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10ПРИМЕНЕНИЕ ТРАНСКРАНИАЛЬНОЙ ЭЛЕКТРОСТИМУЛЯЦИИ И ТЕРАПИИ САНТИМЕТРОВЫМИ ВОЛНАМИ ПРИ ДИСБИОЗЕ ТОЛСТОЙ КИШКИ В ЗАВИСИМОСТИ ОТ МОРФОЛОГИЧЕСКИХ ИЗМЕНЕНИЙ
Мадумарова Алмаза Анваровна Хамрабаева Феруза Ибрагимовна
Центр развития повышения профессиональной квалификации медицинских работников
Цель исследования - изучить состояние изменения слизистой оболочки краев дуоденальных язв во взаимосвязи с инфицированностью Helicobacter pylori у пациентов язвенной болезнью двенадцатиперстной кишки (ЯБДПК) с толстокишечным дисбиозом под влиянием транскраниальной электростимуляции и СМВ-терапии. Исследовано 57 пациентов. Женщин было 22, мужчин 27. В возрасте от 18-65 лет. У всех пациентов был диагностирован ЯБДПК с ДК. Больные были разделены на 3 группы, кроме контрольной: пациентов получавших СМВ-терапию на область дуоденального треугольника - 23 больных, пациентов получавших терапию транскраниальной электростимуляцией (ТЭС) - 19 больных, пациентов получавших СМВ-терапию на область дуоденального треугольника и ТЭС терапию- 15 больных. Контрольную группу составляли пациенты (20 пациентов) получавшие стандартную эрадикационную терапию. Полученные результаты показали, схемы терапии с включением физических факторов, а именно, СМВ -терапию на область дуоденального треугольника и ТЭС терапию по своей морфологической эффективности существенно превзошли аналогичную направленность эффектов стандартных схем эрадикационной терапии. Не исключено, что более высокая эффективность схем с включением физиотерапии связана с более положительной динамикой этих схем по отношению к элиминации хеликобактерной инфекции.
Ключевые слова: язва двенадцатиперстной кишки, дисбактериоз, ТЭС, СМВ, физиотерапия.
MORFOLOGIK O'ZGARISHLARGA QARAB YO'G'ON ICHAK DISBIYOZIDA TRANSKRANIAL ELEKTR STIMULYATSIYASI VA SANTIMETR TO'LQIN TERAPIYASIDAN FOYDALANISH
Tadqiqot maqsadi transkranial elektr stimulyatsiyasi va CMW terapiyasi ta'sirida yo'g'on ichak disbiyozi bilan og'rigan o'n ikki barmoqli ichak yarasi (OIBIY) bilan og'rigan bemorlarda qirralarining shilliq qavatidagi o'zgarishlar holatini o'rganish edi. 57 nafar bemor tekshirildi. 22 ayol, 27 erkak 18-65 yoshda. Barcha bemorlarga OIBIY bilan Dtashxisi qo'yilgan. Bemorlar nazorat guruhidan tashqari 3 guruhga bo'lingan: o'n ikki barmoqli ichak uchburchagi sohasida CMW terapiyasi olgan bemorlar - 23 bemor, transkranial elektr stimulyatsiyasi (TES) bilan terapiya olgan bemorlar - 19 bemor, qabul qilingan bemorlar O'n ikki barmoqli ichak uchburchagi sohasida CMW terapiyasi va TES terapiyasi - 15 bemor. Nazorat guruhi standart eradikatsiya terapiyasini olgan bemorlardan (20 bemor) iborat edi. Olingan natij alar shuni ko'rsatdiki, jismoniy omillarni o'z ichiga olgan terapiya sxemalari, ya'ni o'n ikki barmoqli ichak uchburchagi sohasida CMW terapiyasi va TES terapiyasi o'zlarining morfologik samaradorligi bo'yicha standart eradikatsiya terapiyasi sxemalari ta'sirining o'xshash yo'nalishidan sezilarli darajada oshib ketdi. Fizioterapiyani o'z ichiga olgan sxemalarning yuqori samaradorligi Helicobacter pylori infektsiyasini bartaraf etishga nisbatan ushbu sxemalarning yanada ijobiy dinamikasi bilan bog'liq bo'lishi mumkin.
