ASSESSING THE SIGNIFICANCE OF LOCAL INFLAMMATORY CHANGES IN THE BRONCHIAL TREE FOR THE EFFICACY OF PULMONARY TUBERCULOSIS TREATMENT

Introduction. Currently, there are very few studies analyzing the treatment results of pulmonary tuberculosis patients with local inflammatory changes in the bronchial tree caused by both M. tuberculosis and non-specific microflora, and factors affecting the disease outcome. The domestic and foreign literature data available do not allow us to make a definitive conclusion about the possible prognosis of the disease outcome and the timing of treatment, there is no algorithm developed for the management of such patients in phthisiological practice. The above was the reason for the scientific search for ways to solve the problem of treating pulmonary tuberculosis patients with inflammatory changes in the bronchial tree. Aim. The aim of the study was to assess the importance of local inflammatory changes in the bronchial tree for the efficacy of pulmonary tuberculosis treatment. Materials and Methods. A retrospective-prospective cohort study was conducted, that had included 403 patients with pulmonary tuberculosis. The study included the study group (n=195) with local inflammatory changes in the bronchial tree and the comparison group (n=208) without any inflammatory changes in the bronchi. In patients with local inflammatory changes of the bronchi, a diagnostic forceps biopsy of the bronchial mucosa was performed to confirm the inflammatory lesion. The biopsy material was examined microscopically. The data were processed statistically using parametric and nonparametric criteria. Results and Discussion. The average duration of relief of local inflammatory changes was 3.083±0.213 months for patients with histologically confirmed tuberculous lesion of the tracheobronchial tree and 3.044±0.104 months for patients with nonspecific bronchial lesion. Decay cavities are closed on average in the 3rd month of treatment (in 3.052 and 3.202 months in the study group and in the comparison group, respectively), with no significant difference between the groups. There were no differences between the groups in the dynamics of the timing of closure of the decay cavities, the number of successful cases of treatment in the groups, and abacillation. Local inflammatory changes in the tracheobronchial tree in patients do not increase the timescales of abacillation or the rate and number of successful cases of closure of destructive changes in the patients of the groups studied. Duration and efficacy of treatment depend on the form of tuberculosis and the nature of the tuberculous process course. Conclusions. Local inflammatory changes in the tracheobronchial tree do not increase the timescale of abacillation or the rate and number of successful cases of closing the destructive changes in the patients in the groups under study. Timing of remedying local inflammatory changes depends on the possibility of selecting an adequate chemotherapy regimen. The use of additional local treatments in association with the restriction of the main chemotherapy regimen has less effect than standard unrestricted chemotherapy. Of all the additional local treatments, only the peribronchial administration of anti-tuberculosis drugs associated with the restrictions of the main chemotherapy regimen is comparable to the standard unrestricted regimen in efficacy.