RU2550921C1 - Method for individual selection of immunocorrective therapy for prevention of frequent respiratory infections in primary school-aged children - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: children are divided into 4 groups; the first group includes the children having the following symptoms: short period of breastfeeding in the medical history, frequently ill family members, no complications of respiratory infections, IgA from 0.7 to 1.1 mg/ml, IgG from 10.6 to 16.2 mg/ml; the second group: mother's gestosis during the pregnancy, threatening miscarriage in the medical history, frequent complications of respiratory diseases - sinusitis, otitis; alpha2-globulin from 9.4 to 11.8 g/l, gamma-globulin from 17.8 to 22.6 g/l, TNF-? from 8.7 to 10.1 pg/ml, IgG from 16.7 to 23.7 mg/ml, CD3+ from 51 to 56.2%, CD4+ from 27.2 to 29.4%, CD16+CD56+ from 6.5 to 8.5%, nitro blue tetrazolium reduction test from 25 to 32.8%; the third group: mother's anaemia during the pregnancy, child's positive endocrine heredity, respiratory diseases frequently complicated with bronchitis, Candida seeding in throat swabs, gamma globulins from 12.1 to 14.9 g/l, IgG from 10.9 to 15.5 mg/ml, CD19+ from 7.6 to 9.6%, nitro blue tetrazolium reduction test from 25.5 to 31.7%; the fourth group: allergic reactions in the child's medical history, positive allergic heredity, respiratory diseases frequently complicated with obstructive bronchitis, gamma globulins from 18.1 to 23.1 g/l, IgE from 67 to 261 IU/ml. Acute respiratory diseases are prevented by Multitabs, a vitamin mineral complex, and one of the immunocorrective preparations: in the first group with IRS-19, a preparation of bacterial lysates; in the second group with a preparation of glucosaminyl muramyl dipeptide (Licopid); in the third group with a preparation of azoximer bromide (polyoxidonium); in the fourth group the immunocorrection is not recommended.EFFECT: using the given method enables selecting a variant of immunocorrection depending on the presence or absence of diagnostic signs.2 ex, 1 tbl

Description

The invention relates to medicine, in particular to pediatrics, allergology, immunology, and can be used to reduce the incidence of respiratory infections in children of primary school age.

Often sick children is a dispensary observation group that includes children with frequent respiratory diseases that arise due to transient corrective deviations in the body's defense systems and that do not have persistent organic disorders [1, 2, 3].

There is a method of mass prevention of respiratory infections in children attending organized children's groups, consisting in vaccinating children with anti-influenza vaccines (Grippol, Vaksigripp) [4], which provides the creation of active immunity in vaccinated only against influenza pathogens.

The disadvantage of this method is that up to 400 various pathogens, as well as their associations, can act as an etiological factor in frequent respiratory tract infections in children [1, 5, 6]. Therefore, the prophylactic effect of influenza vaccines is insufficient. Also, with this method, an assessment of the patient’s state of health is not provided, which reduces the effectiveness of the ongoing immunization.

Also known is a method for mass prevention of respiratory infections in children attending organized children's groups, which consists in vaccinating children with vaccines containing antigens of pneumococcal infection (Pneumo 23 vaccine) [4].

This analogue method has similar disadvantages. The introduction of the Pneumo 23 vaccine provides the creation of active immunity in vaccines only against the pathogen Streptococcus pneumoniae, while the cause of infectious diseases in children from the dispensary group, who are often ill, are both bacterial and viral pathogens. With this method, the patient’s health status is also not evaluated, which makes it non-personalized and reduces the effectiveness of the immunocorrection.

As the closest analogue (prototype), the method of using the drug glucosaminylmuramyl dipeptide (lycopid) for the treatment of chronic respiratory tract infections, which consists in administering 1 mg of the drug to children once a day for 10 days, was chosen [7].

The disadvantages of the closest analogue (prototype) include the lack of effectiveness of the treatment. It is believed that the dispensary group of frequently ill children is heterogeneous in their clinical and immunological characteristics [2]. And the appointment of preventive immunocorrection only on the basis of the fact of an increase in the frequency of respiratory infections without an additional assessment of clinical and laboratory parameters, attempts to select an individual variant of prevention reduces the effectiveness of the measures taken.