Kalit so'zlar: o'n ikki barmoqli ichak yarasi, disbakterioz, TES, CMW, fizioterapiya.
THE USE OF TRANSCRANIAL ELECTRICAL STIMULATION AND CENTIMETER WAVE THERAPY FOR COLONIC DYSBIOSIS DEPENDING ON MORPHOLOGICAL CHANGES
The aim of the study was to study the state of changes in the mucous membrane of the edges of duodenal ulcers in conjunction with infection with Helicobacter pylori in patients with duodenal ulcer (DU) with colonic dysbiosis under the influence of transcranial electrical stimulation and CMV therapy. The studies were carried out in 57 patients with DU with intestinal dysbiosis (DK). There were 22 women, 27 men. At the age of 18-65 years. All patients were diagnosed with DU with DC. Patients were divided into 3 groups, except for the control group: patients who received CMW-therapy in the area of the duodenal triangle - 23 patients, patients who received transcranial electrical stimulation (TES) therapy - 19 patients,
patients who received CMW-therapy in the area of the duodenal triangle and TES therapy - 15 patients. The control group consisted of patients (20 patients) receiving standard eradication therapy.
Thus, the therapy regimens with the inclusion of physical factors, namely, CMW-therapy on the area of the duodenal triangle and TES therapy, in terms of their morphological effectiveness, significantly exceeded the similar direction of the effects of standard eradication therapy regimens. It is possible that the higher efficiency of schemes with the inclusion of physiotherapy is associated with a more positive dynamics of these schemes in relation to the elimination of Helicobacter pylori infection.
Keywords: duodenal ulcer, dysbiosis, TES, CMV, physiotherapy.
Purpose of the study - to study the state of changes in the mucous membrane of the edges of the duodenal ulcer under the influence of TES and CMW therapy in patients with dysbiosis.
Material and research methods. The studies were carried out in 57 patients with intestinal dysbiosis (ID). There were 22 women, 27 men. At the age of 18-65 years. All patients were diagnosed with DC. The patients were divided into 3 groups: 23 patients who received CMW therapy for the duodenal triangle area, 19 patients who received transcranial electrical stimulation (TES) therapy, 15 patients who received CMW therapy for the duodenal triangle and TES therapy. The control group consisted of patients (20 patients) who received standard eradication therapy according to the recommendations of the Maastricht V/Florence consensus for the Helicobacter pylori infection treatment (2017): PPI 2 times a day for 14 days; 2 antibiotics 2 times a day for 14 days; Bismuth tripotassium dicitrate 120 mg 4 times a day; Probiotic preparation in the appropriate daily dose for 14 days;
A comprehensive assessment of the general histological structure of the mucous membrane of the edges of duodenal ulcers was carried out after endoscopic examination with the taking of material for histological examination in 51 patients with localization of the ulcer in the duodenum. Histological preparations were assessed in accordance with the modern classification of chronic gastritis by M. Dixon (2006), recommendations by L.I. Aruina (2008) and V.Yu. Golofeevsky (2004).
Microscopy of histological preparations focused on the state of the epithelium and the height of the villi and crypts (enterocytes, goblet cells), the presence of dystrophy, atrophy and foci of gastric metaplasia, and assessed the condition of the Brunner glands.
In addition, the condition of the stroma (severity of neutrophilic, eosinophilic, lymphocytic and plasmacytic infiltration) was assessed qualitatively and semi-quantitatively (in 10 fields of view), which, as is known, is directly involved in the immune regulation of the processes of regeneration and differentiation of epitheliocytes, implements the mechanisms of immune defense, involved in the formation of acute and chronic inflammation.
Research results: In patients with peptic ulcer localized in the duodenal bulb, the main morphological features were pronounced dystrophy of villi enterocytes, a decrease in the number of goblet cells in the villi and crypts, a decrease in the height of the villi, as well as areas of gastric villus metaplasia.
