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The authors have compared the informative value of the tests determining the activity of adenosine deaminase (ADA) and the levels of interferon-gamma (INF-gamma) and neopterin in the diagnosis of pleural effusions of tuberculous (n = 67) and nontuberculous (n = 30) origin. The equally high diagnostic value has been found in the study of the activities of ADA (94.8%) and INF-gamma, which are markers of lymphocytic cellular immunity. There are great differences in the sensitivity of the neopterin test depending whether tuberculosis is isolated or complicates the course of tuberculosis of the lung or intrathoracic lymph nodes, which may be regarded as a reflection of the different status of macrophageal cellular immunity.

The paper analyzes whether it is possible to predict a risk for postoperative empyema, by studying a totality of characteristics of a patient, a pathological process, and the properties of MBT in 46 patients with progressive fibrocavernous tuberculosis. It also shows it actual to accomplish this task with a prediction accuracy of 89.5-100%, by simultaneously taking into account both the bacteriological properties of MBT (the magnitude of Mycobacterium tuberculosis excretion and viability) and different combinations of serum biological parameters that reflect the activity of an inflammatory process.

The paper compares the characteristics of the informative value of tests determining the activity of adenosine deaminase (ADA) activity and the level of gamma-interferon (gamma-IFN) for the differential diagnosis of tuberculous pleurisy (n = 35) and non-tuberculous pleural effusion (n = 53). Both tests were ascertained to have the similar differentially diagnostic capacities with their threshold values of 35 U/l and 180 pg/ ml, respectively. At the same time, the sensitivity and specificity of the ADA test were 98.4% and these of the gamma-IFN test were 94.3 and 96.2%, respectively, with the positive and negative predictive value being 91.3 and 98.3% and 94.3 and 96.2%, respectively, and with the diagnostic value of 94.5% for the ADA test and 96.4% for the gamma-IFN test. There was a high unidirectionality of changes in both values: it was higher than the cut-off points in 94.1% of the patients with tuberculous pleurisy and below them in 88.7% of those with other pleural effusions.

Functional activity of the bronchoalveolar lavage fluid (BALF) phagocytes was studied in 33 and 16 patients with fibro-cavernosis (FC) and infiltrative (I) pulmonary tuberculosis (PT), respectively. Complex examination of BALF, alveolar macrophages (AM) and neutrophils (N) sedimented from BALF revealed interrelationship between functional activity of the cells and the form of PT. Higher activities in BALF of neopterin and elastase mainly secreted by activated AM and N respectively, reflect a higher secretory activity of both types of cells in FC - PT. These patients are also characterized by more pronounced bactericide activity of Ns, which significantly correlates with adenosine deaminase (ADA) activity. It is suggested that changes in BALF of various biochemical parameters examined (neopterin, elastase, ADA and its isoenzymes, 2-deoxyADA) and bactericide activity of the sedimented cells represent are the consequences of differend sides of BALF phagocytes functioning. According to modem notions about the mechanisms of their regulation different intercellular relations are suggested in different form of PT.

The results of examination of 56 patients with destructive pulmonary tuberculosis, which involved the study of biochemical parameters characterizing different stages of an inflammatory process, as well as clinical and X-ray findings were analyzed, by applying various multivariate statistical methods. This approach was shown to be promising for estimating the severity of the process and for specifying the stage of development of an inflammatory process in some patients.

A hundred and three patients with destructive pulmonary tuberculosis were examined. These patients had heterodirectional changes in the serum levels of alpha2-macroglobulin (MG) and its forms. The lowering of the level of the F-form of the inhibitor outstripped the decrease in the activity of total alpha2-MG and it was detectable in the lobar processes with moderate symptoms of intoxication and with the inoculation of adjacent segments. The preservation of the low total activity of the inhibitor and its forms during antituberculous therapy characterize a diminished process. The high content of the S form of alpha2-MG is a feature in patients showing positive changes before and 2 months after treatment whereas the changes in total alpha2-MG and its F form may vary. Whether it is expedient to study the fractional composition of alpha2-MG is determined by the heterodirectionality of changes in its S and F forms depending on the pattern of a process.

Sixty-three patients with fibrocavernous pulmonary tuberculosis were examined before and 1 month after preoperative therapy with antituberculosis agents. The time course of changes in the clinical and X-ray characteristics of the severity of the disease were compared with the alterations of different biochemical indices, including acute-phase proteins, proteolysis inhibitors, intoxication severity. It was demonstrated that improvement of clinical and X-ray characteristics of the severity of a process after preoperative preparation could be predicted with an accuracy of 83% from the baseline serum concentrations of albumin and ceruloplasmin. The accuracy of prediction does not increase when the levels of protease inhibitors, C-reactive protein, adenosine deaminase, medium-weight molecules are simultaneously studied. The likelihood of the clinical and X-ray characteristics becoming better is higher with enhanced ceruloplasmin activity and decreased albumin levels.

Changes in lipid peroxidation parameters (LP), antioxidant system and proteinase inhibitors were studied at different evolutionary stages of experimental osteoarticular tuberculosis in 30 rabbits. All stages of the process were characterized by LP activation which in animals of all groups (except rabbits having the acute stage of arthritis) is accompanied by compensatory increase of superoxide dismutase and ceruloplasmin activity. Deficiency of superoxide dismutase found in the acute stage of arthritis with a growth of LP activity shows its inadequate production at a given stage of articular inflammation. Decrease in alpha 1-proteinase inhibitor activity at the stage of osteitis with reactive synovitis can be caused by the influence of LP products. The importance of this mechanism in the inhibition of alpha 1-proteinase inhibitor, together with reduction in its production at the acute stage of arthritis, cannot be ignored. The results obtained make it possible to recommend further study of the perspectives of antioxidants use in osteoarticular tuberculosis.

All the steps of osteoarticular tuberculosis evolution were accompanied by an increase in proteolytic activity in rabbit blood serum, which was compensated by activation of alpha 1-inhibitor of proteinases at the initial steps of osteitis. The system "proteinases-inhibitors" was imbalanced during the severe phases of arthritis independently on the rate of its development as follows: predominance of proteolytic potential over inhibitory activity, dissimilar activity of alpha 1-inhibitor of proteinases simultaneously with equal rate of alpha 2-macroglobulin content decrease. Dissimilar alterations in the system studied enabled to suggest that differential application of proteinases is suitable for treatment of inflammation with respect to the step of osteoarticular tuberculosis development.

A correlation between the informativeness of the proteinogram, blood ceruloplasmin and haptoglobin levels and connective tissue metabolism indices used to characterize the inflammatory process activity was performed in 55 patients with different stages of tuberculosis of bones and joints. Among the acute phase proteins examined, the most sensitive indices include ceruloplasmin and haptoglobin found in their combination. A higher urinary oxyproline and glycosaminoglycan excretion in different forms of osteoarticular tuberculosis (both of an inflammatory and a degenerative type) should not be interpreted as an indication of activity of the specific process.