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Thus, our research data have demonstrated that maternal liver pathology produces a negative effect on postnatal growth, development and formation as well as a morphofunctional state of gastrointestinal tract organs and the liver of the breed. It seems that the reason of the pathomorphologic alterations in the vascular tissue structures of the stomach, small and large intestines and the liver lies, first of all, in deficiency of a plastic, trophic and energy material of the fetus during the fetal period of development due to maternal liver pathology. Besides, according to medical sources [4, 5, 6], compensatory-adaptive processes in the liver begin early and
actively in fetuses from mothers suffering from hepatic pathology and that, in its turn, can result in delay and retardation of development and formation of other organs.
At the same time, we cannot exclude other factors such as a disordered antitoxic function of the liver and resultant hepatoxins and their metabolites in mother's blood entering the fetus through the placenta, breast milk and causing inflammatory reactive alterations in its body. For these reasons it is necessary to develop substantiated medical and preventive measures aimed at prevention of pathology in children born and fed by mothers with hepatic pathology.
References:
1. Abdullaev N.Kh, Karimov Kh.Ya. The liver in hepatotropic poison intoxication. -Tashkent: Medicine, - 1989. - 140 p.
2. Baibekova E. M., Sultanova L. I. Peculiarities of the liver structure in chronic hepatitis and its medicament correction/J. of Med of Uzbekistan. - 1989. - № 4. - P. 50-53.
3. Vorontsov I. M., Fateyev E. M. Actual problems of natural feeding//J. Pediatrician. - 1997. - № 1. - P. 38-41.
4. Kolesov M. A., Kulikov V. V. Result of prospects of studying morphological foundations on hemocirculation//J. Archives of anatomy, histology and embryology. - 1978. - № 5. - P. 5-19.
5. Malygin A. M. A new method of anatomic drug clearing./Azerb. med J. - 1956, 6: 76-77.
6. Zufarov K. A. New data about digestive and absorptive functions of the bowel and kidney in newborns. - Tashkent: Medicine, - 1978. -40 p.
7. Makhmudov O. S., Chernyavskaya N. V., Lyamina T. P. Congenital hepatitis in children//J. of Med of Uzbekistan. - 1994. - № 4. - P. 5-7.
8. Hasanova R. A. The state of fetuses and newborns in women with viral hepatitis/J. Healthcare of Turkmenistan - 1987. - № 1. - P. 16-19.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-57-60
Akilov Khabibulla Ataullaevich, d.m.s., professor, Head of Children Surgery Department of Republican Research Center of the Emergency Medical Care, pro-rector on education, Head of Children Surgery Department of Tashkent Post-graduate Medical Institute Saidov Farkhod Khamidovich, Children surgeon Department of the Children Surgery, Republican Research Center of Emergency Medical Care E-mail: [email protected] Zalyalieva Mariyam Valievna, d. m.s., professor, Head of the Laboratory of Immunodiagnosis Institute of Immunology, Academy of Sciences of the Republic of Uzbekistan
Dynamics of changes of immunologic parameters in children with chronic colostasis in relation to method of treatment
Abstract: The conservative therapy of colostasis in young children with inclusion of drugs having immunomodulating properties (duphalac, lynex, detoxicants, vitamins) showed significant increase of the parameters of T-cellular immunity (CD3+, CD4+, CD8+ lymphocyes) with normalization of immunoregulatory index, decrease in expression of apoptosis markers and natural cells of killers. The early postoperative period was characterized by monocytopenia, lymphopenia, neutrophylia, some lowering of the concentration of immunoglobulins, growth of apoptosis markers expression, and it is also accompanied by improvement of the parameters of T-cellular immunity due to growth of CD4+ and CD8+ lymphocytes.
Keywords: chronic colostasis, immunology, treatment, children.
Background. In the various countries from 28 to 50% of adults and more than 5% of children are suffering from constipation. In the native literature the analogous parameters in children fluctuate from 16 to 25%, and all authors agree about the opinion that they have tendency to growth every year [1].
Delayed correction of constipation results in various complications in rough changes of microbe landscape (disbacteriosis), the
activity of intestine as organ of digestion and as immune organ disturbs [6; 9].
