A B S T R A C TObjectives: Tuberculosis (TB) still remains an important medical problem due to high levels of morbidity and mortality worldwide. Tuberculous pleurisy is the most common form of extrapulmonary TB. Since tuberculous pleural effusion usually contains a low number of mycobacteria, the diagnostic sensitivity of both direct microscopy and pleural fluid cultures is relatively low.Adenosine deaminase (ADA) is an essential enzyme in the metabolism of purine nucleosides. For an adequate interpretation of ADA, it is important to highlight the fact that ADA is represented by two isoenzymes: ADA1 and ADA2. The ADA1 isoenzymes are found in all cells, with the highest activity in lymphocytes, whereas ADA2 isoenzymes appear to be found only in antigen-presenting cells.The aim of this study is to evaluate the ADA and ADA1 and ADA2 isoenzyme activity in patients with pulmonary TB and tuberculous pleurisy.Methods: This study included 25 patients with pleural effusions (11 with pleural TB and 14 with nontuberculous etiologies), 35 patients with pulmonary tuberculosis (PTB) and 42 healthy subjects.Total ADA activity level in pleural fluid and blood plasma was measured by the ''ADA-test kit'' developed in the Republican Scientific and Practical Center for Epidemiology & Microbiology (Minsk, Belarus). The principle ''ADA-test'' is a colorimetric method in which adenosine is deaminated by ADA and the free ammonia is estimated. Estimated ADA2 activity was calculated from the ADA and 2 0 -deoxyadenosine deaminase activities using the affinity of ADA2 for the two substrates. Results:The mean plasma ADA level in patients with PTB was 19.2 ± 3.3 U/L that was significantly higher than the control group (10.4 ± 0.6 U/L). The difference between patients with pleural TB and the controls is also significant (18.2 ± 2.5 U/L versus 10.4 ± 0.6 U/L, p < 0.05). A significantly higher activity of ADA1 and ADA2 in the blood plasma was observed in patients with PTB and pleural TB than those of the corresponding controls (p < 0.05). I n t e r n a t i o n a l J o u r n a l o f M y c o b a c t e r i o l o g y 4 ( 2 0 1 5 ) 9 3 -9 4 H O S T E D BY A v ai l abl e a t w w w . s c i e n c e d i r e c t. c o m ScienceDirect j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / I J M Y C O
1 ГУ «РНПЦ пульмонологии и фтизиатрии», г. Минск, Беларусь 2 РУП «Центр экспертиз и испытаний в здравоохранении», г. Минск, Беларусь 3 УО «Белорусский государственный медицинский университет», г. Минск, Беларусь Цель исследования: характеристика профиля эффективности и безопасности использования новых противотуберкулезных лекарственных средств у пациентов с туберкулезом с лекарственной устойчивостью возбудителя� Материалы и методы. Проведен ретроспективный и проспективный анализ когорты из 300 пациентов с туберкулезом с множественной лекарственной устойчивостью возбудителя и высокой долей широкой лекарственной устойчивости, получавших новые и перепрофилированные противотуберкулезные лекарственные средства, в Республике Беларусь� Для описания когорты использовали группы переменных для характеристики профиля эффективности и профиля безопасности новых противотуберкулезных лекарственных средств� Результаты исследования. Продемонстрирован высокий уровень терапевтической эффективности в исследованной когорте, а также достаточно благоприятный профиль безопасности новых режимов� Ключевые слова: туберкулез с множественной и широкой лекарственной устойчивостью возбудителя, новые противотуберкулезные препараты, профиль эффективности и безопасности, бедаквилин Для цитирования: Скрягина Е� М�, Гуревич Г� Л�, Солодовникова В� В�, Дюсьмикеева М� И�, Сеткина С� Б�, Журкин Д� М� Опыт применения новых режимов лечения туберкулеза с множественной и широкой лекарственной устойчивостью возбудителя в Республике Беларусь // Туберкулёз и болезни лёгких� -2018� -Т� 96, № 8� -С� 5-14�The objective of the study: to describe the efficiency and safety of new anti-tuberculosis drugs when treating tuberculosis patients with drug resistance� Subjects and methods. In Belarus, the retrospective and prospective analyses were performed in the cohort of 300 patients with multiple drug resistance and high rates of extensive drug resistance, who were treated with new drugs and drugs which were started to be used for the treatment of tuberculosis� In order to describe the cohort, blocks of variables were used to specify the efficiency and safety profiles of new anti-tuberculosis drugs� Results of the study. The high level of therapeutic efficiency of new regimens and their fairly favorable safety profile were demonstrated in the cohort� Key words: tuberculosis with multiple and extensive drug resistance, new anti-tuberculosis drugs, profile of efficiency and safety, bedaquiline For citations: Skryagina E�M�, Gurevich G�L�, Solodovnikova V�V�, Dyusmikeeva M�I�, Setkina S�B�, Zhurkin D�M� Experience of treating multiple and extensive drug resistant tuberculosis with new regimens in Belarus Republic� Tuberculosis and Lung Diseases, 2018, Vol� 96, no� 8, P� 5-14� (In Russ�)
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