The main aim of the study is to examine microbiocenosis of lower respiratory tract and intestine in patients with chronic obstructive pulmonary disease (COPD), lung cancer (LC), lung cancer with community-acquired pneumonia (CAP) and to determine their role in the etiological diagnosis of lower respiratory tract infections (LRTi), including those that develop during cancer chemotherapy (CC), to discuss the possibility of optimizing the treatment tactics.
Materials and methods: To solve this task were examined 147 patients and 30 healthy individuals were divided into 4 groups, according to nosology. The number of patients in the COPD group was 38 people, m / f-35/3, median age 63 (57; 69) years, in the LC group -60 people, m / f - 56/4, with a median age of 65 (58; 71) year; LC groupwith CAP -21 persons m / f - 17/4, with a median age of 73(69; 75) years, in the LC group with CAP developed in the period up to 30 days after the end of chemotherapy (LC with CAP / CC) -28 persons m / f - 22/6, with a median age of 70 (67; 73) years, the norm group -30 healthy persons m / f- 26/4, median age 48(40,691 years. The spectrum of short-chain fatty acids (SCFA) sputum (in bronchoalveolar lavage standards group) and test groups of feces were studied by gas-liquid chromatographic analysis (GLC analysis). Results of the study. In the norm group: total absolute content of SCFA (X) in sputum was 0.032 mg / g, the relative content of acetic acid (pC2) 0906 u, propionic acid (pC3) 0.085 u, butyric acid (pC4) 0.009 u, anaerobic index (Al) -0.104 units. According to the analysis the total absolute content of SCFA in the sputum may be expressed as follows: ∑ SCPA (C2-C4) norm (0,032) <∑ SCFA (C2-C4) COPD (0,201) <∑ SCFA (C2-C4) RL (0,463) < ∑ SCFA (C2-C4) LC with CAP (0.510) < RCMP ∑ (C2-C4) LC with CAP / CC (0.612) (mg / g), the differences are statistically significant when compared with the norm. The findings of the relative content of C2-C4 show a statistically significant increase of the relative content of propionic and butyric acids: PC3 (0,085) pC4 (0.009) norm <pC3 (0.127), pC4 (0,027) COPD <pC3 (0.174), pC4 (0,03 1) LC <pC3 (0.1 981, pC4 (0,037) LC with CAP <pC3 (0.232) pC4 (0,049) LC with CAP/CC (units). While reducing the content of acetic acid: pC2 (0.906) norm> pC2 (0.846) COPD> pC2 (0.792) LC> pC2 (0.765) LC with CAP> pC2 (0.719) LC with CAP / CC (u) in patients of all study groups compared to the norm, and between groups. And the more pronounced changes in the content of SCFA in the sputum are ascertained in lung cancer with CAP during chemotherapy. *The values of Al in the studied groups are displaced to more negative values: Al (- 0.104) rate> Al (- 0.190) COPD> Al (- 0.257) RL> Al (- 0.307) LC with CAP> Al (- 0.391) LC with CAP / CC (sing.) compared with the norm and between groups. The findings of SCPA in feces in the group norm: ~1 SCFA 10.51 mg / g, 0.634 units pC2, pC3 0,189 units, 0,176 units pC4, -0.576 Al units. The total absolute content of SCFA in feces can be expressed as follows: ∑ SCFA (C2-C4) LC (4,11) <∑ SCFA (C2-C4) COPD (4,81) <∑ SCFA (C2-C4) norm (10 51) (mg / g), the differences were statistically significant when compared with the norm; depending on the chemotherapy, preceding the development of the CAP: ∑ SCFA (C2-C4) norm (10,51)> ∑ SCFA (C2-C4) LC with CAP / che- motherapy (5,54)> ∑ SCFA (C2-C4) LC CAP (4,96)> ∑ SCFA (C2-C4) LC (4.11) (mg / g). Results of the study of the relative content of C4-C2 also demonstrate a statistically significant increase of the relative content of propionic and butyric acids: pC3 (0.189), pC4 (0.176) norm <pC3 (0.219), pC4 (0.191) COPO <pC3 (0.239), pC4 (0,201) LC <pC3 (0,250) pC4 (0,221) LC with CAP <pC3 (0,264), pC4 (0.233) LC with CAP / chemotherapy (u), while reducing the content of acetic acid: pC2 (0.634) norm> pC2 (0.590) COPD> pC2 (0,560) LC> pC2 (0.529) LC with CAP> pC2 (0.503) LC with CAP! chemotherapy (u) in patients of all study groups in comparison with the norm. And the more pronounced changes in the content of SCFA in feces are ascertained at LC with CAP during chemotherapy. The values of Al intestinal ecological community of all groups are displaced to more negative values when compared with the norm: Al (- 0.576) norm> Al (- 0.695) COPD> Al (- 0.786) LC> Al ('0.890) LC with CAP> Al (- 0.988) LC with CAP / chemotherapy (u), with the most significant changes were observedin the group of LC with CAP during chemotherapy. Conclusion, Increased absolute SCFA concentration in patients with CQPD, lung cancer, lung cancer with CAP, LC with CAP! CC in comparison with the norm indicates increased number and activity of anaerobic flora, the most significant changes observed in patients with lung cancer with CAP, developed in the period up to 30 days after the end of chemotherapy. The unidirectional changes in SCFA parameters in the sputum and stool demonstrate the dependence of microorganism biocenosis. The resulting information can be used in the etiological diagnosis of LRTI, as well as the development of therapeutic and preventive measures flAw Af infprtiniis rnmnlications and treatment of these patients.