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20УДК: 616-006.441 + 616.34-008.87
EXPERIENCE OF TREATMENT BY YOGHURT TYPE PROBIOTICS IN PATIENTS SUFFERING FROM INTESTINAL DYSBIOSIS, WHICH DEVELOPED ON BACKGROUND OF POLYCHEMOTHERAPY OF HODGKIN'S LYMPHOMA (BEACOPP-II)
KALIBERDENKO VITALIIBORISOVICH MD, Associate professor, V.I. Vernadsky Crimean Federal University, Simferopol, Russia.
ORCID: 0000-0003-1693-3190 KHAMIDOVA SITORA ALISHER QIZI Student, V.I. Vernadsky Crimean Federal University, Simferopol, Russia.
ORCID: 0000-0003-0587-6995 KUZNETSOV EDUARD SERGEEVICH Assistant, V.I. Vernadsky Crimean Federal University, Simferopol, Russia. ORCID: 0000-0001-8309-7810 ABSTRACT
A study was conducted of the effectiveness of the use of yoghurt type probiotics in 136 patients with lymphogranulomatosis suffering from dysbacteriosis of the gastrointestinal tract developed on background of antibacterial therapy and polychemotherapy (BEACOPP-II). It was revealed that these types of dietary supplements are effective for the treatment of intestinal dysbiosis in patients with oncological and hematological disorders. Their use reduces the risk of complications developing such as: an unpleasant taste in the mouth, belching, heartburn, diarrhea, constipation, flatulence, discomfort, or recurrent abdominal pain. Long-term therapies with probiotic-type yogurt in these groups of patients are may recommended.
Keywords: probiotic, dysbacteriosis, eubiosis, dyspepsia, lymphogranulomatosis, polychemotherapy.
ОПЫТ ИСПОЛЬЗОВАНИЯ ПРОБИОТИКОВ ТИПА ЙОГУРТА У
БОЛЬНЫХ СТРАДАЮЩИХ ДИСБИОЗОМ КИШЕЧНИКА, ВОЗНИКШЕМ НА ФОНЕ ПОЛИХИМИОТЕРАПИИ ЛИМФОМЫ
ХОДЖКИНА (BEACOPP-II)
КАЛИБЕРДЕНКО ВИТАЛИЙ БОРИСОВИЧ кандидат медицинских наук, доцент, Крымский федеральный университет имени В.И. Вернадского, Симферополь, Россия.
ОР.ОЮ: 0000-0003-1693-3190 ХАМИДОВА СИТОРА АЛИШЕР КИЗИ студент, Крымский федеральный университет имени В.И. Вернадского, Симферополь, Россия.
ORCЮ: 0000-0003-0587-6995 КУЗНЕЦОВ ЭДУАРД СЕРГЕЕВИЧ ассистент, Крымский федеральный университет имени
В.И.Вернадского, Симферополь, Россия.
ORCID: 0000-0001-8309-7810 АННОТАЦИЯ
Было проведено исследование эффективности применения пробиотиков типа йогурт у 136 больных лимфогранулематозом, страдающих дисбактериозом желудочно - кишечного тракта на фоне приема антибактериальной терапии и полихимиотерапии (BEACOPP-II). Выявлено, что биологически активные добавки данного типа являются эффективными для лечения дисбакте-риоза кишечника у онкологических и гематологических больных. Их применение снижает риск развития таких осложнений как: неприятный привкус во рту, отрыжка, изжога, диарея, запоры, метеоризм, дискомфорт или периодические боли в животе.
Рекомендовано проведение длительной терапии препаратом пробиотиком типа йогурт у указанных групп больных.
Ключевые слова; пробиотик, дисбактериоз, эубиоз, диспепсия, лимфогранулематоз, полихимиотерапия
ХОДЖКИН ЛИМФОМАСИ (ВЕАСОРР-П) ПОЛИХИМИОТЕРАПИЯСИДАН КЕЛИБ ЧИККАН ИЧАК ДИСБИОЗИДА ЙОГУРТ ПРОБИОТИКИНИ ИШЛАТИШ
ТАЖРИБАСИ КАЛИБЕРДЕНКО ВИТАЛИЙ БОРИСОВИЧ тиббиёт фанлари номзоди, доцент, В.И. Вернадский номидаги Крим федерал университети, Симферополь, Россия.
ОР.ОЮ; 0000-0003-1693-3190 ХАМИДОВА СИТОРА АЛИШЕР КИЗИ В.И. Вернадский номидаги Крим федерал университети талабаси, Симферополь, Россия.
ОР.ОЮ; 0000-0003-0587-6995 КУЗНЕЦОВ ЭДУАРД СЕРГЕЕВИЧ В.И. Вернадский номидаги Крим федерал университети ассистенти, Симферополь, Россия.
ОР.ОЮ; 0000-0001-8309-7810 АННОТАЦИЯ
136 беморда лимфогранулематоз полихимиотерапиясидан келиб чиккан ичак дисбиозида йогурт пробиотикини ишлатилган. Ушбу пробиотикнинг онкологик ва гематологик касалликларида ичак дисбиозида эффективлиги аникланган. Уни ишлатиш ножуя холатлар - огиздаги ёмон хислар, кекириш, зарда кайнаши, диарея, ич котиши, кориндаги огриклар, метеоризмларнинг олдини олади. Йогуртни ушбу касалликларда ишлатиш тавсия берилади.
Калит сузлар: пробиотик, дисбактериоз, эубиоз, диспепсия, лимфогранулематоз, полихимиотерапия.