The normal microbe flora with its specific functions determine intestine biocenosis and ecological balance, and disturbance of these functions results in various metabolic disorders, occurrence of deficit of vitamins and microelements, attenuation of immunologic status, that lead to the irreversible processes in the various organs and systems [4].
It has been proved that change or sharp reduction of quantitative and qualitative contents of intestinal microflora effect on morphology and function of the intestinal tract: motor, reduction of the quantity of lymphocytes and lymphatic vessels, level of immunoglobulin G and immune response, rising of the risk of autoimmune and inflammatory diseases [8].
In case of immunity attenuation the risk increases of intestine contamination by pathogenic flora characteristic for disbiotic disorders [6].
At present time in the native and foreign literature there are studied questions of the effect of chronic colostasis (CC) on the state of immune system in children [6; 9].
The development of immune deficit states which progress on the background of chronic feces intoxication, colitis and disbacterio-sis appeared to be additional factor significantly aggravating clinical course of disease. They simultaneously provide progressing of the constipations due to cinergism in functioning of the gastrointestinal tract and immune system closing the "vicious circle" of pathogenesis
[2; 5].
There has been proved the most important function of the gastrointestinal tract, that is, its participation in the formation of reaction of the local and general immune response. This is expressed by closed interaction of immunocompetent formations associated with intestine with contaminating them by bacteria, viruses and other microorganisms as well as presenting in the chyme of foreign molecules with antigen properties. The presented intercommunications and interrelations provide the state of dynamic equilibrium between physiologic status of child's organism, his immune system and microbes associations occupying superficial surface of body and organs communicating with the environment. Dysfunction of gastrointestinal colostasis is one of the most important mechanisms of development of the secondary immunodeficiency state [2; 7; 10]
Purpose of research. Analysis of the results of changes of immunologic parameters in children with chronic colostasis in relation to method of treatment.
Materials and methods. There have been performed investigations of immunologic status of 30 children with chronic constipations induced by one or other pathology of the colon. All
children were treated in the Department of Children Surgery of the Republican Research Center of emergency medical care from 2012 to 2015.
Evaluation of the state of cellular immunity was performed by expression of the superficial antigen of lymphocytes in the reaction of immunofluorescence according to application of instruction with use of monoclonal antibodies of series LT to differential antigens of human leucocytes: CD3 (T-lymphocyte marker), CD4 (marker of helpers/inductors), CD8 (marker of supressor/cytotoxic T-lymphocytes), CD16 (marker of natural killers), CD25 (a-chain of interleukine-2 receptor), CD45 RA (marker of native T- and B-lymphocytes), CD95 (FAS/APO-1 antigen, causing apoptosis). Immunoregulatory index was calculated by the ratio CD4+ and CD8+ cells. The parameters of humoral immunity were studied with method of radial immunodiffusion with analysis of the levels in the peripheral blood of immunoglobulins G, A, M with use of monospecific serums to various classes of immunoglobulins [3].
Results and discussion. Analysis of data obtained during study of parameters of cellular and humoral immunity after conservative treatment for 5-10 days in children at the age to 5 years is presented in table 1.
There was noted unreliable increase in number of leucocytes and lymphocyes in relation to data before treatment (p>0,05).The absolute number of T-lymphocytes (CD3+) has grown significantly in comparison with initial parameters (P<0,05, but did not achieve the control level (p,0,05). Subpopulations of T-cells (helpers/inductors and suppressive-cytotoxic cells) increased significantly, and CD4+ lymphocytes increased reliably to level of control parameters (p<0,05). Immunoregulatory index reliably was increased not only in relation to initial data (p<0,01), but also according to control data. Increase in expression of CD4+ receptors can partially indicates about activation of thymic maturation of T-lymphocytes, strengthening of intercellular interaction that results in tendency to growth of B-lymphocytes and immunoglobulins A and G (p>0,05). There was revealed rising of expression of activation marker CD25+ and reduction of CD95+ leading to observation of increased ratio of marker of positive activation to negative not only in relation to initial data 9p<0,01) but also to control data (p<0,05).
Table 1.
