Abstract. The article discusses the relationship between diseases of the pleura (pleural effusion, pleurisy, empyema) and endocrine disorders, in particular hypothyroidism, as a potential modifying factor in the course of pleural pathology. An analysis of modern literature sources on the pathogenetic mechanisms of pleural effusion
formation in thyroid dysfunction, clinical features, diagnostic approaches and effectiveness of levothyroxine replacement therapy has been carried out. It has been found that some patients with hypothyroidism develop pleural effusions, which regress after reaching euthyroid. The paper describes epidemiological, diagnostic, clinical,
pharmacological and organizational gaps in the study of this comorbid condition. The authors proposed an algorithm for the initial diagnosis of pleural effusions and routing of patients, taking into account the determination of thyroid status. ABC/VED analysis of drugs used in the pharmacotherapy of hypothyroid-associated
diseases of the pleura was performed. Levothyroxine has been shown to be a key etiotropic agent, and timely hormonal correction reduces the need for invasive procedures and improves clinical outcomes. The importance of a
multidisciplinary approach to diagnosis and treatment, which combines pulmonological, endocrinological and clinical-pharmacological aspects, is emphasized.
Keywords: pleurisy, pleural effusion, pleural empyema, hypothyroidism, thyroid dysfunction, ABC/VED analysis, endocrine-pulmonary comorbidity.

УДК: 616.24-007.271-036.12-092-085.23

Реферат

Метою дослідження було проаналізувати ефективність використання в комплексному лікуванні на госпітальному етапі препарату Деркаст у пацієнтів із середньо-тяжким і тяжким загостреннями  ХОЗЛ з урахуванням фенотипу запалення.

Матеріал i методи. Використано доступ до повнотекстових і реферативних баз даних та наукових публікацій.

Результати й обговорення. Відповідно до положень GOLD (2024-2025), у патогенезі дестабілізації перебігу та розвитку загострень ХОЗЛ провідну роль відіграє запальний процес в дихальних шляхах та посилення бронхоконстрикції. Запалення може бути еозинофільним або нейтрофільним (часто стійким до ІКС), тому існує недостатня ефективність стандартної терапії залежно від фенотипів запалення. Тож застосування нового вітчизняного препарату Деркаст, який є інгібітором фосфодіестераз (ФДЕ), здатний забезпечити  в комплексному лікуванні подолання загострень ХОЗЛ на госпітальному етапі. Деркаст, інгібуючи ФДЕ-3, ФДЕ-4 та ФДЕ-5, сприяє розвитку бронхолітичного і протизапального ефектів та потенціації інгяляційних препаратів; причому іони калію і магнію, що входять до складу препарату, забезпечують швидкий і керований ефект стабілізації перебігу ХОЗЛ в умовах стаціонарного лікування.

Висновки. Комплексний підхід до лікування на госпітальному етапі середньотяжких і тяжких загострень ХОЗЛ з використання нового вітчизняного препарату Деркаст, із врахуванням фенотипу запалення, є патогенетично обгрунтованим засобом підвищення ефективності терапії даної категорії пацієнтів. Необхідність призначення інгібіторів ФДЕ у стаціонарному лікуванні цієї когорти пацієнтів викликана зниженням чутливості ß_{2 –} адренорецепторів до ß_{2 –} адреноміметиків внаслідок неконтрольваного та частого їх прийому, стійкістю до ІКС, що призводить до посилення хронічного персистуючого запалення, дестабілізації перебігу та розвитку загострень.

Ключові слова: ХОЗЛ, загострення, Деркаст, тип запального процесу, комплексна терапія

