent to participate in the study.
After clinical, radiological and laboratory studies, three groups of patients were formed, identical in age, sex, disease duration, in which the comparative effectiveness of traditional and proposed methods of complex therapy was further studied. Group I - patients with chronic disease, group II (comparison) and group III (main) - patients with acute course of generalized ca-tarrhal gingivitis. All patients underwent an identical clinical examination, including complaints, anamnesis, visual and instrumental assessment of dental status.
The objective state of the oral cavity and gums was determined on the basis of the dynamics of the following tests: simplified hygiene index (OHI - S), Mul-lemann, Cowell's bleeding index, papillary-marginal-alveolar index (PMA) [6,7].
Together with the general clinical examination, standard digital orthopantomography was used in the
work, followed by the study of the obtained images on a personal computer for a more objective assessment of the bone tissue of the alveolar processes in the area of the intercellular septa.
After conducting clinical, radiological and laboratory studies, the tactics of complex therapy of generalized catarrhal gingivitis with chronic and exacerbated disease courses were developed. In the first stage in patients of I, II and III groups local treatment of HGG was carried out according to a single plan, carried out professional hygienic measures in combination with irrigation of the interdental spaces and applications of the mucous membranes of the gums with chlorhexidine-containing agents. In the second stage of complex treatment of chronic generalized catarrhal gingivitis, patients of group I and II were received together with traditional antibacterial therapy in combination with pro-biotic bifidobacterium - 5 doses 2 times a day for 10 days; immune corrective treatment with recombinant drug cycloferon (2 tabs per day for 10 days). Patients of group II at the first stage of complex treatment continued to receive similar antibacterial therapy as patients of group I. They were additionally prescribed a broad-spectrum antibiotic - amoxiclav 250/125 1 tab. 2 times a day for 7 days; anti-inflammatory drug - nimesil - 1 pack. 2 times a day for 7 days; probiotic - biosporin 2 doses 2 times a day for 10 days. Immune Corrective therapy in this group of patients was performed after the elimination of acute inflammatory phenomena in the gum tissues and after the completion of antibacterial therapy.
The third final step included the prevention of recurrence of the disease in the long term after treatment, by performing professional hygiene measures and repeated course of general or local immune correction with lycopid, every 6 months after completion of comprehensive treatment.
Statistical data processing was performed using the STATISTICA 6.0 Stat Soft Ine, USA software package on a Windows PC using a Microsoft Excel 2000 spreadsheet. To assess the validity of differences between groups, the Student's t-test was calculated [8].
Research results
Regression analysis of the main subjective and objective clinical signs of HCG showed that in the course of the initial treatment of professional measures and the use of chlorhexidine-containing antibacterial drugs, the book's gum condition improved significantly after 2-3 procedures in patients in all groups. At the same time, under the influence of the described treatment-and-prophylactic and hygienic measures, the complete elimination of the inflammatory process in the tissues
of the gums could not be achieved, which was confirmed by the data of dynamic observation of changes in the gum indices. Table 1 shows that after the com-
In the second stage of treatment, the elimination of the inflammatory process ("recovery") in the majority of patients of group I (in 93.5% of cases) was succeeded as early as 6-7 days. After comprehensive treatment in patients of group I, the values of the indices characterizing the gum condition approached values close to the norm: IG-0,28 ± 0,03; IR - 0.12; PMA - 0.73 ± 0.01.
The analysis of clinical parameters in the dynamics of GCG treatment in the acute stage is also marked by a positive result in patients groups II and III. Already at 3-4 day comprehensive treatment, all patients noted improvement in condition of gums : gone soreness, decreased bleeding, redness and swelling. Positive results were achieved in 81.8% of patients of II group and in 96.3% of patients of group III. In cases when after the treatment was preserved signs of inflammation in the gum tissue after the implementation 2 stage of treatment revealed a sharp decrease of pathological manifestations. The main advantages of the developed program complex treatment of heightened GCG that is being tested in group III were due to rapid and complete regression of major symptoms. The normalization of the color and texture of the gums, the absence of pain and bleeding was achieved significantly faster than in patients of group II (an average of 5.9±0.3 days) and a greater number of patients treated.
The best anti-inflammatory effect in patients of group III may have been obtained at the expense of additional introduction in the medical complex on the second stage etiotropic drug biosporin in combination with antibiotic Amoxiclav and anti-inflammatory nosila.
