ALGORYTHM OF DETERMINING INDIVIDUAL DEGREE OF RECURRENCE RISK AMONG CURED PATIENTS WITH NEWLY DIAGNOSED INFILTRATIVE PULMONARY TUBERCULOSIS

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, namely to phthisiology, and can be used in TB clinics for formation of groups of higher risk of disease recurrence among cured patients with newly diagnosed infiltrative pulmonary tuberculosis for the moment of main treatment course end. Presence of risk factors of tuberculosis process progressing in remote period of observation is determined: group A - interruption of main treatment course, widespread infiltration for the moment of treatment beginning - 3 segments and more, drug resistance, contact with patient with open form of tuberculosis before beginning of treatment; group B - men, cavities of decay with 2 cm and more diametre at the beginning of treatment, duration of course treatment not higher than 180 doses, violation of regulated period of preventive fluoroexamination before detection of disease, interruption of hospital treatment. Presence of prognostically significant qualitative factors of type of residual post-tuberculosis changes (RTC) in remote period of observation is determined: contact with patient with open form of tuberculosis (x1), social status (x3), use of drugs (x4), completeness of hospital stage (x5), cavity of decay (x6), completeness of course treatment (x9), residual post-tuberculosis changes at the moment of detection (x10), massiveness of bacteria release (x12), in case if quality factor is absent it is equaled to 0, if it is present - to 1. Presence of prognostically significant quantitative factors of type of residual post-tuberculosis changes in remote period of observation is determined: number of affected lung segments (x2), age - years (x7), duration of course treatment - doses (x8), duration of intensive phase - doses (x11). After that, prognosis of "minor" (Y1) and "major" (Y2) RTC in remote period of observation are determined by formulas Y1 and Y2. On the basis of Y1 and Y2 values comparison conclusion about prediction of "minor" and "major" RTC is made. In case if one risk factor of tuberculosis progressing in remote period from group A or two and more from group B are absent, and 'minor" RTC are present, low degree of recurrence risk, requiring observation in III group of specialised dispensary registration for 1 year, is determined, if one factor of group A or two and more factors of group B are present and presence of "major" RTC, high degree of recurrence risk, requiring observation in III group of specialised dispensary registration for 3 years, is determined, if one factor of group A or two and more factors of group B are present and presence of "minor" RTC, medium degree of recurrence risk, requiring observation in III group of specialised dispensary registration for 2 years, is determined, and if, if one risk factor from group A or two and more from group B are absent, and presence of "major" RTC, medium degree of recurrence risk, requiring observation in III group of specialised dispensary registration for 2 years, is determined.;EFFECT: method allows to reduce frequency of recurrences due to improvement of specialised dispensary observation in group III of specialised dispensary observation of cured patients with newly diagnosed infiltrative pulmonary tuberculosis as the most frequent form of the disease.;4 tbl, 2 ex