In modern environment, tuberculosis (TB) is one of the most important issues in the Health system [1]. According to the World Health Organization (WHO)10.6 million people contracted TB and 1.6 million died from it in 2021 [2, 3].One of the main reasons for the deterioration of the epidemiological situation with TB in the World, and in particular in Ukraine, is the spread of chemoresistant TB (CR-TB) [4, 5]. As a result of the pathomorphosis of CR-TB over the past 13 years, among adult patients there is a clear trend towards an increase in primary resistance to fluoroquinolones (in particular, extensive drug resistance -XDR) from the minimum frequency in 2006 (0%) to almost 30.0% in 2019, on the background of a decrease in multidrug-resistant (MDR) TB without resistance to fluoroquinolones (from 60.0% to 40.0%) [6]. An unfavorable trend has been observed since 2017, when the number of patients with MDR-TB and XDR-TB almost equalized. At the same time, in Ukraine MDR-TB was diagnosed for the first time in 3,924 patients, of which XDR-TB –in 396 (10.1%) in 2023, and the incidence of MDR-TB was 3,645, of which XDR-TB -in 885 patients (24.3%) in 2024 [7.8].Several main factors for risk the deterioration of the course and results of TB treatment have been identified, in particular the resistance of Mycobacteria tuberculosis (MBT); concomitant diseases ‒ human immunodeficiency virus (HIV), diabetes, coronavirus disease (COVID-19); war, etc. [4, 9].Currently, TB has become the most common opportunistic disease in HIV-infection and the main cause of AIDS and death in patients with HIV [10, 11]. The researches of scientists [12] confirmed that only 10-15% of HIV-negative individuals get sick after contact with a bacterioexcreter, and 40-50% of HIV-positive individuals already get sick. It is also known that the combination of TB and HIV-infection is a risk factor for the occurrence of chemoresistant forms: only 27.3% of patients with isolated TB have resistant forms, and among patients with HIV/AIDS/TB co-infection -60.0%.According to the studies of MatsegoraN.A. et al. [11], patients with CR-TB/HIV co-infection have been diagnosed with many forms of comorbidity, leading to multiple organ pathology, which is more pronounced in patients in a state of deep immunosuppression.In patients with deep immunodeficiency, extrapulmonary localization of the tuberculous process, will probably be detected more often than only pulmonary localization (70.1% vs. 62.9%). Among the examined patients with HIV/AIDS/TB co-infection, 30 % had isolated pulmonary TB, 33 % had cThus, the study of the frequency of complications and lesions of organs/systems of patients with CR-PTB/HIV co-infection is relevant for the timely diagnosis of this disease, the development of new modern methods of treatment and the improvement of the course of CR-PTB/HIV co-infectionombined pulmonary/extrapulmonary [13], and the greatest specific gravity was extrapulmonary TB without pulmonary involvement [14, 15, 16]. 

Objective:To study the frequency of complications and organ/system involvement in pulmonary tuberculosis in the context of HIV/AIDS infection.Materials and Methods. We analyzed medical data from 103 patients with pulmonary tuberculosis that developed in the setting of HIV/AIDS infection. The patients were divided into groups: drug-sensitive pulmonary tuberculosis (DS-PTB) –42 patients who excreted Mycobacterium tuberculosis (MBT) strains sensitive to anti-mycobacterial drugs (AMD); and drug-resistant pulmonary tuberculosis (DR-PTB) –61 patients with resistant MBT strains. Data from the period 2020–2024 were analyzed.To study the frequency of complications and organ/system involvement, the results of laboratory tests, abdominal ultrasound, computed tomography of the chest and abdominal organs, and consultations with specialized physicians were taken into account.Microbiological detection of MBT included molecular genetic testing, microscopy and culture methods, and drug susceptibility testing of MBT strains to anti-mycobacterial drugs. HIV/AIDS infection was diagnosed using rapid tests, and viral load was determined by polymerase chain reaction. Microsoft Excel software was used for statistical analysis of the results.Results and Discussion. In both study groups, men predominated by 1.5 times, aged over 30 to 50 years. A severe condition at admission was noted in 23.8% of patients with DS-PTB and 9.8% with DR-PTB. The average hospital stay for DS-PTB was (23.1 ± 2.1) bed-days, and for DR-PTB –(61.7 ± 4.5).In DR-PTB/HIV, miliary tuberculosis predominated 1.7 times more often, and infiltrative pulmonary tuberculosis –2.0 times more often. In DS-PTB/HIV, an increased frequency of disseminated pulmonary. tuberculosis was observed. Patients with DR-PTB reported pronounced intoxication and cachexia twice as often compared to those with DS-PTB.In both groups, sepsis, pericarditis, and spontaneous pneumothorax were diagnosed with nearly equal frequency. Respiratory failure was detected 1.5 times more often in DR-PTB, while chronic obstructive bronchitis was 1.7 times more frequent in DS-PTB. In both groups, chronic hepatitis, liver cirrhosis, ascites, and toxic liver damage were noted. In DR-PTB, chronic hepatitis B, nervous system involvement, and eye disorders were observed twice as often as in DS-PTB.Conclusions. Drug-resistant pulmonary tuberculosis in the context of HIV/AIDS infection had a significantly more severe course due to the development of multiple organ failure. These changes in the combined TB/HIV/AIDS condition contributed to disability in 24.4% (10) of patients with drug-sensitive TB/HIV and in 55.7% (34) of patients with drug-resistant TB/HIV.

Keywords: HIV/AIDS/TB co-infection, complications, organ involvement, systems.