6.2 Results of application of a preparation of system enzymotherapy (Vobenzim) as an agent strengthening action of a causal treatment at children with OSL (croup)

Except diagnostics methods before the doctor always there is a problem of selection of the preparations referred on cupping disbioticheskih of processes, and also capable to strengthen causal treatment action, i.e.

Our attention was involved with a preparation of system enzymotherapy Vobenzim (Mucos Pharma, Gmbh, Germany), possessing antiinflammatory, immunomodulirujushchim, antiagregatsionnym, fibrino - thrombolytic and potentsirujushchim with action.

The basic function of system enzymotherapy (Vobenzima) is a depression of adhesive abilities of the originator and excision of cytokines from circulation therefore this therapy has received a wide circulation in pediatrics. Besides, Biomembranula, obrazuemaja bacteria is very steady against influence of any antibacterial preparations at the expense of creation of the "quorum" presented by components of an intercellular matrix, high rate of cell fission, presence of cells steady against any antibiotics, so-called "persisterov", the enzymes allocated in a matrix, and fermental preparations significantly influence on lizis this Membranula, than provide higher effect of an antibiotic.

The researches spent on our chair, also have shown their efficiency at complicated ORZ [81, 99, 31, 125].

Observed 53 children often and it is long ill with the respiratory infections, being on hospitalisation, at the age from 1 till 9 years with diagnosis ORVI with secondary bacteriemic complications.

Middle age of the patients included in research, has made for the basic group 2,6±0,12 years (from 1 till 6 years); for control group - 3,4±0,12 years (from 1г 2 mes till 9 years). Presence testified To development of a bacteriemic infection is serous-purulent separated of a nose with an unpleasant smell (100 %), otitis development (68 %), the phenomena granuleznogo a pharyngitis with applyings of a mucopurulent secret on a back wall of a pharynx (64 %), puffiness and a hypertrophy of palatine tonsils (100 %), razryhlenie mucous and "zijanie" lacunas of tonsils, and also a bright diffuse hyperemia mucous stomatopharynxes (100 %).

All observable children concerned a category often and is long ill ORVI (to 8 times a year), at 36 (68 %) patients the hypertrophy of tonsils of II degree, at 21 (40 %) - an adenoid disease, at 22 (41,5 %) became perceptible -
Adenoides of II degree, at 2 (3,8 %) - adenoektomija, at 34 (64 %) - the phenomena granulematoznogo a pharyngitis, at 19 (36 %) - a chronic pharyngitis.

At all children before treatment appointment research of a sputum and blood by means of a method of a gas chromatography of mass spectrometry is carried out. The general results are resulted above in chapter 5 section 1.1.

All surveyed children were randomizirovany in two groups: investigated group have made 30 patients receiving Vobenzim in a combination to antibacterial therapy. 23 patients have made group of the comparison, receiving as a causal treatment only antibacterial preparations. Vobenzim it was prescribed at children from 1 year till 3 years on 1 tablet to 3 kg of weight, is more senior 3th years - on 1 tablet on 6 kg of weight within 10 days.

As a result of the spent treatment (a drawing 26) in a nasopharynx microbiocenosis reduction of colonisation Streptococcus in 20 times, Nocardia in 11 times, Peptostreptococcus anaerobius, in 5 times has been noted; bacilli in 4 times, Clostridium perfringens three times, laktobatsill, eubaktery, group Clostridium clostridiums ramosum, Bacteroides frgilis, Enterococcus and others twice. At the same time small growth of number of staphilococcuses, family Enterobacteriaceae kinds, Pseudomonas aeruginosa and Helicobacter pylori is noted.

Also the augmentation of is conditional-pathogenic flora Clostridium ramosum and eubaktery within statistical variability of data, growth of number Propionibacterium spp twice towards indemnification of initial deficiency became perceptible. In blood reduction Streptococcus by 1,3 %, Nocardia on 3 % and moderate augmentation Clostridium ramosum on 2,7 % (fig. 4,5) became perceptible. At the comparative analysis uniformity of a microflora of a saliva and blood also takes place, thus it does not become perceptible prevalence of colonisation Streptococcus in a saliva, in blood prevalence kolonizatsi Staphylococcus has decreased
intermedius on 2 % prevalence Lactobacillus also was enlarged by 2,1 % that is bound to the period rekonvalistsentsii patients.

Drawing 26. Comparison of average number (in cells on ml of a saliva with domnozheniem on 10⁵) microorganisms in the centre of the infection adequate to concentration of their markers in a saliva before treatment vobenzimom.

Antibioticotherapia action in absence vobenzima was showed in essential depression of number of streptococcuses, kampilobaktera, nokardy and a cytomegalovirus. Number laktobatsill thus

It was enlarged on the average in one and a half time. Other components mikrobioty have not undergone quantitative changes.

At including in the therapy program vobenzima, as a result of complex treatment the aggregate number of microorganisms has grown to norm. And vobenzim equally stimulated growth of all members of community (a drawing 27,27а, 28).

Drawing 27. Dynamics of a specific gravity of microorganisms of a saliva at children at OSL (groats) with secondary bacteriemic complications before treatment Vobenzimom

Drawing 27а. Dynamics of a specific gravity of microorganisms of blood at children at OSL (groats) with secondary bacteriemic complications before treatment Vobenzimom

Drawing 28. Results of research of structure of microbic markers in a blood plasma of children a method of a gas chromatography - mass spectrometries. Average value to (N=27) and after (N=13) treatments vobenzimom + antibiotics. Data in microbic cells/ml of assay with domnozheniem on х10*5.

