Objective. To determine the prevalence of Helicobacter pylori (HP) in doctors in Chita, to identify clinical manifestations of infection, endoscopic, ultrasound and morphological changes in the stomach, to conduct eradication treatment with an assessment of its effectiveness, to determine the resistance of HP to clarithromycin and to develop treatment tactics for HP-associated diseases in the region.Material and methods. 70 doctors of Chita were examined, including 55 women and 15 men, average age 47.04±12.76 years (20 persons were 39 years and younger, 33 persons were 40–59 years, 17 people were 60 years and older; 27 persons were gastroenterologists, 17 — therapists, 11 — pediatricians, 5 — surgeons and 10 persons were doctors of other specialties). All doctors underwent antigen (AH) of HP determination in feces, a survey on the original questionnaire to assess clinical manifestations. Ultrasound examination of the stomach was performed in 47 doctors. Endoscopy of the upper gastrointestinal tract (GI) was performed in 35 persons. During endoscopy, in 29 doctors biopsy material of the mucous membrane from 5 points of the stomach were taken. A histological examination of biopsy samples was performed with an assessment using the OLGA system. The resistance of HP to clarithromycin was determined by the molecular genetic method in biopsy samples of gastric biopsy. 44 doctors conducted eradication with different schemes. Adverse events (AE) and treatment tolerance were evaluated. Control of eradication was carried out 6–8 weeks after the end of therapy by determining AH of HP in the feces. Statistical processing was carried out using the method of descriptive statistics, criterion of Student and criterion x2 (Biostatprogramm).Results. A positive AH of HP in feces was registered in 71.4% of the doctors examined: 73.3% of men and 70.9% of women, 75% of people under the age of 39 years, 72.7% of those aged 40–59 years and 64.7% are over 60 years old. Gastroenterologists were infected in 63%, therapists in 70.6%, pediatricians in 72.7%, surgeons in 80%, another specialists in 90% of cases. In the presence of HP, 81.6% of the examined showed symptoms from the digestive organs, 3 times more often a hereditary history of stomach cancer was determined. The wall thickness of the stomach during ultrasound in the infected was recorded 0.21–0.18 mm more than in the group of HP-negative individuals. A histological examination of III–IV degree of activity of inflammation in the stomach was diagnosed in 86.1%, stage III atrophy and colonic metaplasia in 20.7% of the examined doctors. The desire to conduct eradication treatment was expressed by 78% of doctors, 44 people completed the therapy. Non-compliance with the eradication regimen was noted in 9 people. AE were registered in 76.6% of cases. The efficacy of all regimens was 71.4%: when using the regimen with clarithromycin — 73%, with josamycin — 100%, with tetracycline and metronidazole — 33%, with levofloxacin — 100%. HP DNA was detected in 27 samples of gastric. In 10 cases, mutations A2142G and A2143G in the HP genome were detected, providing resistance to clarithromycin, which amounted to 37%.Conclusion1. 71.4% of doctors in Chita are infected with HP, among which the bacterium is most often detected at a young age (39 years and younger).2. Infected doctors are more likely to have gastrointestinal symptoms, a history of gastric damage, and hereditary gastric cancer.3. In 20.7% of doctors, histological examination revealed colonic metaplasia and dysplasia, which confirms the need for treatment and requires further observation.4. Only 78% of Chita doctors expressed their readiness to eradicate HP, and 20.4% of those who started treatment did not comply with the treatment regimen. This fact requires further educational activities.5. The efficacy of eradication by all schemes was 71.4%. Genotypic resistance of HP to clarithromycin was found in 37% of doctors. Further studies are needed to identify the characteristics of the macro- and microorganism (genetic polymorphism of enzymes, HP mutations) in groups, both among doctors and other categories of patients who do not have professional contacts with microorganisms and antibiotics in order to develop recommendations on the use of HP eradication schemes in region.
