Неотложная медицинская помощь (Sep 2016)
PROPHYLACTIC AND THERAPEUTIC EFFICACY OF THE POLYVALENT PYOBACTERIOPHAGE IN THE TREATMENT OF ACUTE DESTRUCTIVE PANCREATITIS
Abstract
BACKGROUND. The high mortality in severe acute pancreatitis is mainly assoociated with septic complications developing during translocation of intestinal potentially pathogenic flora into the initially sterile necrosis.AIMOFSTUDy. To determine the prophylactic and therapeutic effect of polyvalent pyobacteriophage (PBP) included into the complex treatment of acute destructive pancreatitis to reduce the rate of infectious complications and mortality. MATERIALANDMETHODS. The study included 38 patients admitted to the N.V. Sklifosovsky Research Institute for Emergency Medicine with acute destructive pancreatitis and pancreatic necrosis. All patients underwent the standard therapy. In patients of group 1 (N=13), PBP was included into treatment in the first 2 weeks after admission (2–15 day). In patients of group 2 (N=12), the bacteriophage was used during septic complications (16–60 hours). The comparison group consisted of patients not receiving PBP in the course of treatment. The activity of the inflammatory process over time was evaluated by the level of C-reactive protein (CRP). The marker of systemic inflammation was procalcitonin (PCT). We performed immunology tests: the number of leucocytes, lymphocytes (Tand B-lymphocytes), phagocytic activity and oxygen metabolism of neutrophils in the HCT-test, concentration of immunoglobulin A, M, G, circulating immune complexes (CICs) before and after PBP.RESULTS. It was found that the earlier use of PBP had helped reduce inflammation and areas of intoxication, which was manifested by a fall of CRP and PCT (p<0.05), lesser number of complications and mortality in patients of group 1 compared to patients of group 2 and the comparison group. Immunology tests revealed an increase in the absolute number of T-lymphocytes, growth of IgA and IgG (p<0.05) involved in opsonization and antigen presentation to T-lymphocytes and affecting the cellular and humoral mechanisms of immune response to infectious antigens. The use of PBB in patients with infectious complications (group 2) did not lead to a significant reduction of necrosis zones and, as a consequence, indices of inflammation. Only CRP was significantly reduced. The analysis of immunological tests revealed an increase in the number of T-lymphocytes and IgG concentration (p<0.05).CONCLUSIO N. The use of PBP in the treatment of acute destructive pancreatitis in the early stages resulted in sanitation of infection foci, reduction of the number of infectious complications, reduced hospital stay and reduced mortality down to zero. The inclusion of PBP into treatment at a later date after admission did not reduce the number of complications, but it contributed to activation of immune defense mechanisms and reduced mortality compared with the control group.
