THE EFFECT OF CORTISOL ON THE ADAPTATION MECHANISM IN BLASTOCYSTOSIS

Abstract

Relevance. One way of assessing the body’s adaptive capacity is to measure blood cortisol levels, as it is known that changes in the concentration of hormones in the blood, which lead to a reorganization of inter-endocrine relationships, are one of the key components of a complex regulatory system. High cortisol levels suppress the immune response and disrupt the gut’s protective barrier, making the body more susceptible to Blastocystis spp. Studies show that stress and elevated levels of adrenal cortex hormones exponentially increase the number of Blastocystis spp. cysts in feces, exacerbating oxidative stress. A reduction in local defenses allows blastocysts to penetrate the epithelium more readily, exacerbating inflammation and the translocation of microflora. A prolonged battle against a parasite against a background of elevated cortisol levels leads to the depletion of the body’s adaptive capacity. In this regard, investigating the restoration of the body’s adaptive capacity and addressing the issue of individualizing treatment based on the reduction in patients’ compensatory mechanisms, particularly when cortisol levels are elevated, is crucial for optimizing diagnostic and therapeutic strategies and improving the prognosis for patients with blastocystosis.

The aim of the study was to investigate the effect of cortisol on adaptive mechanisms and to determine the effectiveness of treatment for patients with blastocystosis using previously developed algorithms for predicting treatment efficacy.

Materials and methods. 312 patients with blastocystosis were examined; they received treatment as part of a blind study using one of the following drugs: co-trimaxazole, secnidazole or nifuratel, employing a prognostic approach. Algorithms were first developed to predict the effectiveness of treatment for patients for each of the specified drugs. Two levels of effectiveness were predicted: high and satisfactory. The criterion for treatment effectiveness was the degree of regression of the clinical manifestations of the disease, which was ≥ 31% for high treatment effectiveness and ≤ 30% for satisfactory treatment effectiveness. The severity of the stress state was determined by the stress coefficient, which reflects the ratio of the percentage values of cortisol and insulin. The prognostic algorithms were developed using the Wald-Henkin heterogeneous sequential procedure.

Results. It was found that, when using a ‘blind’ method to prescribe one of the drugs, a high therapeutic effect was achieved in 168 (54 per cent) patients, and a satisfactory effect in 144 (46 per cent). When analyzing the probable advantage of replacing a specific drug with others, it was found that, in cases where co-trimoxazole proved ineffective, prescribing secnidazole was preferable, as in this case a favourable prognosis (high efficacy) was observed in 75 per cent of cases, whereas with nifuratel this figure was three times lower (25 per cent). It should be noted that in this situation, there were no recorded cases (0%) where the prognosis was favourable for both nifuratel and secnidazole.

An analysis of the stress ratio showed that a normal or slight increase (≤3.0 units) was characteristic of patients with a predicted high response, as it was observed in 41.1% of patients in this group and was 3.6 times less common (in 11.1%; p<0.001) in the alternative group. As for a significant increase in this indicator (˃5.1 units), this was observed 2.7 times more frequently (p<0.001) in the group with a predicted satisfactory response.

The results obtained indicate that the so-called phenomenon of ‘resistance’ to treatment in patients with blastocystosis develops against a background of a reduction in the body’s adaptive capacity.

Conclusions. It has been established that in blastocystosis, various types of changes in hormonal regulation are observed as a result of alterations in the cortisol-to-insulin ratio. The ‘choice’ of response type was determined by the severity of the disease, the characteristics of the body’s adaptive processes and its individual capabilities. The application of algorithms to predict the efficacy of blastocystosis treatment using co-trimaxazole, secnidazole and nifuratel made it possible to increase the predicted treatment efficacy by 37.3 per cent, bringing it to a total of 91.3 per cent. The phenomenon of ‘resistance’ to treatment in patients with blastocystosis develops against a background of a significant reduction in the patients’ body’s reserve of adaptive mechanisms, particularly when plasma cortisol levels are ≥ 501 nmol/L and the stress index is ≥ 5.1 units.