Parameters Before treatment After conservative treatment After operation Control group
1 2 3 4 5
Leucocytes, abs 6440±900* 6700±120 6570±130* 5725±409
Lymphocytes,% 40,1±2,4* 42,8±2,1 38,0±4,0* 45,85±2,1
Lymphocytes, abs 2582±380 2867±140 2496±262 2619±120
CD3+,% 34,4±2,38** 44,7±2,5* 36,3±1,8* 54,0±2,2
CD3+, abs 888±54*** 1281±71* 906±45*** 1414±57
CD4+,% 23,4±1,0** 30,4±1,4 26,3±1,9* 32,1±2,3
CD4+, abs 604±26** 872±40 656±47* 840±60
CD8+,% 16,9±1,0* 18,3±1,3 21,0±0,9 22,1±1,8
CD8+, abs 436± 22* 524± 37 524±22 579 ±47
CD4/CD8 1,38±0,06 1,66± 0,05* 1,25±0,04* 1,48±0,06
CD20,% 32,7±2,57* 34,9±1,8** 29,3±1,6± 26,7±1,3
CD20+, abs 844±66* 1001±51* 731±39 699±34
IgA mg% 99,7± 13,97 108,7±12,3 105± 25,8 91,6 ±5,8
IgM mg% 70 ±4,47 76±5,1 74,3± 2,2 80,9± 6,4
IgG mg% 973± 141 1041±112 900± 90 963± 35
CD25+,% 22,4± 1,68 24,6±1,5 21,7 ±1,2* 24,5± 1,2
CD25+,% 586± 44 705±42 541± 30 642 ±31
1 2 3 4 5
CD95+,% 22,5± 2,2 20,9±1,9 25,3± 0,8 25,6± 1,5
CD95+,% 58,1± 56 599±54 631± 20 670± 38
CD45/CD95 1,0± 0,02 1,17±0,03* 0,86± 0,015 0,95± 0,06
Monocytes,% 5,2± 0,4 5,57±0,3 4,6± 0,4 5,1±1,2
Monocytes, abs 335± 25 319±17 302± 26 282 ±73
Neutrophils,% 61,4±2,3* 51,5±3,4 70,2± 2,5* 50,0± 5,4
Neutrophils, abs 3954± 148 2948±192 4612± 164 2862± 309
CD16+,% 23,9 ±2,4 21,4±1,8 22,0± 1,6 21,7± 1,9
CD16+, abs 617 ±66 613±51 549 ±39 568± 49
Note: * - <0,05; **p<0,01; ***p<0,001 in comparison with control
Reduction of the level of CD95+ receptor expression indicates about decrease in lymphocytes readiness to programmed death — apoptosis and appeared to be favorite sign of the treatment performed. On the background of treatment there is noted reduction of neutro-phils to the level of controls, reliable in relation to initial parameters 9p<0,05). The grow of monocyte number shows improvement of monocyte-macrophage chain (p<0,05). With regard to natural cells killers there were no reliable changes during the process oftreatment, however the tendency to their reduction was noted.
Clinical case. Patient E.B of 3-year-old-age. History of illness N883/243. Admitted with complaints of colicky pains in the abdominal cavity, nausea, vomiting, abdominal distention, stool and gas retention.
From anamnesis: abdominal pains began on 05.01.14, pains were colicky, because a child was under dispensary observation due to chronic constipation. On 05.01.14 and 06.01.14 the patient mother did cleansing enema after which there was stool, pains attenuated, and night was relatively calm. On 07.01.14pains repeatedly occur, and to the morning there was noted nausea, vomiting, colicky pains in the abdomen, abdominal distention. The child has become naughty, weak, the pains in the abdomen increased due to which there was admission to the Republican Research Center.
The child was suffering from the chronic constipations from 2012. There fore the child received conservative treatment some times from the pediatricians gastroenterologists with short time effect. The child was treated in the Department of Children's surgery in the Children's Hospital N 2 during the period 08.11.13-14.11.13, where there was made diagnosis of dolichomegacolon. Subcompensated form. Chronic constipation. Chronic colitis. Hemorrhoids. There was offered operative treatment from which there was temporary refusal. Duration of constipation may last to 8-10 days.
There has been established diagnosis: Malformation of the colon. Dolichomegacolon. Colostasis in the stage of subcompensation. Hemorrhoids. Intestinal disbacteriosis.
Laboratory examination at admission: Hb-92 g/l; Color index-0,86; Er.-3.2 g/l; Leuc.-5.4g/l; Seg.-61; Eos.-1; Lym.-35; Mon.-3; ESR-4.
