CC BY
4
9. Economics, edited by A. S. Bulatov, Moscow, BEK Publishing House, 1995. -604c.
UDC 625
Bababekova N.B. associate professor Khodjaeva S.M. associate professor Nabieva D.D. assistant Akhrarov Kh.Kh. assistant
Tashkent pediatric medical institute CELLULAR IMMUNITY IN CHILDREN WITH PSORIASIS
Annotation: The article considers the issues of studying the features of cellular immunity in children of preschool age with psoriasis, before and after therapy. The study included 28 children suffering from psoriasis aged 3 to 6 years. The control group for comparison consisted of 12 healthy children of the same age and gender. In this research, personal and family history of patients were thoroughly studied, and general clinical examinations were conducted. Also, in order to determine some indicators of cellular immunity (CD3+, CD4+, CD8+, CD16+ and CD20+), immunological methods were used.
Thus, the results of the study showed that in preschool children suffering from psoriasis, there is a decrease in the total number of T-lymphocytes (CD3+), T-helper cells (CD4+), T-suppressors (CD8+), and an increase in B-lymphocytes (CD20+), natural killer cells (CD16+) and immunoregulatory index. After the treatment, an increase in the level of CD3+, CD20+, CD4+ and CD8+ immunoregulatory lymphocyte subpopulations is noted. Simultaneously, the inclusion of immunomodulating therapy leads to the normalization to the control values of the indices CD4+ and CD8+ of immunoregulatory lymphocyte subpopulations.
Key words: children, cellular immunity, lymphocytes, immunomodulating therapy, index.
Topicality. Psoriasis is one of the most common chronic inflammatory disorder that affects the skin of children and ranks second in terms of incidence after atopic dermatitis [1,3], its share in the structure of pediatric dermatoses ranges from 1 to 8% [4].
Recently, the problem of psoriasis is emphasized in connection with an increase in the incidence among children, especially preschool and older, an increase in the number of complicated forms and lethargy regarding treatment [2]. The clinical course of psoriasis in children has its own peculiarities compared with adults. Therefore, the study of the features of the clinical course of psoriasis in children, taking into account the age aspect, is of great practical importance [6].
In the multifactorial pathogenesis of psoriasis, impaired immune mechanisms play a leading role [5, 7]. However, to date, objective and informative immunological criteria for assessing the nature of the course of psoriasis in children, prediction and its outcome have not been developed [1,8]. In this regard, the topicality of studying immunity, in particular cellular immunity in children with psoriasis, is still relevant.
Materials and methods. The studies were conducted on the basis of the pediatric dermatology department of the Tashkent pediatric medical institute clinic. The study included 28 children suffering from psoriasis aged 3 to 6 years. Of these, there were 18 girls (64%), and 10 boys (36%). The control group for comparison consisted of 12 healthy children of the same age and gender.
Before initiating the study, written permission for the examination was taken from the parents or from the guardians of all the examined children. Personal and family history was thoroughly studied in all patients with psoriasis, general clinical examinations (blood, urine, feces, biochemical studies) were conducted, the children were consulted by a pediatrician, neuropathologist, ENT, ophthalmologist, dentist and, if necessary, by other specialists. All patients received inpatient treatment, treatment was prescribed taking into account the age, stage, severity and clinic of the disease. After treatment in the hospital, sick children were regularly (at least once a month) observed on an outpatient basis for 3 years.
Immunological methods for studying cellular immunity included: determining the total number of T and B lymphocytes, their subpopulations (CD3+, CD4+, CD8+ and CD20+). At the same time, from the total number of lymphocytes, the determination of the percentage of T-lymphocytes was performed in the reaction of indirect rosetting (PHRO), respectively, by the detection of populations and subpopulations of T-lymphocytes and B-lymphocytes. The study of the nature of changes in the indices of CD4+ and CD8+ subpopulations of T-lymphocytes was carried out with the calculation of the immunoregulatory index (IRI).
Depending on the therapy, the patients were divided into age categories, divided into 3 groups: the control group and the two studied groups. In all groups, the subjects were of similar age and gender. I-st study group (I-SG, n = 13) -traditional medical therapy was carried out to the patients, according to the standard of treatment including antihistamines, sedatives, hyposensitizing, hepatoprotective therapy, as well as calcium preparations and vitamin preparations. As a local therapy, 1-2% salicylic and boric acid ointments, corticosteroid creams and ointments were prescribed.
II-nd studied group (II-SG n = 15), in addition to the standard basic drug therapy, patients were additionally prescribed an immunomodulator of polyoxidonium® (Polyoxidonium) for use in pediatrics, 6 mg 2 times a day. The duration of treatment was 10 days. The obtained data were subjected to statistical processing on a Pentium-4 personal computer using the programs developed in Excel 2013.
Results and discussion. The clinical course of psoriasis, in childhood, in contrast to adults has its own characteristics. According to the results of anamnestic data collection, the duration of the disease ranged from 3 months to 4 years. In 7 (25%) mothers observed by our patients, the pregnancy was normal, in 21 (75%) with toxicosis and threatened miscarriage, in 19 (68%) women anemia was observed during pregnancy. Most of the children (90%) were born on time, without complications. Asphyxia was observed in 2% of children at birth, and birth trauma in 1%. According to the results of the study, in children, the psoriatic process begins suddenly with the appearance of single, sometimes multiple eruptions, within limited areas. The primary elements of the rash were round-oval papules, covered with silver-white scales, pink lentil-sized. At the same time, psoriatic lesions were more often located on the scalp (77.3%), body (79.1%), upper (91.8%) and lower extremities (90.0%), less frequently on the face (33.6% ) and folds (2.7%) and the process mainly proceeds in the form of a vulgar form (86.4%), while the eruptions had a drop-like (36.4%), nummular (10.9%) and plaque (39.1 %) form.