The value of hygiene index indicated good hygienic condition of the oral cavity (0,6±0,03), the performance of the index bleeding, and PMA was normal in the group of patients treated by the developed technique and basically was close to zero values in 96.3% of patients directly after the treatment. At the same time, despite all the positive effects in the treatment process, after the end of therapy in patients of group II the normalization of periodontal indices from the initial was observed in 86.4% patients, the rest was just improvement of the gingival status. Follow-up in the long-term period showed that the results of complex therapy of chronic GCG (group I) and MHC in the acute stage ( II and III groups) achieved through the use of selected
pletion of stage I (after 3-4 procedures) the greatest tendency to normalization of gingival indices was found in patients of group I, to a lesser extent - in patients of groups II and III.
drugs at various stages of treatment in patients of all groups within 6-12 months remained stable. In these terms the clinical signs of disease recurrence were absent in the overwhelming number of patients (93,3%) of cases resorption of tips of interdental partitions were not.
Conclusions
1. The method of complex step-by-step therapy, which involves the use of professional hygienic interventions, antibacterial, anti-inflammatory and im-munomodulating agents used in a certain sequence, in the treatment of generalized catarrhal gingivitis has been developed and implemented.
2. Obtained clinical results of the stage treatment of chronic and exacerbated HCG proved that elimination of the inflammatory process, and as a manifestation of this, normalization of gingival indices in a short time occurs only in patients I and III groups.
3. The highest efficacy of complex stage treatment was observed in patients of group III with exacerbated manifestation of the disease, this is obviously due to the additional use in the stages of complex therapy of drugs having anti-inflammatory (Nimesil) and etiotropic (probiotic Biosporin) action, in combination with and cycloferon, which required confirmation of both microbiological and immunological dynamic studies.
References
1. Vanyunina V.V. Osobennosti patogeneza i lecheniya khronicheskogo kataral'nogo gingivita u bol'nykh s displaziei soedinitel'noi tkani: Avto-ref. diss. . kand. med. nauk. Novosibirsk, 2000. - 22 s.
2. Lamonta R. Dzh. Mikrobiologiya i immu-nologiya dlya stomatologov. / Pod. red. R.Dzh. La-mont, M.S. Lantts, R.A. Berne i dr.; per. s angl. V.K. Leont'eva. - M.: Prakticheskaya meditsina, 2010. - 504 s
3. Kulakov, A.A. Rol' zashchitnykh faktorov organizma v patogeneze vospalitel'nykh zabolevanii parodonta / A.A. Kulakov, O.A. Zorina, O.A. Boriskina // Stomatologiya. - 2010. - №6. - s.72-77.
4. Bezrukova I.V. Kliniko-laboratornaya otsenka effektivnosti lecheniya patsientov s bystroprogressi-ruyushchim gingivitom // Parodontologiya. -2003.-№ 1. S. 3 — 7.
Gum indices in patients of groups I, II and III after the first stage of treatment (M ± m)
Parameters Groups of patients
I group (n=33) II group (n=22) III group (n=27)
Hygiene index Green-Vermillion 0,67±0,02* 0,91±0,04*** 0,94±0,04***
IB 1,2±0,08* 1,5±0,1*** 1,44±0,1***
Index PMA 16,7±0,5* 34,4±2,1 *** 36,8±1,9***
Notes: * p <0.05 - significantly compared to baseline;
** p <0.05 - significantly compared to treatment group I level.
5. Tebloeva, L.M. Osteoimmunologiya i para-dontit / L.M. Tebloeva, K.G. Gurevich // Patolog-icheskaya fiziologiya i eksperimental'naya terapiya. -2014. № 3. -s 67-72.
6. Beloklitskaya G.F. Znachenie ob"ektivnykh klinicheskikh indeksov v parodontal'noi diagnostike / G.F. Beloklitskaya, A.A. Peti, L.G. Sandyga // Zb. nauk. prats' spivrobitnikiv KMAPO im. P.L. Shupika. — K., 1999. — Vyp. 8, kn. 1. — S. 218—228.
7. Manchini G. Immunochemical quantitation of antigens by single radial immunodiffusion / G. Manchini, A.O. Garbonara, S.F. Heremans // Immuno-chemistry. - 1965. - № 6 (2). - P. 234-235.
