A.V. Rudenko, S.P. Pasechnikov, N.V. Mitchenko, E.M. Kornilina

Evaluation of efficiency of combined therapy of women with acute uncomplicated pyelonephritis, with the presence of infection of the mollicutes of urine and sexual ways. Message 2. Results of studying the state of local immunity

The studies of mucosal immunity (MI) in urine samples and vaginal swabs of 72 women diagnosed with acute uncomplicated pyelonephritis (AUP) and concomitant inflammatory gynecological diseases, and of 23 healthy women were performed. Before treatment, when evaluating the humoral factors of MI, a significant increase in the level of many indicators was revealed in comparison with the control group.

In the patients of the research group, the genitourinary ways of which were infected with mollicutes, the proposed treatment scheme was used, which included not only classical antibiotic therapy of the urological orientation, but also antimicrobial and immunotherapy of inflammatory diseases of the genitals with the use of doxycycline, probiotic Biosporine, specific human immunoglobulins against ureaplasma and mycoplasma.

After treatment, an improvement in the condition of the MI of the urinary and genital ways mucous membranes in all groups of patients was ascertained, which indicated a decrease in the activity of the inflammatory process in the urogenital tracts, and to a greater extent in the urinary tracts. The significant changes in the MI parameters in urine in patients of the study group were noted, in contrast to the patients of the comparison group: the normalization of the level of Ig A, M, G, secretory IgA and secretory component, the greatest decrease in the median for the C3-component of complement (by 22.8 times) and lactoferrin (by 16.0 times). In the vaginal swabs of these patients, the median values for IgM and tumor necrosis factor-a (TNF-a) decreased in relation to the initial values by 2.5 and 2.9 times, while in comparison group patients - by 1.5 and 1.7 times).

The antibacterial therapy did not significantly alter the immunological parameters in vaginal swabs of patients of the second comparison group, the urinary tracts of which were infected only by classical bacteria, while at the same time there was a significant increase (3.5 times) in the level of TNF-a, which indicated the preservation of the chronic inflammatory process in the genitals against the background of a decrease in signs of inflammation in the kidneys and urinary tracts after the course of treatment according to the proposed scheme.