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2.2 CHARACTERISTIC OF PATIENTS

At a preliminary stage of work it is spent klinikoyoinstrumentalnoe inspection of 137 children with the diagnosis «Jet arthritis», were, on inspection and treatment in DRKB №2 (Saransk, Mordovia) with 2003 for 2007 At the majority of patients sharp flow of disease took place.

In the report further klinko-imunologicheskogo the research spent from approval of Local ethical committee at the Moscow State University of N.P.Ogaryov, at the age from 6 till 15 years with a long and chronic jet arthritis, assotsiirovannym with hlamidijnoj the aetiologies, arrived in a hospital 58 children who have compounded the basic bunch of research are included in stages of an aggravation of process. Children were excluded from research with JURA, patients, seropozitivnye io revmatoidnomu to the factor, children with other differentiated variants of jet arthritises (virus, iersinnoznye), and also with the established variants of chronic arthritises (psoriatichesky an arthritis, ankilozirujushchy spondiloartrit, an arthritis at diseases of an intestine, etc.).

The clinical characteristic of patients is presented in table 3. Diagnosis ReA was established on the basis of the "Berlin" criteria (Kingsly G., Sicper J., 1996) and E.I.Alekseevoj's recommendations and co-authors (2005). Hlamidijnaja the infection contamination is confirmed by laboratory methods (with detection of antibodies in a blood plasma the immunoenzyme method) at 56 children, thus at 12 patients in addition reveals antibodies to hlamidijam in joint oil or microorganism antigens in scrapings from an urethra or with konjunktivy an eye. At the remained 2 patients in an illness debut the full clinical picture of syndrome Rejtera with a lesion of eyes and urogenitalnogo a path and laboratory diagnostics, facultative in this case for diagnosis statement (Alekseeva E.I. and soavt took place., 2003) io to the different causes it has not been spent. IFA spent with use of the analyzer and a standard panel of reactants for detection of antibodies of a class And, M and G to Ci Pneumoniae and With/. Trachomatis.

All patients received etiotropnuju therapy by antibiotics in flow of 7 days, symptomatic NTTVP-THERAPY diklofsnak-natrism in daily ’ to a dose of 2-3 mg/kg not less than 4 weeks, local injections GKS (depot - medrola) and, under indications, basic treatment.

All children have been surveyed under the program of the basic disease: JURA, JUAS and other differentiated forms of juvenile chronic arthritises have been excluded. From concomitant diseases at the majority of children the pathology (45 %), and also caries and a periodontosis (31,3 %) is revealed LOR.

TablitsaZ

The clinical characteristic of children included in the basic bunch of research

Chronic jet argri gy hlamidijnoj aetiologies
Number of patients 58
Boys 35
Girls 23
Middle age 11,2±0,6

A little bit less often (26 %) pathology ZHKT in the form of a dyskinesia zhelchevyvodjashchih pathes, a chronic cholecystitis, a jet pancreatitis, an intestine dysbacteriosis, hr was observed.

gastroduodenita, vegeto - a vascular dystonia, Mars and-functional kardnonatii (22,3 %), dizmetabolicheskie nefropatii (3,6 %), ljamblioz and helminthic invazii (11 %), atopicheskie diseases (5,3 %).

On character of therapy children with chronic ReA hlamidijnoj aetiologies were randomizirovany on 3 bunches (tab. 4):

- Patients of 1st bunch (п=20) received the standard scheme of treatment and derinat,

-Patients of 2nd bunch (п=20)-standard therapy and likopid, one of most good itself. The immunomodulating factors which have recommended and awakely used at a given pathology (Alekseeva E.I. and soavt., 2005; Valieva S.I., 2005),

- Patients of 3rd control bunch (п=18) — only the standard scheme of treatment. '

All bunches of patients were comparable on the cores poloyovozrastnym to indicators, duration of disease and character of an articulate syndrome. Last in all bunches has been presented, basically, oligoartritom (61-65 %) with primary involving in process of joints of feet. Duration of disease did not exceed 3 years and

Таблица4

The clinical characteristic of patients ReA. Included in research

Indicator Allocation of patients by therapy variants
Grujpa 1, п=20 Bunch 2, п=20 Bunch 3, п=18
Girls/boys 9/11 7/13 7/1 1
hronncheeky / a long arthritis 16/4 15/5 14/4
Average vozrasg, years И.5+0,3 11,1+0,4 10,3 + 0,5
Duration of illness, years 2,8+0,5 2,5+0,3 2.5+0.2
Anatomical class 1,0±0,1 0,7+0,1 0,8+0,1
Functional class 1,3±0.4 1,5±0,3 1,7±0,5
Laboratory activity L7+0.3 1,5+0,3 1,5±0,4

Has averaged 2,67+0,3 years. At change roentgenography are revealed at 20 % of patients in a kind okolosustavnogo an osteoporosis and an illegibility of articulate surfaces and 5,5 % of patients - in the form of individual uzur and narrowings sutavnoj clefts. The anatomical class of illness corresponded 0,9+0,09 on SHtejnbrokkeru. Functional infringements did not confine ability of children to self-service. FK illnesses has compounded 1,5+0,3. Laboratory activity of process corresponded 1 2 degrees (1,6+0,4).

*

Immunomodulating factors according to E.I.Alekseevoj's recommendations and co-authors (2005) applied within a week prior to the beginning of antibacterial therapy, in parallel with it (within 7 days) and even a week after the treatment terminal sumamedom or rulidom. Likopid (Joint-Stock Companies "Пептек") appointed from calculation of 10 mg/sut within 21 days. For 8 day connected an antibiotic. Derinat applied from calculation of 2,5-5 ml v/m in day in number of 10 injections. An antibiotic connected after 4 injections of a preparation.

For analysis of a state of the basic indicators of the immune status research of the heparinized blood taken asepticheski from an elbow vein on morning to meal at 88 children (58 of the basic bunch and 30 healthy), from them 39 girls and 49 boys is carried out. Research of indicators of the basic immune responses was spent twice: at receipt and chsrez40-41 day from the treatment beginning. Research 34 immunologicheskih parametres is carried out. The assessment of the immune status is spent at 38 children with ReA, not having in the anamnesis congenital immunodefitsitnyh states before and after various schemes of treatment. Research was spent at children of 1 bunch (p-20), receiving in addition derinat and patients 3 control bunches (п=18), receiving standard treatment.

The standard bunch was compounded by practically healthy 30 children of a city of Saransk, selected on a principle of the random sample, clinical signs not having at the moment of inspection immunopatologii.

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Scientific source RODIONOVA SVETLANA VIKTOROVNA. STUDYING of EFFICACYY of IMMUNOMODULATING FACTOR DERINATA In TREATMENT of CHRONIC JET ARTHRITISES HLAMIDIJNOJ of the ETIOLOGY At CHILDREN. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. Saransk 2007 . 2007

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