Журнал «Актуальная инфектология» Том 7, №2, 2019

Relevance. Nowadays antimycobacterial therapy (AMBT) dominates the complex treatment of patients with tuberculosis (TB). Disorders of protein and aminoacid metabolism has an important role in the complex of metabolic malfunctions. Concentration of aminoacids in the blood serum can be regarded as an objective reflection of the condition of metabolic balance and their dynamic equilibrium is provided by protein catabolism in various organs and tissues as well as the exogenous way nutrition.

Objectives – to evaluate the rates of protein metabolism (PM) of patients with first time diagnosed pulmonary tuberculosis (FDTB) who received standard AMBT.

Materials and methods. We have investigated 67 patients with FDTB, age 18 – 62 y.o., among them 53 (79,1%) were males and 14 (20,9%) – females. Control group consisted of 30 healthy individuals, age 18 – 55 y.o., males – 16 (53,0%), females - 14(47,0%). With the purpose of the studying the effect of the AMBT in all the patients on the rates of PM, the levels of distinct nonessential (NAA) and essential (EAA) aminoacids in blood serum and the levels of ammonia (mg in 100 ml of BS) of every patient were measured before and after the end of the intensive phase of treatment and compared to the healthy individuals. Etiotropic AMBT for all the patients with FDTB was carried according to the order № 602 from 04.09.2014.

Results and discussion. The received results evidently show, that before the start of the treatment there were discovered severe changes which manifested in imbalance, the decrease of levels of distinct NAA and EAA in BS as well as their total number. There was established a confirmed decrease (р<0,05) of the total levels of EAA in BS by 19.3%(in 1,2 times) to 8.8±0,4 mg in 100 ml of  BS in patients with FDTB in comparison to the healthy individuals (10,9±0,7 mg in 100 ml of BS). It happened due to certain decrease (р<0,05) in levels of discrete EAA of BS (lysine, histidine, arginine, methionine, phenylalanine) and steady tendency of decrease in levels of them (threonine, valine, leucine) compared to the healthy donors. According to the results of measurements of total number of EAA of BS in patients with FDTB before the treatment, it was established it’s confirmed decrease(p<0,05) by 19,3%( in 1,2 times) to 15,9±0,4 mg in 100 ml of BS in comparison to the rates of healthy donors(19,7±0,9 mg in 100 ml of BS). Also we can observe a confirmed (р<0,05) decrease levels of distinct NAA(glutamic acid, glycine, glutamine) and steady tendency of decrease of levels(serine, proline, alanine, tyrosine) in comparison to healthy donors. The levels of ornithine, aspartic acid, cysteine correlate to the rates of healthy donors. We observed confirmed (р<0,001) increase of levels of ammonia in 2,1 times to 1,41±0,06 mg in 100 ml of BS in comparison to healthy individuals (0,7±0,1 mg in 100 ml of BS).  Analysis of results of measurement of total levels of aminoacids of blood serum (TLAA of BS) shows it’s confirmed decrease (р<0,05) by 19,3% (in 1,2 times) to 24,7±0,8 mg in 100 ml of BS before the start of the treatment compared to the healthy donors (30,6±2,4  mg  in 100 ml in BS). Such result was fully predicted considering that the confirmed decrease (р<0,05) TN of EAA of BS and TN of NAA of BS in comparison to the rates of healthy donors was observed before the start of the therapy.

Treatment with AMBT during 2 months had a certain positive effect on TN of aminoacids of BS and caused a confirmed (р<0,05) increase to 27,2±0,5 mg in 100 ml of BS in comparison to the pretreatment rates, but compared to the rates of healthy individuals it only showed a steady tendency to increase. The levels of lysine, histidine, threonine, methionine, isoleucine, phenylalanine stayed on the pretreatment rates. But there was observed a steady tendency to increase of levels of arginine, valine, leucine compared to the pretreatment rates. So the levels of most of the EAA of BS and their TN didn’t reach the rates of healthy individuals under the influence of AMBT. A confirmed increase (р<0,05) of TN of NAA of BS to 18,1±0,2 mg  in 100 ml of BS was present in comparison to the pretreatment rates of 15,9±0,2 mg  in 100 ml of BS and steady tendency to increase in comparison to the rates of the healthy individuals 19,7±0,9 mg  in 100 ml of BS. A confirmed (р<0,05) increase of the concentration for only 4 amino acids was established: serine, proline, glycine, glutamine in comparison to the pretreatment rates. In comparison to the healthy donors a steady tendency to the increase of the levels of such NAA as glycine, proline, glutamine was observed. The levels of serine and tyrosine corresponded with rates of healthy individuals. The levels of alanine and glutamic acid during AMBT were unaltered. A confirmed ( р<0,05) decrease of ammonia levels by 40,4%(in 1,7 times) to 0,841±0,02 mg in 100 ml of BS in comparison to the pretreatment rates and steady tendency to matching the rates of healthy individuals.

 Conclusions. Applying of AMBT has a certain positive effect on the rates of PM, but it is insufficient for a complete normalization of metabolism, namely for a full recovery from PM disorders, which are present in patient with FDTB and accomplishment of the rates of healthy individuals. The established changes in the spectrum of aminoacids reflect the disorders of PM in generally and are the basis for development of new methods of pathogenic therapy, with the goal of increasing the effectiveness of treatment of patients with TB.