Immunogramm: Lymf.-35%; CD3-lf.-22%; CD19-Vlf-32%; CD4 helpers/inductors -18%; CD8-suppressive/cytotoxic lf-12%; CD25 -29%; CD95-22%; CD16-14%; CD45-26%; IgG-627mg%; IgA-63mg%; IgM-45 mg%.
Marked T-cellular immunodeficiency in combination with deficit of humoral immunity.
The patient began to receive cleaning of the large intestine every day by method of siphon enemas with 1% solution of sodium chloride.
There were prescribed: duphalac, diet therapy, mesim, nospa, linex and vitamin complex "B" every second day intramuscularly
The independent stool was obtained on the 10 day.
Laboratory data before discharge: Hb-106 g/l; Color ind.-0,88; Er.-3,6g/l; Leuc.-8.0g/l; Seg.-48; Lym.-44; Mon.-6; ESR-4.
Immunogramm: lymp. —42%; CD3-39%; CD4-24% CD8-17%; CD20-B-lf-30%; CD25-23%; CD95-21%; CD16-14%; IgG-820 mg%; IgA-68 mg%; IgM-70 mg%.
The therapy performed with inclusion of vitaminotherapy and linex allowed significantly improvement of clinical-immunological status of the child on the 10 day after onset of treatment.
This example indicated about stopping of clinical signs of dolichomegacolon and secondary immunodeficiency state.
Thus, the conservative therapy in children with chronic colostasis provided improvement of T-cellular immunity with restoration of CD4+ helper/inductor cells with tendency to positive changes of humoral and monocytic-macrophagal chains of immunity at the short-term period after onset of treatment.
Analysis of the immune status, performed on the 5-10 day after operation, revealed immunosuppression that is explained by surgical postoperative stress, using of antibiotics. As it is known, antibiotics inhibit immune system.
In the postoperative period on the 5-10 day there was observed reduction of the relative and absolute number of lymphocytes, monocytes (p<0,05) on the background of reliable increase in neutrophils (p<0,05). At the same time there was found some increase in CD3+ T-lymphocytes at the expense of growth of CD4+ helpers/inductors and reliable growth of CD8+ sup-pressor/cytotoxic cells (p<0,05). There was noted increased expression of CD95+ receptors, change in the ratio of positive/negative markers of activation to reduction of relatively initial data (p<0,05) and control (p<0,01). The changes occurred after surgery in the populations of immunocompetent cells was reflected in the synthesis of immunoglobulin G, level of which reduced in 1.1 times. It is possible this is related to ability of T-suppressors to block production of immunoglobulins in the observed postoperative period.
The investigations performed showed that operation in children with chronic colostasis in the nearest postoperative period is accompanied by specific immune disorders. The complexity of patho-genesis in children with chronic colostasis as well as deepness and duration of immune disorders on the basis of immaturity of immune system in children under 5 years old show impossibility of the fast restoration of the immunity functions. This induces necessity to develop various schemes of immunocorrecting therapy including probiotics contributing to normolization of the intestinal microflora, restoration of local and systemic reactions.
Thus, in children with chronic colostasis of the young age (1-5 years) the chronic intoxication on the background of the immaturity of immune system is accompanied by marked T-cellular immunodeficiency (decrease in CD3+. CD4+, CD8+ lymphocytes), without significant changes of the functional activity of B-immunity, neutrophilia, activation of natural killer cells (NKC).
Conclusions.
1. Conservative therapy of colostasis in young children with inclusion of preparations having immunomodulating properties (duphalac, linex, detoxicants, vitamins) revealed significant increase in parameters of T-cellular immunity (CD3+, CD4+, CD8+, lymphocytes) with normalization of immunoregulating index, reduction of expression of apoptosis markers and NKC.
2. The early postoperative period in children of young age was characterized by monocytopenia, lymphopenia, neutrophilia, some reducing of the immunoglobulin concentration, growth of apop-
tosis marker expression, but it was accompanied by improvement of parameters of T-cellular immunity at the expense of growth of
CD4+ and CD8+--lymphocytes. These data reflect tendency to
restoration of the damaged parameters of immunity in children of young age after surgery performed.
