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Samieva Gulnoza, doctor of medical sciences, Head of the Department of Physiology and Pathophysiology, Samarkand State Medical Institute E-mail: samg83@rambler.ru Abdirashidova Gulnoza, assistent of the department of physiology and pathophysiology,
Samarkand State Medical Institute E-mail: gulnoza_ganisher@mail.ru
Kurbanov Golib,
assistent of the department of physiology and pathophysiology,
Samarkand State Medical Institute E-mail: kurbanovgolib1988@gmail.com
PATHOGENETIC ASPECTS OF ENDOGENOUS INTOXICATION AND ITS INFLUENCE ON THE COURSE OF VARIOUS FORMS OF STENOTIC LARYNGOTRACHEITIS IN CHILDREN
Abstract: In the pathogenesis of acute stenosing laryngotracheitis (ASLT) in children, one of the leading clinical manifestations is endogenous intoxication syndrome. In this regard, the purpose of our study was to study the effect of endogenous intoxication on the clinical course of acute stenosing laryngotracheitis. The study is based on a clinical and laboratory examination of275 children with acute stenotic laryngotracheitis. In order to diagnose the nature and severity of intoxication syndrome, we conducted a dynamic study of indicators: SMP, toxic blood factor, CIC. Also carried out the calculation of leukocyte index of intoxication - LII. As the results of studies showed, in patients with ASLT at the height of clinical manifestations, there was an increase in the content of all indicators of endogenous intoxication in comparison with the group of healthy children (P < 0.05-0.001). Thus, our studies revealed an increase in the SMP, CEC, TF, which are known to have a direct role in the pathogenesis of bacterial infections. It was revealed that in ASLT in children, the level of endogenous intoxication indicators are in direct proportion to the clinical characteristics and severity.
Keywords: Acute stenosing laryngotracheitis, endogenous intoxication.
Introduction. The problem of combating the syndrome the leading place is occupied by the violation of micro - and of endogenous intoxication is highly relevant, since this syn- macrocirculation. It is high endogenous intoxication (EI) in drome occurs in almost all children with critical conditions these conditions that is the main factor of mortality. In this and is leading, including in the pathogenesis of acute stenotic regard, it is very important to study the degree of endotoxemia laryngotracheitis (ASLT). Being one of the leading clinical and its effect on the clinical course ofASLT [3; 5; 8]. manifestations of ASLT, endogenous intoxication syndrome Of particular interest is the question of the effect of en-
is the result of destructive processes, as a result of which an ex- dogenous intoxication on the clinical course of various forms cessive amount of intermediate and final metabolic products of acute stenosing laryngotracheitis. In this regard, the pur-accumulate in the body, which have a toxic effect on the most pose of our study was to study the effect of endogenous inimportant life support systems [1; 2; 4; 10; 12]. toxication on the clinical course of acute stenosing laryngo-
In ASLT in patients with exhaustion of reparative pro- tracheitis [6; 9; 11]. cesses and a sharp decline in the natural functions of the body, Patients and research methods. The study is based on
toxic shock can develop. Its development is due to the use of clinical and laboratory examination of275 children with acute large doses of antibiotics, since this causes the death of a large stenosing laryngotracheitis, who were admitted to the Infec-number of pathogens and the abundant flow of endotoxins tious Diseases Hospital No. 3 in Tashkent from 2011 to 2014. into the blood, in which the serious condition of the body All the examined children were divided into 2 groups accord-is aggravated by a sharp violation of hemodynamics, circula- ing to the forms of acute stenosing laryngotracheitis according tion and perfusion of tissues. In the pathogenesis of shock, to the classification of Yu. V. Mitina.
Medical science
- 1 group of 122 (44.4%) children of patients with primary stenosing laryngotracheitis (PSLT);
- Group 2 - out of 153 (55.6%) recurrent stenosing laryngotracheitis (RSLT).
In order to diagnose the nature and severity of intoxication syndrome, we conducted a dynamic study of indicators: SMP (medium molecular peptides) - according to the method of N. I. Gabrielyan, toxic blood factor using specific antigenic biological tests - test assay for death time paramecium in the serum of the patient (A. A. Pafomov and others). Circulating immune complexes (CIC) were also determined (Haskova and the leukocyte index ofintoxication (LII) was calculated (Kalf-KalifYa). The degree of endogenous intoxication of the organism was assessed by the content ofmedium-weight molecules in the serum and the Kalf-Kalif index (leukocyte intoxication index - LII).
The results and discussion. As shown by the results of laboratory studies in patients with ASLT in the midst of clinical manifestations, there was an increase in the content of all indicators of endogenous intoxication in comparison with the healthy group (P <0.05-0.001). For example, the SMP indicators in children with PSLT increased by 94.6%, and in children with RSLT - by 114.6%, the toxic factor in children with PSLT increased by 81.5%, and in children with RSLT - by 134.7%. The level of the CEC in children with PSLT increased by 3.4 times, and in children with RLLT by 4.1 times. Consequently, the level of the CEC in children with ASLT, combined with the severity of the patient's condition. Comparing the information of the indicators in the EI assessment, it should be noted that the LII is the most informative level of which in children with PSLT increased 4.4 times, and in children with RSLT - 7.4 times.
It should be noted that when comparing the indices of endogenous intoxication: SMP, TF (transferin), CEC and
LII with clinical symptoms of intoxication, their highest values were recorded in patients with a very serious condition, and the higher the level of EI indicators, the higher the degree of intoxication.
Thus, our studies have revealed an increase in the CEC, which, as is well known, plays a direct role in the pathogenesis of bacterial infections.
Analyzing the data of the foregoing, it can be judged that in the case of ASLT in children, the level of indicators of endogenous intoxication are in direct proportion to the clinical characteristics and severity of the course
Thus, with moderate degree in sick children, the level of SMP increased by 14.7%, with a severe degree - by 94.6% and with a very severe degree - by 141.1%, respectively, to the indicators of healthy children. With moderate degree, the level of toxic factor increased by 26.4%, with severe - by 81.5% and with very severe - by 103.1%, relative to the corresponding indicator of healthy children.
An identical picture develops in children with RSLT. The level of indicators of endogenous intoxication is in direct proportion to the severity of the course of the disease, but the level of these indicators is slightly higher than in children with PSLT. Thus, according to the clinical and biochemical manifestations, the syndrome of endogenous intoxication is a syndrome of inconsistency between the formation and elimination of bacterial exo - and endotoxins, products of normal and pathological metabolism, inflammatory mediators, etc. that causes the severity of the clinical course and the degree of intoxication in children with acute stenosing laryngotracheitis. The level of EI indicators is directly proportional to the severity of the clinical course and the degree of intoxication, and in patients with RSLT this level is slightly higher than in children with PSLT.
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