Study of the immunomodulating and detoxifying effects of lactulose

Yaroslavl State Medical Academy

Doctor of Medical Sciences, Professor G.A. SUKHANOV

Candidate of Medical Sciences A.N. ABISSES

On the results of a clinical study of the immunomodulating and detoxifying effect of lactulose syrup "Lactusan"

In the Road Clinical Hospital of Yaroslavl, which is the base of the Departments of Surgical Diseases and Therapy of the Yaroslavl State Medical Academy, a clinical approbation of a biologically active food supplement (BAA) of the drug Lactusan was carried out.

Purpose of the study.

1. To study the detoxifying effect of the drug Lactusan on patients with toxic forms of goiter.

2. To study the immunomodulating effect of Lactusan on patients with diabetes mellitus.

3. Find out the effectiveness of Lactusan in the treatment of patients with diseases of the digestive system.

Materials and methods.

Used: Lactusan syrup containing 40% lactulose, 12% lactose, 4% galactose and 1% ash.

Examined before and after treatment with Lactusan:

— 10 patients with thyrotoxic goiter,

— 42 patients with type 1 and type 2 diabetes,

— 35 adult patients with diseases of the digestive system (chronic hepatitis, chronic colitis, chronic pancreatitis),

— 25 children with diseases of the digestive system (intestinal dysbacteriosis, chronic gastroduodenitis, chronic colitis).

In all control groups, against the background of traditional treatment for these diseases, patients took Lactusan 2 teaspoons 2 times a day for 7-10 days.

In patients with thyrotoxic goiter and diabetes mellitus, the effectiveness of Lactusan was monitored by changes in cellular and humoral immunity factors.

The number of T and B cells was assessed by indirect immunofluorescence with monoclinal antibodies, the content of immunoglobulins of classes G, M, A using radial immunodiffusion according to Mancini, the level of circulating immune complexes (CIC) by a spectrophotometric method with polyethylene glycol, the functions of oxygen-dependent metabolism of neutrophils, in reactions of spontaneous and stimulated luminol-dependent chemiluminescence on a Beta-1 radiometric counter.

In diseases of the digestive system, in addition to studying the indicators of bilirubin, transaminase, alkaline phosphatase, an ultrasound examination of the abdominal organs (liver, gallbladder, pancreas) was performed.

Changes in the immunological status in patients with impaired thyroid function after the use of Laktusan.

Prior to treatment with Lactusan, patients had a decrease in the number of T-lymphocytes, an increase in the level of circulating immune complexes (CIC), a violation of neutrophil functions in the form of a decrease in digestion ability and inhibition of the production of reactive oxygen species according to the test of spontaneous and stimulated chemiluminescence.

After treatment with Laktusan, there was an increase in the production of class A immunoglobulin, a decrease in the level of the CEC, an increase in the phagocytic activity of neutrophils and the normalization of their digestive capacity, and an increase in the production of reactive oxygen species.

Results of the immunomodulating action of Laktusan in the treatment of patients with diabetes mellitus.

Before treatment with Lactusan, patients with diabetes mellitus compared with healthy people had a decrease in the number of T lymphocytes, a decrease in the content of class C serum immunoglobulin, impaired neutrophil functions in the form of a decrease in the phagocytic number and phagocytic index, as well as a sharp drop in the production of reactive oxygen species by neutrophils according to a spontaneous test. and stimulated chemiluminescence. In some patients, an increase in the concentration of immunoglobulins of classes A and M was revealed.

Treatment of diabetic patients with the use of Laktusan led to an increase in the number of T cells by 45%, B cells by 92%, increased production of immunoglobulin classes A (by 45.8%) and M (by 12%). The treatment did not affect the content of class C immunoglobulin, the level of circulating immune complexes and phagocytic parameters. The data of immunological studies in patients with diabetes mellitus were also analyzed depending on the types of this disease.

Both in patients with type 1 diabetes mellitus and in patients with type 2, there were changes in the immunogram corresponding to the total data.

In particular, a decrease in the number of T-lymphocytes, a decrease in the content of serum immunoglobulin class G, a violation of phagocytosis and neutrophil functions according to the test of spontaneous and stimulated chemiluminescence were found. In some patients, an increase in the concentration of immunoglobulins of classes A and M was revealed. The level of circulating immune complexes (CIC) was within the physiological norm.

In patients with type 1 diabetes, compared with similar data in patients with type 2 diabetes, higher rates of stimulated neutrophil chemiluminescence were noted. According to other indicators of immunity, there was no significant difference in patients with type 1 and type 2 diabetes mellitus.

