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Chapter 7 DISCUSSION of RESULTS of RESEARCH

For today the pathology of organs of digestion at children takes the second place in structure of the general case rate after illnesses of organs of breath. At early age to 95 % of all pathology GASTROINTESTINAL TRACT has functional character whereas the organic nature have only about 5 % of diseases [27, 92, 100].

The first year of a life is starting and the most significant in formation of health of the child in the future. It is known, that the reasons of illnesses of the person are pawned in this period of a life [67]. Such symptoms as intestinal gripes, regurgitations, constipations, meet at children of the first months of a life, according to different authors, in 40-90 % of cases and are a consequence of adaptation of an organism of the child to new conditions of existence. morfofunktsionalnogo maturing of organs GASTROINTESTINAL TRACT symptoms usually pass in process, they are the most frequent reason of the raised uneasiness of parents and an occasion to the reference to the doctor [2, 5, 35, 43-45, 60, 63, 64, 66-68, 92, 100, 103, 110, 149]. Long current FRZHKT at early age can become complicated secondary disturbances, such as a syndrome of superfluous bacteriemic growth in a small bowel and fermentopatija which, in turn, become the reason of deeper disturbances in a mucosa of an intestine (JUICE). At 87 % of children with long and persistent current FRZHKT by 6-7 years this or that chronic pathology of the alimentary system [177] is formed.

Thus, necessity of forecasting, timely diagnostics and preventive maintenance FRZHKT, and also etapnoj pathogenetic correction of the given conditions taking into account specific features of the child is indisputable. In the modern literature of the works proving the similar approach to a choice of a method of correction FRZHKT at children of early age, answering to all above-stated problems, we have not found out.

For the purpose of value definition laktaznoj insufficiency and microbic disturbances at FRZHKT at children of early age we survey 102 children at the age from 1 till 6 months. According to the Roman criteria III for children

Early age, diagnosis FRZHKT has been established at 62 children who have made the basic group (OG). The control group (KG) was made by children of the same age who do not have symptoms of any pathology. Application of the hydrogen respiratory test (VDT) with a load the lactose, recognised highly informative in diagnostics laktaznoj failures (LN), has allowed to establish presence LN at 23 (37,1 %) children. On the basis of it children OG have been sectioned into 2 subgroups: FR with LN and FR without LN.

The establishment of diagnosis FRZHKT was spent by us according to the Roman criteria III according to which at children of the first half of the year of a life distinguish following kinds FR: infantile regurgitations (MS), infantile intestinal gripes (MKK), functional constipations (FZ).

In structure FRZHKT at children surveyed by us dominated MS, they are noted at all children (100 %), in 71,0 % were observed MKK, in 4 % - FZ. At overwhelming majority of children (71,0 %) took place sochetannyj character FR.

The clinical semiology against LN had some differences: at children of this subgroup in 100 % combinations MKK and MS were observed, but was not FZ. Unlike them, at FR without LN in 100 % were observed MS and at 46,1 % from them it was unique symptom FR, with MKK they were combined in 46,1 %, with FZ - in 7,7 %.

The analysis of dynamics FRZHKT depending on age has shown, that MS is the steadiest implication FR and are observed at all children during all first half of the year of a life. MKK tend to depression with the years: become perceptible at 95,0 % of children in the first 2 months, at 72,0 % of children is elderly 34 months and at 41,2 % of children of 5-6 months. FZ, on the contrary, appear later and are observed only at the age of 5-6 months at 17,7 % of children. Combinations of symptoms at the age of 1-2 months become perceptible in 100 %, at the age of 3-4 months - at 76,0 %, at the age of 5-6 months - at 29,5 % of children.

We have not found out dependence of frequency of occurrence FR on a feeding kind. MS became perceptible at all children, both on thoracal, and on artificial feeding; MKK were a little bit more often (81,0 %) at children on thoracal feeding and only at 50,0 % of children on artificial feeding.

Exception were FZ which were observed only at children on artificial feeding (15,0 %). Combinations of symptoms at children on thoracal feeding are taped at 83 %, on artificial feeding - at 45 %.

At the majority of children surveyed by us symptoms FRZHKT have begun since 1 month - 58,0 %, is more rare from first weeks - at 29,0 %, at 9,7 % - from 2 months, at 3,3 % - from 3 months. At children with LN symptoms FR were shown not later than the first month of a life: at 21,7 % - since the first weeks, at 78,3 % - since 1 month. Unlike them, at the majority of children without LN symptoms FR were shown since one month of a life - at 46,1 % or from first weeks - 33,3 %, but at 15,4 % the beginning of symptoms FR became perceptible from 2 months, and at 5,2 % - from 3 months.

Our research has shown some features of clinical picture FRZHKT depending on presence LN. Frequency LN, on our data, had negative age dynamics. At children of 1-2 months LN it has been taped at 52,2 %, at 20,4 % in 3-4 months and in 5-6 months - at 17,4 %. The data obtained by us coincide with data of the American scientists [73] in which opinion, improvement of mastering of lactose and depression of expression MKK occurs by 3-4 months. The most frequent and long MKK at LN are observed at the age of 3-4 months. At the same age more frequent MS though the most plentiful MS are observed in 1-2 months.