In patients, a certain relationship of morphological changes with the fact of infection with Helicobacter pylori was also noticed. Thus, moderate and severe dystrophy was observed much more often in the presence of infection with Helicobacter pylori (44.7% of cases). In the absence of Helicobacter pylori infection, epithelial dystrophy was observed only in 8 patients, while the severity of dystrophic changes was minimal. However, the differences between the frequency of villous dystrophy and atrophy at the edges of duodenal bulb ulcers in the compared groups of patients were not significant.
Therefore, the known facts have been confirmed that dystrophy and atrophy in the mucous membrane of the duodenal bulb are regular morphological elements of duodenal ulcers, and even more so in its edges. Apparently, therefore, no fundamental connection between these changes and infection with Helicobacter pylori was found. Gastric metaplasia of villi enterocytes was detected
in a total of 38 of 59 patients, but the frequency of detected infection with Helicobacter pylori had only a non-significant tendency to be higher than in patients without gastric metaplasia. Therefore, one should agree with the point of view that gastric metaplasia can be a compensatory morphological factor in conditions of inflammation and dystrophy of the bulbar mucosa in patients with duodenal ulcers.
In this regard, the results of the assessment of the stroma of the mucous membrane of the edges of ulcers of the duodenal bulb and morphometry are of the greatest interest. inflammatory infiltrate in the examined patients before treatment (table 1) and after treatment (table 2).
Table 1.
Morphometric characteristics of the stroma of the mucous membrane of the edges of
u cers of the duodenal bulb before treatment
1 group n=20 2 group n=23 3 group n=19 4 group n=15
Neutrophil infiltration 322±112 487±98 401±89 326±89
Lymphocytic infiltration 3697±115 2997±157 3025±412 2689±501
Plasma cell infiltration 3266±254 3122±239 2798±405 4123±304
Table 2.
Morphometric characteristics of the stroma of the mucous membrane of the edges ulcers of
the duod enal bulb aft ter treatment
1 group n=20 2 group n=23 3 group n=19 4 group n=15
Neutrophil infiltration 212±62 177±53* 115±15** 110±18**
Lymphocytic infiltration 800±92** 904±69* 225±25** 189±92**
Plasma cell infiltration 2266±250 1922*237 1898±405 1723±214*
Note: * - р < 0,05; ** ^ < 0,001.
From the tables and figures, it is obvious that against the background of the ongoing eradication therapy according to any schemes, a clear improvement in morphometric parameters characterizing the inflammatory process in the edges of ulcerative defects of the duodenal bulb was noted. At the same time, the most pronounced changes were related to a decrease in the density of neutrophilic and lymphocytic infiltration in almost all groups of patients.
At the same time, the data obtained allow us to state that the inclusion of physical factors in the treatment regimens leads to a more pronounced positive change in the cellular composition of the duodenal mucosa. Thus, the density of neutrophilic (from 401±89 - 326±89 to 115±15 -110±18, respectively, in the 3rd and 4th groups, p < 0.001) and lymphocytic (from 3025±412 -2689± 501 to 225±25 - 189±92, respectively, in the 3rd and 4th groups, p < 0.001) of infiltration, which in turn may indicate a decrease in the activity of inflammatory and immunoinflammatory processes. In addition, it was noted that the inclusion of TES in eradication therapy significantly (p<0.05) reduces the density of plasmacytic infiltration in the 4th group of patients (from 4123±304 to 1723±214).
The density of inflammatory infiltration is closely related to such morphological changes as microcirculation disorders (vasodilation, sludge, leukopedesis and erythrocytopedesis) and
mucosal stromal edema. It is characteristic that in the 3rd and 4th groups these changes were almost completely stopped during the control histological examination.
Thus, the therapy regimens with the inclusion of physical factors, namely, CMW-therapy on the area of the duodenal triangle and TES therapy, in terms of their morphological effectiveness, significantly exceeded the similar direction of the effects of standard eradication therapy regimens. It is possible that the higher efficiency of schemes with the inclusion of physiotherapy is associated with a more positive dynamics of these schemes in relation to the elimination of Helicobacter pylori infection.
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