8. Antomonov M.Yu. Matematicheskaya obrabotka i analiz mediko-biologicheskikh dannykh / M.Yu. Antomonov // K.: Firma malogo druku, 2006.508 s.
ДИСБАЛАНС ЦИТОКШОВОÏ СИСТЕМИ ТА МЕТОДИ ЙОГО УСУНЕННЯ У ХВОРИХ НА ГЕНЕРАЛ1ЗОВАНИЙ КАТАРАЛЬНИЙ Г1НГ1В1Т
Шостенко А.А.
ДВНЗ «Буковинський державний медичний утверситет», кафедра стоматологи дитячого в1ку, асистент
IMBALANCE OF THE CYTOKINE SYSTEM AND METHODS OF ITS ELIMINATION IN PATIENTS WITH GENERALIZED CATARRHAL GINGIVITIS
Shostenko A.
HSEE "Bukovinian state medical university", department of pediatric dentistry, assistant
Анотащя
У данш статп наведеш отримаш результати дослщження показнишв цитошново! системи до i шсля комплексного л^вання у 82 хворих на генералiзований катаральний гiнгiвiт з хронiчним та загостреним перебiгом. Вмiст концентрацii 1Л-4, ЬЛ-ip i ФНП-а визначали в ротовш рiдинi наборами реагентiв «Протеиновый контур», «Цитокин» (Санкт-Петербург, Роая) методом твердофазного iмуноферментного ана-лiзу. Розроблено та впроваджено комплексну терапш, яка передбачае використання на рiзних етапах ль кування професiйних ппешчних заходiв, протизапальних, антибактерiальних, iмуномоделюючих препа-ратiв та пробiотикiв. В робот встановлено, що позитивна динамiка показнишв цитокiнового профiлю бiльш чiтко прослвдковувалась, по вiдношенню до вивчаемих цитошшв, у хворих з загостреним перебтем генералiзованого катарального гiнгiвiту, за рахунок використання в них запропонованого методу комплексного лшування.
Abstract
This article presents the results of the study of indicators of the cytokine system before and after complex treatment in 82 patients with generalized catarrhal gingivitis with chronic and exacerbated course. The content of the concentration of IL-4, IL-1P and TNF-а was determined in the oral fluid by the sets of reagents "Protein circuit", "Cytokine" (St. Petersburg, Russia) by enzyme-linked immunosorbent assay. Complex therapy has been developed and implemented, which involves the use at various stages of treatment of professional hygiene measures, anti-inflammatory, antibacterial, immunomodulatory drugs and probiotics. It was found that the positive dynamics of the cytokine profile was more clearly traced in relation to the studied cytokines in patients with acute course of generalized catarrhal gingivitis, due to the use of the proposed method of complex treatment.
Ключовi слова: катаральний пнпвгт, iмунокорегуюча терашя, пародонт, цитокши, запалення.
Keywords: catarrhal gingivitis, immune corrective therapy, periodontal disease, cytokines, inflammation.
It is known that in the process of implementation of inflammation in periodontal tissues involves a number of local immune mechanisms, and its development is the result of a complex intracellular cooperation, which is an important nonspecific granulocytes and macrophages.
Secretion of activated cells phagocytosis a large set of biologically active substances, mediators of cell interactions (IL-1, IL-1P, TNF-a ol), potentiates the availability of new neutrophils and monocytes-macro-phages into the site of inflammation. These processes are crucial in the initial stage of development of the immune response.
It is known that cytokines are produced by cells of the monocyte-macrophage level and lymphocytes during the development of inflammatory processes. They
stimulate the immune response and provide intercellular cooperation [1], but in some cases go beyond the only mediator functions, and by acquiring a systemic nature, trigger a cascade of pathological reactions [2]. It is proved that the accumulation in the blood serum and mixed saliva proinflammatory and reduced anti-inflammatory cytokines, is a leading factor in the patho-genesis of inflammatory and destructive processes in the organism [3].
Today zastarelosti the provision that the formation of inflammatory-destructive process in the periodon-tium is associated with a pronounced rise in blood and oral fluid proinflammatory cytokines IL-1ß and TNF-a that play a major role in the development of the progressive variant of the disease. Found a significant in-