For children with FR in a combination with LN feedings arising right after that corresponds to data of the American scientists [73] are characteristic MKK. Also at children with LN the expressed abdominal distention and a passage of flatus, a frequent watery chair with an acidic smell and a slime small amount becomes perceptible.

According to R.G. Barr from co-workers. [81], MKK take place not only at LN, but also without it. Our research also has taped presence MKK at 100 % of children with LN, but, at the same time, and at 63 % of children with FR without LN at which MKK arose irrespective of feeding. Thus we observed the expressed abdominal distention and the strengthened passage of flatus during a defecation at all children with MKK, irrespective of LN. Thus, in our opinion, for judgement about genesis MKK it is necessary
Research carrying out laktaznoj activity as the same symptoms can be both are bound, and are not bound with LN.

In research C.H. Lifshitz from co-workers. [129] it is shown, that concentration of hydrogen in exhaled air at children of the first months of a life is raised, that testifies to incomplete mastering of lactose, and at children with gripes as basal, and postprandialnyj hydrogen level authentically above, than in control group. On our data, basal level of hydrogen at children with FR was authentically above, than in KG, that, probably, speaks the strengthened bacteriemic growth in a small bowel. However only at LN hydrogen level considerably accrued after lactose reception. The highest level of hydrogen (basal, in 30 minutes and in 60 minutes after a load) became perceptible at children of 1-2 months.

We have noted also some age features of dynamics of symptoms FRZHKT. By results of our research, MS become perceptible throughout all first 3-4 months, but it is the most plentiful at the age of 1-2 months. A frequent watery chair with a small amount of slime and an acidic smell most typical for children at the age of 1-2 months. The expressed abdominal distention, mainly after feeding, is characteristic for children at the age of 3-4 months. More frequent and intensive passage of flatus also is characteristic for children at the age of 3-4 months. It coincides with age dynamics MKK.

We have analysed communication of character and expression FR depending on a kind of feeding and have found out some differences. According to Lucas A. [134], frequency MKK at children who are on thoracal and artificial feeding, essentially does not differ. However results of our research have shown, that at children with FR, being on thoracal feeding, authentically become perceptible MKK is more often, feedings arising right after, and also are observed more plentiful MS, and the chair has mainly watery character with a slime small amount. For children on artificial feeding are more characteristic MKK, arising through 1 hour after feeding, more rare chair with greens small amount.

Some pathological conditions of pregnancy and sorts GASTROINTESTINAL TRACT can influence maturing processes [4, 5, 149, 168]. Therefore we have studied features of the obstetric anamnesis of mothers.

Having analysed the anamnesis of children surveyed by us, we have taped authentically higher frequency of a pathology perinatalnogo the period at children with FRZHKT: the pathology of pregnancy of mother is noted at 90,3 %, a delivery by cesarean sections - at 35,5 %, application of antibiotics in sorts - at 35,5 %, a prematurity - at 8,1 %, dokarmlivanie by an admixture in maternity home - at half of children with FR (50,0 %). Children of KG did not have pathology perinatalnogo the period. Complications in sorts became perceptible at mothers of children with FR without LN (56,4 %) is more often. Antibiotics in sorts also were more often applied at mothers of children with FR without LN (53,8 %). The estimation on scale Apgar at children OG has on the average made 7,480,07 a point, in KG - 7,730,14 a point, authentic differences is not taped (> 0,05; t=1,76; Р=0,082). All children with LN were born by the full-term. Unlike them, among children with FR without LN not full-term were born 5 (12,8 %) children.

All children of KG have been enclosed to a breast right after births. Unlike them, only 64,5 % of children OG have been enclosed to a breast at once, 14,5 % - in the first days, 21,0 % - later. In subgroup FR with LN all children have been enclosed to a breast at once. Unlike them, in subgroup FR without LN than half at once are enclosed to a breast less - 43,6 % of children, in the first days - 23,0 %, after 1 days - 33,4 % of children.

In our opinion, perinatalnaja the pathology can be of great importance in development FR, influencing as on maturing of structures of an intestinal epithelium and formation of neuroendocrinal regulation GASTROINTESTINAL TRACT, and on formation intestinal mikrobioty. In the first months of a life in an intestine there is very important process of formation intestinal mikrobioty. Research, I. Adlerberth in 2009, has shown, that the qualitative structure mikrobioty depends on variety of factors: microfloras of an intestine and patrimonial ways of mother, a way of a delivery, applying time to a breast, character of feeding, appointment of antibacterial preparations and vaginal antiseptics in sorts, environments of the child, in particular - duration of its stay in maternity home [75].
Dynamic molekuljarno-genetic research of an intestinal microbiocenosis of children of the first year of the life, spent C. Palmer from co-workers. [99], has confirmed, that individuality of structure mikrobioty is traced already since a birth. But in the first months of a life mikrobiota it is rather small, astable, subject to external and internal influences. In the course of its formation are possible disbioticheskie deviations which can be reflected in a functional condition GASTROINTESTINAL TRACT, that is participate in formation FRZHKT.