The objective of the invention is to reduce the frequency of respiratory infections in children of primary school age by personalizing the selection of immunocorrective therapy in accordance with the developed features.

Often sick children are divided into 4 groups:

1 group

Children with signs: insufficient history of breastfeeding, the presence of often sick family members, the absence of complications of respiratory infections, IgA levels from 0.7 to 1.1 mg / ml, IgG from 10.6 to 16.2 mg / ml;

2 group

Children with signs: gestosis in the mother of the child during pregnancy, a history of abortion, frequent complications of respiratory diseases - sinusitis, otitis media; levels of alpha2-globulins from 9.4 to 11.8 g / l, gamma globulins from 17.8 to 22.6 g / l, TNF-α from 8.7 to 10.1 pg / ml, IgG from 16.7 to 23.7 mg / ml, CD3 + from 51 up to 56.2%, CD4 + from 27.2 to 29.4%, CD16 + CD56 + from 6.5 to 8.5%, HCT test induced from 25 to 32.8%;

3 group

Children with symptoms: anemia in the mother of the child during pregnancy, heredity of the child due to endocrine diseases, respiratory diseases are often complicated by bronchitis, fungi of the genus Candida are sown in smears from the throat, gamma globulins from 12.1 to 14.9 g / l, IgG from 10.9 to 15.5 mg / ml, CD19 + from 7.6 to 9.6%, HCT test induced from 25.5 to 31.7%;

4 group

Children with signs: a child’s history of allergic reactions, heredity aggravated by allergic diseases, respiratory diseases are often complicated by obstructive bronchitis, gamma globulin levels from 18.1 to 23.1 g / l, IgE from 67 to 261 Me / ml.

In this case, the prevention of frequent respiratory diseases is carried out by the vitamin-mineral complex (multitabs drug) and one of the immunocorrective drugs.

In the first group, bacterial lysates (IRS-19), in the second group, glucosaminylmuramyl dipeptide (lycopide), in the third group, azoximer bromide (polyoxidonium), in the fourth group, immunocorrection is not recommended.

The essence of the proposed method is as follows: to select a method of immunocorrective therapy aimed at reducing the frequency of respiratory diseases in a child of primary school age, a comprehensive clinical and laboratory examination is carried out, including data collection on risk factors for frequent respiratory diseases, the frequency of respiratory infections, the presence and nature of complications , throat swab for fungi, biochemical blood test, blood test for immunogram.

The purpose of the invention is the identification of the most effective variant of immunocorrection to reduce the frequency of respiratory diseases.

The use of the developed criteria when choosing the option of immunocorrection made it possible to increase the effectiveness of preventive measures in frequently ill children of primary school age by 18%.

Between the set of essential features of the claimed object and the achieved technical result there is a causal relationship, namely:

1) The dispensary group of often sick is heterogeneous in their clinical and immunological characteristics [2]. The studies conducted by the author revealed several groups of frequently ill children with different sensitivity to immunocorrective drugs. Using the developed criteria when choosing a method of preventive immunocorrection allows you to increase the effectiveness of the measures taken.

2) The appointment of multivitamins and minerals restores their deficiency and increases the body's resistance to infectious pathogens in children receiving them. This is due to the fact that currently in most regions of Russia a significant deficiency of vitamins and minerals remains in the diet [8], which may be a factor that reduces the body's resistance to infectious pathogens.

EFFECT: invention reduces the frequency of respiratory infections in frequently ill children by 67%. When prescribing the same drugs without using the developed methodology for choosing the option of immunocorrective therapy, the incidence of respiratory infections decreased only by 47% (p <0.001).

The possibility of carrying out the claimed invention is shown by the following examples.

Clinical example No. 1

In the period from 09.2012 to 12.2013 a preventive program was carried out in the 2nd grade of school No. 7 of Torzhok. The average age is 8.4 ± 0.6 years. Distribution by gender: boys - 14 (48.3%), girls - 15 (51.7%). At the beginning of the school year, a survey was conducted with the allocation of a dispensary group of frequently ill children (who carry infectious diseases of the respiratory tract more than 4 times a year), which amounted to 11 people.

Then, children from the dispensary group of often ill patients were examined, including collecting data on the prevalence of risk factors, the frequency of respiratory infections, the presence and nature of complications, a smear from the throat on mushrooms, a biochemical blood test, and a blood test for an immunogram.

