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Optimizing Treatment of Urinary Tract Infections in Patients with Type 2 Diabetes Mellitus

DOI:10.31550/1727-2378-2020-19-2-20-26
Bibliography link: Morugova T.V., Nasyrtdinova A.D., Chakryan S.A. Optimizing Treatment of Urinary Tract Infections in Patients with Type 2 Diabetes Mellitus. Doctor.Ru. 2020; 19(2): 20–26. (in Russian) DOI: 10.31550/1727-2378-2020-19-2-20-26
Optimizing Treatment of Urinary Tract Infections in Patients with Type 2 Diabetes Mellitus
22 April 08:16

Study Objective: To assess the feasibility of adding Imunofan, a Russian immunomodulatory agent, to treatment regimens for exacerbations of urinary tract infections (UTI) in patients with type 2 diabetes mellitus (T2DM).

Materials and Methods: One hundred twenty-five people were included in the study: 35 apparently healthy people (control group); 30 DM patients without UTI; 30 T2DM patients with UTI, who were receiving conventional antibacterial treatment and symptomatic therapy; and 30 T2DM patients with UTI, who in addition to conventional treatment received arginyl-α-aspartyl-lysyl-valyl-tyrosyl-arginine (immunomodulatory agent Imunofan), 1 ml intramuscularly once a day for 10 days. Humoral and cellular immunity was studied on the first day of UTI exacerbation, which was also day 1 of treatment, and after eight weeks, in the convalescent phase.

Study Results: Inclusion of Imunofan in the baseline treatment regimen improved the patients’ immunological profiles. Patients receiving Imunofan showed a greater increase in СD3, СD4, and the immunoregulatory index (CD4/CD8). Moreover, their СD4 counts, while within the normal range, were higher than those of the healthy people. Their CD16 counts continued to increase and after eight weeks reached the levels observed in the DM patients without UTI. Imunofan increased HLA-DR levels, which rose above the upper limit of normal. It also increased the phagocytic activity of innate immunity (phagocytic activity of white blood cells and bactericidal activity of neutrophils as measured by spontaneous and induced nitroblue tetrazolium tests) as well as IgG and IgA levels, and reduced the levels of interleukins 4 and 1β and tumor necrosis factor-α.

Conclusion: Evaluation of changes in the cellular and humoral components of innate and adaptive immunity showed that in T2DM patients UTI are associated with indolent inflammation and delayed convalescence. When added to UTI treatment regimens, Imunofan restores normal parameters and reduces the risk of progression of chronic kidney disease in T2DM patients with UTI.

Contribution: Morugova, T.V. — study design, review relevant publications, the content of the paper checking, participated in writing all parts of the paper, approval of the manuscript for publication; Nasyrtdinova, A.D. — assistance with selection and organization of the study population, thematic publications reviewing, data analysis and interpretation, and participated in writing the final manuscript; Chakryan, S.A. — data analysis and interpretation, assistance in writing the final manuscript.

Conflict of interest: The authors declare that they do not have any conflict of interests.

T.V. Morugova — Bashkir State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 3 Lenin Street, Ufa, Russian Federation 450008. eLIBRARY.RU SPIN: 2976-9605. E-mail: tmorugova@yandex.ru

A.D. Nasyrtdinova (Corresponding author) — Bashkir State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 3 Lenin Street, Ufa, Russian Federation 450008. E-mail: aliyarena@yandex.ru

S.A. Chakryan — Bashkir State Medical University (a Federal Government-funded Educational Institution of Higher Education), Russian Ministry of Health; 3 Lenin Street, Ufa, Russian Federation 450008. E-mail: uro2010@mail.ru

Table 1
Cellular immunity parameters in study subjects, Me (25; 75)

t3_1.jpg

Note: Abbreviations in Tables 1, 2, and 3: DM = diabetes mellitus; UTI = urinary tract infection; V1 = before treatment; V4 = after eight weeks of treatment.

Table 2
Phagocytic activity of white blood cells (WBC) in study subjects, Me (25; 75)

t3_2.jpg

Table 3
Major immunoglobulin classes in study subjects, Me (25; 75)

t3_3.jpg

Table 4
Interleukins (IL) and tumor necrosis factor (TNF)-α in study subjects, Me (25; 75)

t3_4.jpg

Received: 03.03.2020
Accepted: 24.03.2020

Optimizing Treatment of Urinary Tract Infections in Patients with Type 2 Diabetes Mellitus
22 April 08:16
LITERATURE
  1. The Federal Register of Diabetes Patients. URL: http://diaregistry.ru/ (Accessed 02.03.2020) (in Russian)
  2. Shamkhalova M.Sh., Vikulova O.K., Zheleznyakova A.V. Epidemiology of chronic kidney disease in the Russian Federation according to the Federal Register of Adult Patients with Diabetes (2013–2016). Diabetes Mellitus. 2018; 21(3): 160–9. (in Russian)
  3. Shestakova M.V., Dedov I.I. Diabetes mellitus and chronic kidney disease. M.: MIA; 2009. 480 p. (in Russian)
  4. Shestakova M.V. Diabetes mellitus and chronic kidney disease: modern diagnosis and treatment. Annals of the Russian Academy of Medical Sciences. 2012; 1: 45–49. (in Russian)
  5. Russian clinical recommendations of urology. M.; 2016. 492 p. (in Russian)
  6. Nikulin B.A. Assessment and correction of the immune status. M.: GEOTAR-Media; 2007. 376 р. (in Russian)
  7. Pavlov V.N., Musin D.R., Alekseev A.V., Gatiyatullina R.S., Ishemgulov R.R., Nasibullin I.M. et al. The effectiveness of the use of pyobacteriophage and indicators of water-electrolyte balance in patients with urolithiasis disease. Medical Bulletin of Bashkortostan. 2010; 5(2): 30–3. (in Russian)
  8. Pavlov V.N., Pushkarev A.M. Immunobiological approaches in the prevention and treatment of infectious and inflammatory complications in urological patients. In: Aliev Yu.G., Arefiev O.A., Asfandiyarov F.R., Batyushin M.M., Bejanyan S.K., Belova A.N. et al. Infections and inflammations in urology. M.; 2019: 76–116. (in Russian)
  9. Geerlings S.E., Stolk R.P., Camps M.J., Netten P.M., Collet T.J., Hoepelman A.I.; Diabetes Women Asymptomatic Bacteriuria Utrecht Study Group. Risk factors for symptomatic urinary tract infection in women with diabetes. Diabetes Care. 2000; 23(12): 1737–41. DOI: 10.2337/diacare.23.12.1737
  10. Zemskov A.M., Zemskov V.M., Berezhnova T.A., Zemskova B.A., Kulintsova Ya.V. Laboratory indications as markers of diagnosis and immunotherapy of infections. Bulletin of New Medical Technologies. 2017; 4: 186–93. (in Russian)
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