3. In the children with chronic colostasis immune system id differed by marked cellular and humoral deficit on the background of immaturity of immune system, characterized for these patients that requires inclusion of immunomodulating therapy into the complex of treatment.
References:
1. Abaev Yu. K. Constipations in children. Medical news. - M., - 2007. - N 14; 30-37.
2. Bondarenko S. B. Complex program of the dolichosigma treatment in children: diss. ... cand. med.sci. - Rostov-na-Donu. - C. 18-29.
3. Zalyalieva M. V. Methods of the evaluation of lymphocyte subpopulations of the peripheral blood in human. Methodical Recommendations. - Tashkent, - 2004, - P. 16.
4. Kopanev Yu. L. Peculiarities of the Chylak forte use in the functional disorders of the gastrointestinal tract, biocenosis disturbances and other pathological states. FARMATEKA, - 2008, - N 14, P. 72-76.
5. Kopeikin V. N. Pathogenesis and treatment of nonspecific inflammatory disease of the colon - the current aspects. Materials of the 7th Congress of Pediatricians of Russia. Children's gastroenterology. The present and the further. - M., - 2002. P. 140.
6. Momotov A. A. Immunological parameters in children with chronic colostasis. Xipyprrn дитячого BiKy. - Kiev, - 2013, - N4. P. 43-47.
7. Rimargun A. H., Urusova N. I., Vasechkina L. I. et al. Role of opportunistic fungi in the microbiota of the colon in the pathology of gastrointestinal tract in children. Rossiyskiy jurnal gastroenterologii, gepatologii, koloproktologii. - 2001, - Vol.11, - N 5. - P. 58.
8. Havkin A. I., Komarova O. N. Constiptions in children of the first year of life in the structure of the functional disorders of the gastrointestinal tract. The main approaches for treatment. Russkiy medicinskiy jurnal. - M., - 2015, - N 3. - P. 152-157.
9. Tsimbalova E. G., Potapova A. S., Baranov K. N. Chronic constipations in children. Voproci sovremennoy pediatrii. - M., - 2015, -N3. - P. 152-153.
10. Park H. J., Kamm M. A., Abbasi A. M., Talbot I. C. Immunohistochemical study of the colonic muscle and innervation in idiopathic chronic constipation. Dis.Colon.Rectum. - 1995. - Vol. 38. - P. 509-13.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-60-63
Alimova DonoMirjamalovna, Tashkent State Dental Institute, Uzbekistan teacher assistant of department of faculty therapeutic dentistry
E-mail: [email protected]
Effect of lipid peroxidation on severity of clinical course and recurrence of aphthous stomatitis
Abstract: A study to assess lipid peroxidation oral fluid and blood serum in 110 patients with recurrent aphthous stomatitis of varying severity in the periods of exacerbation and remission.
The period of convalescence in patients with KAS clinical course of moderate and severe saved local and systemic imbalance in the system POL-AOS, which is a factor in determining the severity of the clinical course and risk of recurrence.
The research results indicate the need for antirecurrent treatment of patients with KAS in the period of remission of clinical manifestations in the mucous.
Keywords: recurrent aphthous stomatitis; peroxide oxidation of lipid; antioxidant; malondialdehyde; superoxide dis-mutase.
In everyday clinical practice patients with diseases of oral mucous membrane (OMM) represent one of the most difficult problems in dentistry due to diagnostics and treatment difficulties [1,485-491].
Recurrent aphthous stomatitis (KAS) currently represents one of the most urgent issues of modern dentistry due to the prevalence, both in Uzbekistan and around the world. Increase in the proportion of severe forms, absence of tendency to decrease the frequency of relapses were noted [5, 30-33; 11, 76-79; 9, 229-232; 18, 12861287].
Recurrent aphthous stomatitis is one of the common diseases of OMM. According to Rybakov A. I. and Banchenko G. V. (1978), it was 5% of all the diseases of oral mucosa. According to other researches, 20% of population suffer from aphtae in that or another life period. It was found that the age of most ofpatients ranged from 20 to 40 years. Persons of both genders suffer equally before puberty, but females predominate among adults [4, 9-11].
Etiology and pathogenesis of KAS have not been clarified till the end. It was found that state of microbiocenosis of oral mucosa play significant role in the pathogenesis of inflammatory processes [10, 225-