Hospitalized patients had a degree of severity: mild in 1 (3.6%) patient, moderate - 14 (50%) and severe in 13 (46.4%) patients. During the study of the cellular immunity markers, it was noted that in patients with moderate form of the disease, before treatment, a decrease in the total number of peripheral blood CD3 + T-lymphocytes was observed (49.09 ± 0.90 against 63.43 ± 0.59 in healthy). While the total number of B-lymphocytes (CD20 +) was at significantly high levels (18.36 ± 0.90 versus 11.50 ± 0.33 in healthy ones), (P <0.05). This was confirmed by indicators of the suppression and induction index and was expressed by I EC = 1.29 and T AI = 1.60 values, respectively. Before treatment, patients with immunoregulatory T-cell subpopulations showed a decrease in the level of CD4+ (30.73 ± 0.51 vs. 33.64 ± 0.58 in healthy), CD8+ (15.73 ± 0.38 vs. 20.71 ± 0.67 in the healthy) and, accordingly, an increase in the immunoregulatory index (IRI = T 1.22), (P <0.05). Accordingly, confirming these changes, an increa se in the number of natural killer cells (CD16+) was noted with the AI induction index
= T 1.28.
Thus, in children with psoriasis in preschool age with a moderate form of the disease in the period of exacerbation before treatment, a significant decrease in CD3+, CD4+, CD8+ and an increase in the level of CD20+, CD16+ and IRI are observed.
In the group of patients with a severe form of the disease before treatment, the total level of T-lymphocytes was reduced (50.43 ± 0.71 versus 63.43 ± 0.59 in healthy), the B-lymphocyte count in an elevated state (17.52 ± 0.55 vs. 11.50 ± 0.33) compared with healthy children. The suppression index and induction index were within the SI = j 1.26 II = T 152 values. The number of natural killer cells (CD16+) was increased (19.22 ± 0.66 patients; 14.40 ± 0.12 healthy), respectively, the induction index was II = T 1.33 values. The levels of CD4+ and CD8+ were also reduced (31.57 ± 0.45 and 15.52 ± 0.34 patients; 33.64 ± 0.58 and 20.71 ±
0.67 healthy) and, accordingly, the indicator of immunoregulatory index was significantly increased (IRI = t 1.29).
Thus, in children with psoriasis in preschool children with a severe form of the disease during the exacerbation period before treatment, there was a decrease in CD3+, CD4+, CD8+ and an increase in the level of CD20+, CD16+ and IRI; however, these values did not differ significantly from those of the moderately severe group.
As a result of the treatment in children with moderate severity of the disease at the end of 3 weeks, the CD8+ and IRI scores reached the healthy children (II = 1.28 and t II = 127, respectively). However, the values of these datas differ significantly from those of the control group, i.e. remained lower or higher values. The total index of suppression and the total index of induction compared with the control group were, respectively, | TIS = 1.01 and tTII = 1.02 values. It can be concluded that after rational therapy was carried out in children, patients with psoriasis with moderate form, there was a positive change in the immune status, expressed as an increase in CD3+, CD4+, CD8+, a decrease in the number of CD20+, IRI, CD16+. At the same time, the indices of CD8+ and IRI were within the control values. In children with a moderate form of the disease, after the traditional therapy was carried out, there was an increase in the overall level of CD3+, CD20+, CD4+ and CD8+ and a decrease in IRI and CD16+ cells as compared to before treatment.
In the severe form of psoriasis, after traditional therapy, an increase in the total number of T-lymphocytes (CD3+), subpopulations of CD4+ and CD8+, a decrease in the total number of B-lymphocytes (CD20+) and the level of CD16+ was noted. Despite the positive dynamics, these indicators of the immune system in this group of patients differed from normal values. It should be noted that in these patients after rational therapy on the part of immunological parameters, normalization of indicators was observed on the part of CD4+ (33.64 ± 0.58 healthy, 33.74 ± 0.46 after treatment) and CD16+ (14.40 ± 0.12 healthy, 14.65 ± 0.36 after treatment). At the same time, the total induction index was within the limits I TII = 1.00 and |TII = 1.01 values. The total number of CD3+ T-lymphocytes, the level of CD8+ content tended to increase, the total number of B-lymphocytes (CD20+) tended to decrease, however, these values remained higher than those of the control group.
Thus, in severe psoriasis disease in children after the therapy, it was observed increase of CD3+, CD4+ subpopulations and CD8+, decrease CD20+, CD16+. After rational therapy from CD4+ and CD16+, normalization of indicators was noted. However, this downward trend has slowed down, and this again confirms the focal depth of organ damage in this age group.
Conclusions. In preschool children with psoriasis, there is a decrease in the total number of T-lymphocytes (CD3+), T-helper cells (CD4+), T-suppressors (CD8+), and an increase in B-lymphocytes (CD20+), CD16 + natural killer cells and immunoregulatory index. After therapy, an increase in the level of CD3+, CD20+, CD4+ and CD8 + immunoregulatory lymphocyte subpopulations is noted.
At the same time, the inclusion of immunomodulating therapy contributes to the normalization to the control values of the indices CD4+ and CD8+ of immunoregulatory lymphocyte subpopulations.
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