The investigation of clinical-physiological manifestations of community-acquired pneumonias (CAP) quite allows characterizing the patient´s state and forming the functional component of the diagnosis (Chuchalin A.G. and co-authors, 2006). In particular, it is spread to the determination of the external respiration apparatus, which remains insufficiently studied at CAP up to the present time. So, the total non-elastic lung resistance (TNR) defined at the respiration biomechanics investigation at pneumonias was studied in single works (Tetenev F.F., 1981; Marshall R., Christie R., 1954). There are no works found out by us on the CAP TNR of lungs and its component - tissular rub - on lung zones and compared to the alveolar-capillary permeability of lungs.
The purpose of the work is to study and compared the lung TNR and alveolar-capillary permeability (ACP) in CAP patients in the acute period of the disease.
Materials and methods
35 patients suffering from the medium severity level CAP were examined, among them 21 patients with the focalization of pulmonary infiltration in the inferior lobe of the right lung and 14 patients with that in the inferior lobe of the left lung in the disease acuity (2-3 days of hospitalization); all the patients being aged from 16 to 55 years old. All the CAP patients and 30 healthy volunteers (I control group) were subject to the lung TNR investigation, the last being carried out in the phase of inspiration (TNRinsp) and expiration (TNRexp): integral and regional values. The integral TNR was measured by the method of transpulmonary pressure and spirogram simultaneous recording. The regional TNR values in the superior, central and inferior lobes of lungs were measured by means of the simultaneous recording of zonal ventilation rheograms by the method of Fringerman E.A. and transpulmonary pressure. The graphic recording of the curves and the computation of integral and regional TNR factors was performed by means of a special computer program. Also, the ventilating pulmonoscintigraphy was performed on all the CAP patients and 10 healthy volunteers (II control group). The nuclear medicine studies were carried out on the gamma camera "Omega 500" ("Technicare", USA-Germany). The image registration and processing was performed with the help of the computer system "Scinty" produced by the RDC "Gelmos" (Russia). As the radiopharmaceutical (RPC) for the ventilating pulmonoscintigraphy the DTPA was used. The polypositional static pulmonoscintigraphy was carried out after finishing the RPC inhalation in four standard projections, then repeatedly on the 10th and 30th min in the posterior-frontal projection. In the CAP patients and II control group the ACP was determined on the 10th and 30th min: primarily in the affected and intact lungs, then additionally in every lung on the 3 lobes (superior, central and inferior) - so called regional factors. As there were no authentic ACP differences between the right and left lungs and also the superior, central and inferior lobes found out in the control group, the general ACP values for the corresponding lung lobes were used. The findings got were subject to statistical processing with the help of the program STATISTICA-6, for Windows.
Results
The integral TNRexp values were higher in the CAP patients, than in the healthy persons (0,540±0,049 kPa·sec/l and 0,369±0,036 kPa·sec/l; р=0,003). As a result of the TNR regional values studies in the CAP patients it was found out that in the affection area the TNRexp increased with the infiltration presence in the inferior lobe of the right lung, and the TNRinsp and TNRexp increased, if the infiltration was focalized in the inferior lobe of the left lung. In the inferior lobe of the intact lung the TNR didn´t change; in the central lobe of the right lung the TNRinsp and TNRexp were increased at any focalization of the pathologic process; in the superior lobe of the intact lung the TNRexp increased at the dextral CAP and the TNRinsp and TNRexp increased at the sinistral CAP. The lung ACP integral values increase was found out on the 10th and 30th min of the investigation in the affected (22,1±3,4% and 36,6±2,4%; р=0,007 and 0,003) and intact (20,4±3,8% and 33,9±3,5%; р=0,003 and 0,006) lungs at the lung infiltration focalization in the inferior lobe of the right lung, and also in the affected (20,4±3,2% and 35,2±3,8%; р=0,005 and 0,002) and intact (7,4±2,4% and 32,4±2,4%; р=0,004 and 0,005) lungs at the lung infiltration focalization in the inferior lobe of the left lung. In the CAP patients (irrespective of the lung infiltration focalization) an ACP increase for radioaerosol was registered, first, ambilateral - both in the affected and in all intact lobes of both lungs, second, both on the 10th and 30th min of the investigation. Thus, at the CAP acuity a diffuse increase of the lung alveolar-capillary structures´ permeability was found out.
Conclusions
The obtained results of the lung TNR and ACP regional values changes say apparently for an increased genuine mechanical lung activity in these lobes, due to the action of which a significant part of the lung TNR is worn down.
The work was submitted to III international scientific conference «Basic Research», Dominican Republic, April, 10-20, 2008, came to the editorial office 22.04.2008.