The appointment and selection of the option of prophylactic immunocorrection was carried out in accordance with the developed features.

In accordance with them, 4 children were included in the group with the highest efficiency of bacterial lysates (IRS-19) together with the vitamin and mineral complex, 4 children in the group with the highest efficiency of glucosaminyl muramyl dipeptide (lycopid) together with the vitamin and mineral complex, 3 children with the high efficiency of the azoximer bromide (polyoxidonium) together with the vitamin-mineral complex. 1 patient was included in the group, which is not recommended for immunocorrection.

Pupils of class 2B of school number 7 in Torzhok made up the control group. The average age is 8.5 ± 0.5 years. Distribution by gender: boys - 16 (51.6%), girls - 15 (50%). In this class, 10 people belonged to the dispensary group of frequently ill children.

There were no statistically significant differences in age and sex between children in the selected groups.

The appointment of immunocorrective therapy in this group was carried out only on the basis of indications for the use of immunocorrective drugs in accordance with the instructions for their use. Such indications include an increase in the frequency of respiratory diseases.

Since the instructions for use of various immunocorrective drugs do not indicate in which cases, to reduce the incidence of respiratory infections, one or another variant of immunocorrection should be preferred, the choice of the method of prevention was determined randomly.

Thus, 3 children received immunocorrection with bacterial lysate preparations (IRS-19) in conjunction with the vitamin and mineral complex, 4 children received immunocorrection with glucosaminyl muramyl dipeptide (lycopid), and 3 children with the azoximer bromide (polyoxidonium) together with the vitamin and mineral complex.

For statistical data processing, Statistica 10 software packages were used. For processing the obtained results, non-parametric methods for assessing quantitative attributes were used: the Man-Whitney test and the Wilcoxon test.

The incidence of respiratory infections was estimated 3 months after immunocorrection (table 2).

Thus, the application of the developed criteria when choosing the option of immunocorrection of FBI of primary school age made it possible to increase the effectiveness of preventive measures by an average of 18%.

Clinical example No. 2

In the period from 09.2012 to 12.2013 a preventive program was carried out in the 3A grade of school number 7 in Torzhok. The average age is 9.4 ± 0.5 years. Distribution by gender: boys - 16 (53.3%), girls - 14 (46.7%). At the beginning of the school year, a survey was conducted with the allocation of a dispensary group of frequently ill children (who carry infectious diseases of the respiratory tract more than 4 times a year), amounting to 10 people.

Then, children from the dispensary group of often ill patients were examined, including collecting data on risk factors, the frequency of respiratory infections, the presence and nature of complications, a smear from the throat for fungi, a biochemical blood test, a blood test for an immunogram, including phenotyping of immunocompetent cells according to CD3 differentiation clusters , CD4, CD8, CD 16, CD 19, CD56; determination of the concentration of serum immunoglobulins M, G, A, E, evaluation of the functional activity of neutrophils microscopically by the number (%) of diformazan-positive neutrophils in a spontaneous and zymosan-stimulated nitrosine tetrazolium reduction test (HCT test), determination of the concentration of tumor necrosis factor alpha (TNF -α).

The appointment and selection of the option of prophylactic immunocorrection was carried out in accordance with the developed criteria.

In accordance with them, 4 children were included in the group with the highest efficiency of bacterial lysates (IRS-19) together with the vitamin and mineral complex, 4 children in the group with the highest efficiency of glucosaminyl muramyl dipeptide (lycopide) together with the vitamin and mineral complex, 2 children with the high efficiency of the azoximer bromide (polyoxidonium) together with the vitamin-mineral complex. 1 patient was included in the group, which is not recommended for immunocorrection.

Pupils of class 3B of school number 7 in Torzhok made up the control group. The average age is 9.6 ± 0.4 years. Distribution by gender: boys - 15 (50%), girls - 15 (50%). In this class, 9 people belonged to the dispensary group of frequently ill children.

There were no statistically significant differences in age and sex between children in the selected groups.

The appointment of immunocorrective therapy in this group was carried out only on the basis of indications for the use of immunocorrective drugs in accordance with the instructions for their use. Such indications include an increase in the frequency of respiratory diseases.

