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CHAPTER 7. THE PATHOGENETIC SUBSTANTIATION AND TREATMENT OF CHILDREN WITH THE LONG SUBFEBRILE CONDITION

High frequency of the registration, often ill children, prevalence in a clinical picture, along with a long subfebrile condition, symptoms active replikatsii gerpesvirusov, such as, a lymphadenopathy, gepatosplenomegalija, a tonsillitis, long intoksikatsionnyj the syndrome, laboratory acknowledgement of activity GVI, served as a substantiation to carrying out etiopatogeneticheskoj and immunokorregirujushchej to therapy.

At razrabotkeprogrammy treatments sick gerpesvirusnoj an infection with long subfebrilitetomispolzovali the pathogenetic approach. Efficiency of use of a causal treatment was estimated on retrogress of clinical symptoms, such as: change of character of a temperature curve, a tonsillitis, a lymphadenopathy, gepatosplenomegalija., frequency of diseases ORVI and anginas during observation.

As the indicators characterising expression of an immunodeficiency, a number of domestic and foreign authors recommend to estimate frequency of acute respiratory diseases and frequency of anginas in a year [46, 48, 130, 159].takzhe it was estimated laboratory indicators (titr specific antibodies of classes IgM and IgG, antigenemija, DNA detection gerpesvirusov in blood, a saliva, urine).

For the purpose of suppression replikatsii viruses, patient GI prescribed acyclic nucleosides (atsiklovir and its analogues). It is known, that atsiklovir (Zoviraks — the commercial name) is acyclic nukleozidnym analogue dezoksiguanidina. In virusinfitsirovannyh cells there are metabolic transformations. After triple fosforilirovanija under the influence of virus timidinkinazy (guanilatkinazy), atsiklovir turns in farmakologicheski the active form-atsiklovir-trifosfat. Last serves as DNA-polymerase inhibitor, preventing synthesis of virus DNA. Guanilatkinaza gerpesvirusov contacts atsiklovir -

trifosfatom in one thousand times faster, than cellular. It provides accumulation of the operating beginning, exclusively, in the infected cells. DNA-polimeraza gerpesvirusov always wrongly includes fosforilirovannye acyclic nucleosides in trailer sites of new synthesised virus DNA instead of the natural

dezoksiguanintrifosfata therefore it is broken replikatsija the originator. In our work we used Zoviraks for the purpose of suppression of virus DNA. At peroral application dose Zoviraksa has made 5 mg \kg of mass — at children to 2-uh years, and 10 mg \kg — at children are more senior 2-uh years, frequency rate of reception - of 5 times a day.

In the second, in our researches we isplzovali Viferon - complex antiviral and immunomodulirujushchy a preparation made in a kind suppozitoriev, including rekombinantnyjalfa - 2Ьинтерферон, as a part of a preparation also are present antioxidants — vitamins E and With which render membranostabilizirujushchee action. The mechanism of action of interferon is caused by suppression of a reproduction of a virus nastadii, obligatory for all viruses — blockade of the beginning of translation, t. e synthesis virusspetsificheskih fibers. Besides the alpha - 2Ьинтерферон suppresses also other stages of their reproduction - otpochkovyvanie affiliated virus populations of cells. Viferon prescribed to children sick GI, in age dosages vtechenie 10-15 days simultaneously with acyclic nucleosides as, their joint appointment has a number of advantages.

Atsiklicheskienukleozidy brake replikatsiju viruses at DNA level, and IFN — suppress synthesis of virus fibers and an exit of virions of posterity. Besides, at an appreciable becoming infected of cells there is their destruction, iviriony get to blood where they will immediately be neutralised by interferon. The antioxidants which are a part suppozitoriev viferona, reduce perekisnoe oxidation of lipids, usilivajutekspressiju receptors on cells, raising efficiency
Treatments. Therapy "Viferonom" was spent according to references of professor V.V. Malinovsky with co-authors [37].

Thirdly, preparations exogenous IFN are logically combined with use in clinical practice of its inductors. It is high — both the low-molecular natural and synthetic bonds united by ability to cause in an organism formation of endogenous interferon.

Inductors IFN possess anti-virus, immunomodulirujushchimi and other, characteristic effects for interferon [25, 26]. Them

Antiviral activity coincides with activity of exogenous interferons [20].

In our researches we used tsikloferon from calculation 6-10мг/kg/days at children is more senior 2th years. TSikloferon promotes korrektsiiimmunnogo the organism status, stimulates production in and y-ИФН. A preparation entered per os2 once a week.

Appointment tsikloferona was spent after use virostatikov, and immunomoduljatorov. Fourthly, at patients GI of children at aftertreatment stages provodilasterapija, referred on restoration metabolic funktsiipovrezhdennyh cells. About necessity of carrying out metabolicheskojterapii it is specified in G.A.Samsyginoj's [57] works, M.V.Fedorovoj, T. G.Tareevoj (1997), etc. In a complex of metabolic therapy vhodilivitaminy groups V:V1, В2, В6, В12, calcium and potassium preparations (a calcium pantothenate, Pananginum), antioxidants which prescribed vvozrastnyh dosages simultaneously with tsikloferonom on etapahreabilitatsii.

Thus, etiopatogeneticheskaja therapy was spent to 2 stages.

At the first stage sick gerpesvirusnoj an infection prescribed 2 groups of preparations:

1) abnormal nucleosides (prevent synthesis of virus DNA);

2) interferon preparations — an alpha (possess anti-virus and immunomodulirujushchim action);

The first stage of treatment was spent in a hospital. The second stage of treatment was spent in out-patient conditions. The patient prescribed interferon inductors (allow to restore production IFN, possess antiviral and immunomodulirujushchim action) and metabolicheskujuterapiju (correction of the fermental status of lymphocytes).

At a reactivation gerpesvirusnoj infektsiinaznachali a repeated course of abnormal nucleosides and interferon preparations.

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Scientific source Lebedeva Tatyana Mihajlovna. Clinico-pathogenetic value gerpesvirusov at long subfebrile conditions at children. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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