Objective. To determine the composition of the the parietal microflora of the colon under the condition of a tumor process and to assess the possibility of using these data from this study in the diagnosis of the colon cancer. Methods. The main group included patients (n=75) operated on in the Trans-Baikal Regional Oncology Center for the colon cancer. Among them are 38 men and 37 women aged 20 to 75 years. Control group consisted of 25 patients. The material of the main group, biopsies of tumor tissue and visually unchanged colon mucosa was taken intraoperatively during tumor removal. In patients of the control group, the material was taken during the colonoscopy. process. The detection of Helicobacter pylori in the biopsy of the mucous membrane was carried out by determining the urease activity, as well as by the method of polymerase chain reaction. The composition of the intestinal microbiota was determined by the bacteriological method. Results. As a result of comparison of the colon microbiota of the cancer patients and the control group, statistically significant differences in the quantitative composition of Lactobacillus spp., Bifidobacterium spp., Bacteroides spp., Clostridium spp., Enterococcus spp., E. coli (typical), E. coli (lactose-negative), Enterobacteriaceae, Staphylococcus spp. (CNS), Candida spp. were revealed. Moreover, a clear tendency of changes in the level of certain microorganisms (Bifidobacterium spp., E. coli (typical), Clostridium sp.) was detected when comparing the mucous membrane of a healthy person, unchanged mucous membrane of a patient with colorectal cancer, tumor tissue. A statistically significant dependence of the level of microorganisms on the sex of a patient, as well as the form of tumor growth, was revealed. Conclusion. Thus, a reliable correlation between the clinical and morphological characterization of the colon malignant tumor and the composition of the intestinal microbiota has been revealed. The microbiological features established within in the course of the study, which arise precisely under the conditions of colon cancer, can be used as an additional diagnostic marker in the diagnosis of a malignant process. What this paper adds It was found that thequantitative composition of the intestinal microbiota during the transformation into mucous and malignant tumor tissue in colon cancer and the correlation of specific microorganisms with the patient’s gender and the form of tumor growth. The state of the intestinal microbiota may represent a promising diagnostic marker for the detection of a malignant tumor.
1Краевая клиническая больница №1, Чита 672038, Российская Федерация 2 Читинская государственная медицинская академия, Чита 672090, Российская Федерация Цель исследования. Изучить частоту встречаемости генетического полиморфизма IL-1β (C3953T, T511C, T31C), IL-10 (G1082A, C592A, C819Т) и его ассоциацию с концентрацией IL-1β, IL-10 в сыворотке крови и лимфоцитарно-тромбоцитарной адгезией у больных разными формами хронического гнойного среднего отита. Материал и методы. Обследованы 299 пациентов с хроническим гнойным средним отитом (146 пациентов с мезотимпанитом, 153 -с эпитимпанитом) и 183 человека без патологии (контрольная группа). Всем обследуемым для верификации диагноза были выполнены стандартные общеклинические, рентгенологические, аудиометрические исследования, проведен молекулярно-генетический анализ ДНК методом ПЦР и иммунологическое исследование методом ИФА. Статистическую обработку полученных данных проводили с использованием пакета программ STATISTICA 6,0 (StatSoftInc., США). Критический уровень значимости при проверке статистических гипотез принимался менее 0,05. Результаты. Установлено статистически значимое преобладание гомозиготного генотипа С/С и гетерозиготного генотипа -Т/С по высокопродуцирующему аллелю С* гена IL-1β соответственно в полиморфных локусах 31 и 511 и гомозиготных генотипов А/А и С/С по низкопродуцирующим аллелям соответственно А* и С* гена IL-10 соответственно в полиморфных локусах -1082 и -819 в группе пациентов с кариозно-деструктивным течением хронического гнойного среднего отита. Зарегистрированы высокие значения содержания IL-1β (р<0,05) на фоне низких значений IL-10 (р<0,05) в сыворотке крови у лиц с эпитимпанитом при носительстве высокопродуцирующих вариантов генов провоспалительных цитокинов и низкопродуцирующих аллелей противовоспалительных цитокинов. Лимфоцитарно-тромбоцитарная депрессия обнаружена у всех пациентов с хроническим гнойным средним отитом. Заключение. Полученные данные позволяют предположить, что общим иммунопатогенетическим звеном хронического гнойного среднего отита является ось: гены IL-1β, IL-10 -соответствующие цитокины -лимфоцитарно-тромбоцитарная адгезия. Носительство генотипов -31СС и -511ТС промотора гена IL-1β повышает вероятность развития деструктивной формы заболевания. Ключевые слова: интерлейкины, однонуклеотидный полиморфизм, хронический гнойный средний отит, лимфоцитарно-тромбоцитарная адгезия. Для цитирования: Байке ЕВ, Дутова АА, Байке ЕЕ. Иммуногенетические механизмы патогенеза хронического гнойного среднего отита. Сибирское медицинское обозрение. 2018;(1): 36-43. The aim of the research.To study the frequency of genetic polymorphism of IL-1β (C3953T, T511C, T31C), IL-10 (G1082A, C592A, C819T) and its association with concentration IL-1β, IL-10 in the blood serum and lymphocytic-platelet adhesion in patients with various forms of chronic purulent otitis media. Material and methods. 299 patients with chronic purulent otitis media (146 patients with mesotympanitis, 153 with epitimpanitis) and 183 patients without pathology (control group) we...
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