For the purpose of an estimation of a condition of a microflora of an intestine at all observable children we had been spent feces crops on a dysbacteriosis and quantitative PTSR a feces.

As a result of our research it is taped, that, according to feces crops, the quantity of is conditional-pathogenic bacteria at children with FRZHKT has been authentically raised, in comparison with KG. Quantity Citrobacter freundiiбыло raised in all groups, above at children on artificial feeding (4,950,35 WHICH/G), in KG its quantity corresponded to admissible norm. Quantity Klebsiella oxytocaбыло raised in all groups, above at children with LN (5,260,40 WHICH/G), more low in KG. Quantity Klebsiella pneumoniaeбыло raised in all groups, above at children on thoracal feeding (5,610,25 WHICH/G), more low in KG. Staphylococcus aureusобнаружен in all groups, with the greatest quantity at children with LN (4,300,13 WHICH/G), in KG - 2,150,42 WHICH the data obtained by us about rising of quantity of is conditional-pathogenic flora in an intestine at children with FR coincide with data F. Savino and co-workers. [79].

According to PTSR a feces, the total of microbes at children with FR has been lowered (10,100,09 WHICH/G), in comparison with KG (10,190,10 WHICH/G), it raised only at the age of 5-6 months (10,220,16 WHICH/G) a little. The quantity bifidobaktery at children OG has been lowered (8,710,14 WHICH/G), and authentically differed from KG (9,410,14 WHICH/G). The quantity laktobaktery was more low at children on thoracal feeding (5,850,32 WHICH/G), a little above at children on artificial feeding (6,740,59 WHICH/G). Quantity Bacteroides fragilisво all groups was within norm, above at children with FR at the age of 5-6 months (8,780,20 WHICH/G).

According to L. Lehtonen and co-workers. [128], with MKK it is more often found out in children Clostridium difficile, differing by appreciable proinflammatory effect. We have received similar results. On our data, quantity Clostridium difficileповышено at all children with FR, including with MKK, above at children on artificial feeding (6,260,54 WHICH/G). Quantity Enterococcus spp.во all groups was within norm, above - at children with on artificial feeding (6,130,13 WHICH/G). Quantity Klebsiella pneumoniaeповышено in all groups, above at children with LN (4,660,27 WHICH/G). Quantity Faecalibacterium prausnitziiбыло above at children with FR at the age of 1-2 months (5,130,67 WHICH/G).

The intestinal microflora exists in constant interaction with an epithelium and immune system of an intestine, it posesses the major role of a stimulator of immune system, both structurally, and is functional. Under the influence of microbic stimulus there is an activation of membranous and cellular receptors, the differentiation of Th-lymphocytes is regulated, there is a development of cytokines and secretory IgA, permeability of an epithelium decreases, the protective barrier of an intestine becomes stronger. Morfologicheski it is accompanied by weak signs of an inflammation in a mucosa of an intestine (JUICE) - insignificant limfoplazmotsitarnoj infiltration of own plate which reflects process of adaptation and can be recognised by "physiological". In an intestine kalprotektina level can serve in a feces to one of possible markers of an inflammation.

According to our research, level kalprotektina at children with FR has averaged 344,5825,32 mkg/g, that authentically above, than in KG - 82,926,47 the mkg/g (p

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Scientific source KUBALOVA Saida Sultanovna. CLINICAL VALUE LAKTAZNOJ of INSUFFICIENCY And MICROBIC DISTURBANCES AT FUNCTIONAL DISORDERS of the GASTROENTERIC TRACT At CHILDREN of EARLY AGE. The dissertation on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg - 2014. 2014

Other medical related information Chapter 7 DISCUSSION of RESULTS of RESEARCH:

  1. THE TABLE OF CONTENTS
  2. CHAPTER 4. DISCUSSION
  3. Chapter 4 Discussion of the received results
  4. THE TABLE OF CONTENTS
  5. Chapter 7 DISCUSSION of RESULTS of RESEARCH
  6. CHAPTER 8. THE CONCLUSION (DISCUSSION OF THE RECEIVED RESULTS)
  7. INTRODUCTION
  8. CHAPTER №5 DISCUSSION
  9. the Table of contents
  10. Chapter 5 Discussion of the received results
  11. Chapter 7 DISCUSSION of RESULTS of RESEARCH
  12. THE TABLE OF CONTENTS
  13. CHAPTER 4. THE CONCLUSION (DISCUSSION OF THE RECEIVED RESULTS)
  14. THE TABLE OF CONTENTS
  15. Chapter 7 DISCUSSION of RESULTS of RESEARCH