After treatment in patients with type 1 diabetes, an increase in the number of T-cells (by 68.5%), B-cells (by 86.6%) cells, increased production of immunoglobulin A classes (by 85.7%), immunoglobulin class M (by 29%) ), increased phagocytic activity of neutrophils (by 8.8%). The treatment did not affect the content of class G immunoglobulin, the level of circulating immune complexes and phagocytic parameters, as well as the function of neutrophils.

In patients with type 2 diabetes, the treatment also had a positive effect on a number of immunological parameters, but to a somewhat lesser extent. Thus, an increase in the number of T-cells (by 45.2%), B-cells (by 78.6%) cells, an increase in the production of class A immunoglobulin (by 30.7%), class M immunoglobulin (by 6.2%) was ascertained. The treatment performed had no effect on the content of class G immunoglobulin, the level of circulating immune complexes, phagocytosis indicators, and neutrophil function.

The conducted studies testify to the positive effect of the treatment with Laktusan in diabetes mellitus on a number of immunological parameters.

On the therapeutic efficacy of Lactusan in the treatment of gastroenterological patients.

Treatment with Laktusan (along with traditional therapy) was analyzed in 35 adult patients, including 17 with chronic hepatitis, 14 with chronic colitis, and 4 with chronic pancreatitis. Most of the patients were under the age of 60 years.

During the study, attention was paid to changes in the clinical manifestations of the disease - pain in the epigastrium and in the right hypochondrium, the presence of discomfort, bitterness in the mouth, weakness, disorder of the stool, as well as the content of transaminases, bilirubin, alkaline phosphatase, the severity of dysbacteriosis. The comparison group consisted of identical patients who received only traditional therapy.

Under the influence of treatment, all patients improved, confirmed by the dynamics of symptoms, as well as blood tests (bilirubin decreased on average from 80 mmol / l to 22 mmol / l, transaminase from 87 to 45 units, and alkaline phosphatase from 190 to 125 units. ).

The length of stay in bed was on average 19 days per day for chronic colitis, 28 days per day for chronic hepatitis, 25 days per day for chronic pancreatitis, compared with the comparison group, the length of stay in bed decreased by 4 days. When prescribing the drug, there were no complications. In 2 patients with dysbacteriosis, in whom, after 1 course, there was no complete recovery of the microflora, it recovered after a second course.

In the children's department Lactusan treated 25 children under the age of 1 year - 6 people, from 1 to 3 years old - 10 people, from 3 to 7 years old - 5 people, over 7 years old - 4 people. Boys - 13, girls - 12.

The main clinical diagnoses were: intestinal dysbacteriosis - 17 people, chronic gastroduodenitis - 4 people, chronic gastritis - 2 people, chronic colitis - 2 people, the last patients also had dysbacteriosis.

Intestinal dysbacteriosis: staphylococcal - 10, proteus - 1, colibacillary - 2, associated - 12. In all cases, clinical improvement was noted: normalization of stool, reduction of flatulence and abdominal pain, improvement in well-being.

Laboratory indicators: in the feces on a micro-landscape after 1 month, S.aureus was isolated in 4 children, E.Coli in 1 child, Pr. Vulgaris - 1. In cases of associated dysbacteriosis - 5 people, E.Coli (hemolytic and lactose-negative) - 5 people.

In all cases, the number of normal flora colonies increased. In 1 child with iron deficiency anemia, in addition to improving the microlandscape, the indicators of "red blood" - Hb and erythrocytes improved. In all cases, in the coprogram - improving the digestion of carbohydrates.

Thus, Lactusan is promising in the treatment of diseases of the liver, biliary tract and intestines as a remedy that eliminates violations of the intestinal biocenosis and affects metabolism, and thus, a positive outcome of the disease.

FINDINGS

1. The hematoprotective function of lactulose has a normalizing effect on the immune system of patients with toxic goiter, and therefore Lactusan can be used both for the conservative treatment of thyrotoxicosis and for preoperative preparation.

2. The inclusion of Laktusan in the traditional treatment regimen for type 1 and type 2 diabetes mellitus provides an increase in T cells by 45%, B cells by 92%, immunoglobulins by 12%-45.8%, which makes it mandatory to use Laktusan in the treatment of patients with diabetes mellitus with local and general purulent complications .

3. Lactusan is promising in the treatment of diseases of the liver, biliary tract and intestines as a remedy that eliminates violations of the intestinal biocenosis and positively affects metabolism, and thus, a positive outcome of the disease.