Since the instructions for use of various immunocorrective drugs do not indicate in which cases, to reduce the incidence of respiratory infections, one or another variant of immunocorrection should be preferred - the choice of the method of prevention was determined randomly.

Thus, 3 children received immunocorrection with bacterial lysate preparations (IRS-19) together with the vitamin and mineral complex, 3 children received immunocorrection with glucosaminyl muramyl dipeptide (lycopide), together with the vitamin and mineral complex, and 3 children with the azoximer bromide (polyoxidonium) together with the vitamin and mineral complex.

For statistical data processing, Statistica 10 software packages were used. For processing the obtained results, non-parametric methods for assessing quantitative attributes were used: the Man-Whitney test and the Wilcoxon test.

The incidence of respiratory infections was evaluated 3 months after immunocorrection (table 3).

Thus, the application of the developed criteria when choosing the option of immunocorrection of FBI of primary school age made it possible to increase the effectiveness of preventive measures by an average of 19%.

Bibliography

1. Albitsky V.Yu., Kamaev I.A., Ogneva M.L. Often sick children. N. Novgorod: NGMA, - 2003. - 180 p.

2. Romantsev M.G., Ershov F.I. Often sick children: modern pharmacotherapy. M .: Geotar Media, - 2006. - 192 p.

3. Samsygina G.A. Often sick children: problems of pathogenesis, diagnosis and therapy // Pediatrics. - 2005. - No. 1. - S.66-74.

4. Acute respiratory infections in children: treatment and prevention. A manual for doctors.- M., 2002. - 70 p.

5. Korovina N.A., Zaplatnikov A.L., Cheburkin A.V., Zakharova I.N. Often and long-term sick children: modern possibilities of immunorehabilitation. a guide for doctors.- M .: Contimed, 2001. - 68 p.

6. Zamakhina EV, Fomina VL, Kladova OV, Butakova EP, Bazanova AS, Legkova TP, Uchaykin V.F. Clinical and pathogenetic significance of the persistence of respiratory viruses in frequently ill children // Pediatrics. Magazine them. G.N. Speransky. - 2009. - T. 87. - No. 3. - S. 42-46.

7. Russian Medicines Radar Register. 2011. Issue 3. Reference. Radar Media. - 2011

8. Ruleva A.A., 2011; Tutelian V.A., Spirichev V.B., Shatnyuk L.N. 1999

Claims (1)

A method for personalizing immunocorrective therapy for the prevention of frequent respiratory infections in primary school children, characterized in that often ill children are divided into 4 groups, the first of which includes children with signs: insufficient history of breastfeeding, the presence of often sick family members, no complications of respiratory infections, IgA levels from 0.7 to 1.1 mg / ml, IgG from 10.6 to 16.2 mg / ml; in the second, children with signs: gestosis in the mother of the child during pregnancy, a history of abortion, frequent complications of respiratory diseases - sinusitis, otitis media; levels of alpha2-globulins from 9.4 to 11.8 g / l, gamma globulins from 17.8 to 22.6 g / l, TNF-α from 8.7 to 10.1 pg / ml, IgG from 16.7 to 23.7 mg / ml, CD3 + from 51 up to 56.2%, CD4 + from 27.2 to 29.4%, CD16 + CD56 + from 6.5 to 8.5%, HCT test induced from 25 to 32.8%; the third group includes children with signs: anemia in the mother of the child during pregnancy, heredity due to endocrine diseases, respiratory diseases are often complicated by bronchitis, fungi of the genus Candida are sown in throat smears, gamma globulin levels are from 12.1 to 14.9 g / l, IgG from 10.9 to 15.5 mg / ml, CD19 + from 7.6 to 9.6%, HCT test induced from 25.5 to 31.7%; the fourth group includes children with signs: a child’s history of allergic reactions, heredity aggravated by allergic diseases, respiratory diseases are often complicated by obstructive bronchitis, gamma globulin levels from 18.1 to 23.1 g / l, IgE from 67 to 261 Me / ml, In this, the prophylaxis of frequent respiratory diseases is carried out with the multitab vitamin-mineral complex and one of the immunocorrective drugs: in the first group, the lysates of bacteria IRS-19, in the second group, with glucosaminylmuramyldipe poultry (lycopid), in the third group with the preparation of azoximer bromide (polyoxidonium), in the fourth group immunocorrection is not recommended.