In dynamics of disease at patients, treated Vobenzimom disbioticheskie changes of a microflora of a stomatopharynx tended to normalisation both qualitative, and quantitative structure that has lowered duration of the basic clinical symptoms and duration of disease (a drawing 29).

Drawing 29. Clinical implications of catarral symptoms at children at OSL (groats) with secondary bacteriemic complications

Apparently from the presented data patients, treated Vobenzimom significant had changes on such indicators as «appetite depression», «zalozhennost a nose», «wet tussis», «the general duration of tussis», «auskultativnye changes in lungs», duration of other clinical symptoms tended to reduction.

The maximum clinical effect is noted at 38 % of children for 6 days of reception of a preparation. In the same terms at 42 % of children change of density of a sputum in favour of its colliquation while in comparison group these changes were registered only at 38 % of children became perceptible.

Data of clinical efficiency correlated with depression of level of colonisation patogenov. So in a saliva level of colonisation Streptococcus has decreased on 95 %; Nocardia on 92 %; Peptostreptococcus anaerobius on 78 %; Streptomyces on 48 %; Clostridium ramosum on 43 %; Candida on 42 % (a drawing 30).

Drawing 30. Results of research of structure of microbic markers in a saliva of children a method of a gas chromatography - mass spectrometry before treatment Vobenzimom. Data in microbic cells/ml of assay with domnozheniem on х10*5 (п=18)

In blood that means as a whole on an organism, including an intestine, level of colonisation Streptococcus has decreased on 18 %; Nocardia on 17 % (a drawing 31).

Drawing 31. Results of research of structure of microbic markers in blood of children a method of a gas chromatography - mass spectrometry before treatment Vobenzimom (п=18)

Against treatment by preparation Vobenzim investigated indicators of a microbiocenosis of an intestine (a drawing 32).

To the ambassador

Drawing 32. Indicators of a microbiocenosis of an intestine at children, treated preparation Vobenzim to (I) and in 10 days after the termination of treatment (II)

Apparently from the presented data disappearance of a golden staphilococcus, reduction of maintenance E.coli typical on 2,6 %, E.coli laktozonegativnye on 31,6 % completely became perceptible. Besides it maintenance rising bifidobaktery on 8 %, laktobaktery on 3,6 %, E.coli hemolitic on 7,7 %, not fermenting bacteria on 23 %, enterococci on 27,1 % became perceptible.

Microbiocenosis normalisation korelirovala with reduction of the form of gravity of disease. So, after treatment Vobenzimom indicators leukocytic and nuclear indekssov intoxications at children at ORVI with bacteriemic complications corresponded to a satisfactory condition of children.

Drawing 33. Dynamics of the form of gravity of disease on a leukocytic index of an intoxication (LII) and to a nuclear index of an intoxication (JAII) at children at ORVI with bacteriemic complications to (I) and after treatment Vobenzimom (II)

Thus, the microbionomics of the child as in an acute respiratory infection, and rekonvalistsentsii represents the uniform medium presented both pathogenic, and is conditional-pathogenic bacteriemic flora. Appointment of preparations of system enzymotherapy at children with OSL (croup) with secondary bacteriemic complications promotes faster cupping of clinical symptoms of disease, eradikatsii patogenov, to reduction of terms of stay in a hospital, that as a whole reduces economic expenses for treatment of the patient and confirms expediency of application of this therapy.

As a result of the spent work there is clear, that a new direction in molecular microbic diagnostics - definition mikst - infections, disbiozov and inflammatory processes on specific markers (to fat acids, aldehydes and sterolam) with the help hromato - mass spectrometries at patients OSL (croup) with secondary
Bacteriemic complications in one experience has shown presence of diverse microorganisms (aerobes, anaeroby, aktinobakterii, mushrooms, viruses) with primary colonisation Streptococcus, Peptostreptococcus anaerobius Nocardia, Streptomyces, Clostridium and other is conditional-pathogenic flora. At patients OSL (croup) with secondary bacteriemic complications therapy Vobenzimom promotes fever cupping, implication intoksikatsionnogo a syndrome (a malaise, appetite depression, delicacy, depression of physical activity), the phenomena of a rhinitis, a tonsillitis, a pharyngitis, an otitis after 6th day of reception of a preparation. At treatment by preparation Vobenzim sick OSL (croup) with bacteriemic complications in dynamics of disease the sanifying effect in the form of normalisation of quantitative and qualitative structure normoflory stomatopharynxes, depressions of quantity of fungoid flora, and also pathogenic flora that has found reflexion in correction disbioza oral cavities becomes perceptible. Against therapy Vobenzimom colonisation reduction in saliva Streptococcus on 95 % is noted; Nocardia on 92 %; Peptostreptococcus anaerobius on 78 %; Streptomyces on 48 %; Clostridium ramosum on 43 %; Candida on 42 %; in blood Streptococcus has decreased on 18 %; Nocardia on 17 % and normalisation of number of the basic inhabitants of an intestine laktobatsill, eubaktery, bifidobaktery and others, that confirms expediency of appointment of preparations of system enzymotherapy at children with OSL (croup) with secondary bacteriemic complications

6.3.