Given the growing public adherence to malnutrition and the frequent use of antibacterial drugs, problems of the occurrence of dysbiosis disorders of the gastrointestinal tract annually increase - [1]. Along with other reasons, the use of antibacterial drugs are one of the main cause of intestinal dysbiosis. At present, dysbacteriosis is observed predominantly of natural microbial genesis. What is explained by the violation of the homeostasis of the natural microflora of the gastrointestinal system, leading to the occurrence of intestinal dysbiosis. The prevalence of this clinical condition among all age groups in the human population exceeds more than 90% and is constantly increasing -[2]. This adversely affects the clinical course, diagnosis and treatment of various nosologies, leading to a worsening of the course of various diseases and their path morphism - [3, 4]. Traditionally, the correction of dysbiosis states is achieved by introducing microbial associations of a healthy person in the form of probiotics into the patient's digestive system - [5]. But most modern drugs around the world are based on a limited number of bacterial strains, which are often poorly effective - [6, 7]. Probiotics such as yogurt are especially recommended when conducting antibacterial therapy, taking cytotoxic drugs, as well as for correcting the microflora of the digestive system in people with lactase deficiency. That is due to the simplicity of their reception and relatively high bioavailability. Probiotics such as yogurt are widely used as part of complex treatment of various pathological conditions, including diseases of the gastrointestinal tract, cancer with long courses of polychemotherapy, which are characterized by the suppression of normal microflora with the development of dysbiosis syndrome - [8, 9, 10].
Aim of the study. To study the effectiveness of probiotic therapy in patients with dysbiosis initiated by polychemotherapy, antibacterial therapy in conditions of oncological vigilance. To determine the effectiveness of probiotic preparations such as yogurt in patients with the above mentioned conditions.
Materials and methods. The study was conducted on the basis of the results of treatment of 136 patients with Hodgkin's lymphoma, suffering from intestinal dysbiosis with and / or after polychemotherapy (BEACOPP-II protocol) and its concomitant antibacterial therapy. The study involved patients with excluded organic pathology of the digestive system: scars, erosion, hernia of the esophagus, gastritis, peptic ulcer of the stomach and duodenum, ulcerative colitis, Crohn's disease, primary tumors of the gastrointestinal tract; diseases leading to excretory insufficiency of the liver and pancreas. The patients underwent a polychemotherapy course in the conditions of the hematology and chemotherapy department of the State Budgetary Institution of Healthcare of the Republic of Crimea "Crimean Republican Oncology Clinical Center named after VM Efetov" in Simferopol, from April 2015 to March 2017. The drug used in the study contained: lyophilic dried microbial composition of living strains of lactobacilli (Lactobacillus rhamnosus and Lactobacillus Murinus), differing from other lactobacilli by a more pronounced (by 40 - 45%) viability in the presence of antibiotics and possessing a higher activity (by 35-40%) in suppressing pathogenic and conditionally pathogenic microflora. Statistical processing of the results was carried out using Microsoft Office Excel 2013, with the calculation of the t-criteria using the Student's method for relative values, the data were considered reliable at t = 2, the accuracy of Pt = 95.5% and the risk of error p <0.05.
Results of the research 136 patients with Hodgkin's lymphogranulomatosis who received a course of polychemotherapy and
had an intestinal dysbacteriosis developed on the background of receiving antibacterial therapy were examined. During the initial examination of patients, it was revealed that 47 (34.56%) patients had grade II dysbiosis, and 89 (65.44%) patients had grade I dysbiosis. In 31 (22.79%) patients, dyspepsia was observed by the type of dyspepsia / unstable stool, dyspepsia / constipation was observed in 18 (13.24%) of the patients examined. Flatulence was observed in 32 (23.53%) patients prior to the initiation of probiotic therapy. 55 (40.44%) patients complained of discomfort and abdominal pain. Only the most subjective, clinically significant syndromes were taken into account. The results of a retrospective analysis and dynamic examination of 136 patients before and after treatment of intestinal dysbiosis against the background of taking antibacterial, radiation and chemotherapy, and / or after them (see table 1). After a 2 month treatment with a probiotic type drug, yogurt was recorded in the study group: degree II dysbiosis was not observed in the observed patients, degree I dysbiosis was detected in 42 (30.88%) patients. Unstable stool, diarrhea after 2 months of treatment was determined in 3 (2.21%) patients. Constipation after treatment was observed in 2 (1.47%) of the investigated. Flatulence was detected in 6 (4.41%) patients. Discomfort and abdominal pain were observed in 8 (5.9%) patients after a course of treatment. In 23 (16.91%) of the observed patients, after 2 months of treatment with a probiotic drug such as yoghurt, grade I dysbiosis was bacteriologically determined, despite the absence of any clinic and complaints of the digestive system on the part of patients. In 94 (69.1%) people, intestinal eubiosis was clinically and bacteriologically determined. The significance of the difference for all the above groups is t = 2, Pt = 95.5% and p <0.05.
Table 1. Clinical status of patients with Hodgkin's lymphoma with intestinal dysbiosis before and after using probiotic therapy.
Conclusion: Probiotic drugs such as yogurt are highly effective in correcting intestinal dysbiosis in cancer and hematological patients on the background of chemotherapy and concomitant antibiotic therapy and / or after it.
It is proved that the use of probiotics such as yogurt significantly reduces in patients with dysbacteriosis, developed on the background of polychemotherapy, accompanied by the use of antibacterial agents, the prevalence of such dyspeptic disorders such as unpleasant taste in the mouth, belching, heartburn, diarrhea, constipation, flatulence, discomfort or periodical pain in the stomach. A probiotic therapy, lasting from 2 months to more, makes it possible to correct such conditions as dysbiosis of I and II degrees, contributing to the eubiosis of the intestines in a significant part of the observed patients.
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