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Features immune status changes in children with chronic diseases of lower respiratory
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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-81-83
Musazhanova Rano Anvarbekovna, Leading Researcher. Republican Specialized Scientific and Practical Medical Center of Pediatrics Ministry of Health of the Republic of Uzbekistan
E-mail: evovision@bk.ru
Features immune status changes in children with chronic diseases of lower respiratory
Abstract: Thus, our findings of immunological status in different age groups in patients HBNDP celebrate the suppression of cellular immunity and phagocytes of neutrophils, activation of humoral immunity. It was found that changes in immune status were more pronounced in children aged 7-15 years.
Keywords: Children, immune status, chronic lower respiratory diseases.
Relevance. In the structure of respiratory diseases in children occupy an important place chronic lower respiratory diseases (CLRD) Main place in the structure belongs CLRD chronic bronchitis (CB) and bronchiectasis [1, 2, 6]. Despite advances in the treatment and prevention of chronic diseases caused by bacterial and viral microflora, increasing the number of severe and forms sluggish and torpid course of the inflammatory process, with frequent exacerbations, and low efficiency of the ongoing causal treatment, suggesting that failure of the immune system [3]. Today there is no doubt that immunological mechanisms are somehow involved in the development of almost any pathological conditions or being a cause of, or a consequence, and the main cause chronic disease and its complications [5].
When CLRD often develop secondary immunodeficiency, which can cause the development and chronicity of the pathological process with frequent relapsing little amenable to conventional therapy. In this regard, interest is the identification of the role of the immune system in the formation of CLRD in children [4].
This work is part of research carried out in our clinic, the aim of which is to study the features of the immune status in children with chronic bronchitis and bronchiectasis in exacerbation of the disease.
Material and methods. We observed 305 children with CLRD aged from 3 to 15 years. The patients presented two groups — 263 children with chronic bronchitis (CB), and 42 children with bronchiectasis (Beb) who were hospitalized in the pulmonology department of the Republican Specialized Scientific and Practical Medical Center of Pediatrics Ministry of Health of the Republic of Uzbekistan, and also studied performance of 20 healthy children of the same age. The comparison group consisted of 40 patients with acute bronchitis (OB).
Diagnosis is based on clinical classification of the main forms of bronchopulmonary diseases in children, approved at a special meeting of the XVIII National Congress on Respiratory Diseases (2009).
Immunological parameters were determined by indirect rosetting using monoclonal antibodies: by Garibe FU, [1995]. Determination of serum immunoglobulins A, G, M in the peripheral blood was performed by single radial immunodiffusion in gel G. Manchini et al [1965].
The data were processed by variation statistics using Student's Fisheru — personal computers using the application package.
Results and discussion. The study examined the immune status of patients with varying severity possible to establish the immunodefi-cient state with signs of stress humoral immunity and multi-directional nature of the immunological shifts. Patients with chronic bronchitis in both age groups identified the following deviations in the phase of exacerbation of the disease: a significant reduction in the relative and
absolute number of CD3 +--lymphocytes (45,4±0,8% was in the
group of children aged 3-6 years; 1165,4±22,6 mkl at 61,5±2,2%; 1377,9±44,2 22,6 mkl in healthy children, p<0.001) relative to the comparison group (54,7±1,4%; 1288,1±42 6 mkl p<0.01), in the older age group of 7-15 years-41,6±0,7%; 1100,4±16,622,6 mkl at 61,5±2,2%; 1377,9±44,2 mkl in healthy children, p<0.001, relative to the comparison group (50,2±2,5%; 1245,5±30,6 mkl p<0.01). Patients in Beb disease exacerbation phase as determined by changes in the immune status with the multidirectional nature of immunological changes, as evidenced by a significant decrease in the relative and absolute number of CD3+lymphocytes to 36,8±0,6%; 915,1±22,6 mkl at 61,5±2,2%; 1377,9±44,2 mkl in healthy children, p<0.001, relative to the comparison group (50,2±2,5%; 1245,5±30,6 mkl p<0.001). A more pronounced decrease in CD3+ lymphocytes were observed in patients Beb differed from children with HB 1.1 times and was 1.7 times lower than the normal values. The content of the relative and
absolute number of CD4+--lymphocytes was reduced (33,4±1,1%
was in the group of children aged 3-6 years; 389,2±13,8 mkl at 39,1±2,1%; 538, 7±15,6 mkl in healthy children, p<0.001) relative to the comparison group (38,5±1,2%; 495,9±19,8 mkl p<0.01) in older age group 7-15 years — 28,9±1,0%; 318,0±10,7 mkl at 39,1±2,1%; 538,7±15,6 mkl in healthy children, p<0.001, relative to the comparison group (37,9±1,3%; 472,0±16,2 mkl p <0.01). In the study of the number of CD4 +--lymphocytes in patients Beb content relative and absolute numbers of CD4 +--lymphocytes were
significantly reduced to 25,1±0,9%; 229,7±9,6 mkl at 39,1±2,1%; 538,7±15,6 mkl in healthy children, p<0.001, relative to the comparison group (37,9±1,3%; 472,0±16,2 mkl p<0.001).
Section 8. Medical science
In relation to the group of children with HB indicators CD3 + lymphocytes was reduced 1.2 times and was 1.6 times lower than the normal range. It was noted a significant increase in the relative and absolute number of CD8 + lymphocytes (23,6 ±0,6% was in the group of children aged 3-6 years; 275,0 ±6,7 mkl at 19,5±1,8%; 268,7±11,2 mkl in healthy children, p<0.001) relative to the comparison group (19,4±1,1%; 253,7±8,6 mkl p<0.01) in older age group 7-15 years — 25,8 ±0,5%; 283,9±5,6 mkl at 19,5±1,8%; 268,7±11,2 mkl in healthy children, p<0.001, relative to the comparison group (18,9±1,2%; 235,4±7,7 mkl p<0.01). Patients Beb also noted a significant increase in the relative and absolute number of CD8 + lymphocytes to 27,2±0,5%; 248,9±5,4 mkl at 19,5±1,8%; 268,7±11,2 mkl in healthy children, p<0.001, which was 1.4 times higher compared to the children about (the comparison group). A more pronounced increase in CD3+ lymphocytes were observed in patients Beb differed from children with HB 1.1 times and was 1.4 times higher than the normal rates. IRI revealed a decrease in both age groups of patients in the 1.4 and 1.8-fold due to a significant increase in the number CD8+ cells compared to CD4+. Patients also showed Iran Beb decline 2.2 times lower than the normal value and 1.2 times lower in relation to the group of children with chronic bronchitis. It was noted a significant increase in relative and absolute numbers compared to healthy children — CD16+ lymphocytes and is 12,9 ± 0,4%; 331,1±11,4 mkl in children aged 3 to 6 years and 14,2±0,4%; 375,6±11,2 mkl between the ages of 7 and 15 years, respectively (10,2±1,3%; 228,5±16,2 mkl in healthy children; P<0.001), in relation to the comparison group (10,1±1,0%; 237,8±12,5 mkl in children aged 3 to 6 years and 9,8±0,8%; 243,8±12,0 mkl between the ages of 7 and 15 s, respectively, p<0.05). Patients Beb also noted a significant increase in relative and absolute numbers compared to the practical healthy children natural killer cells — CD16+ lymphocytes to 16,4±0,7%; 407,8±10,9 mkl (10,2±1,3%; 228,5±16,2 mkl in healthy children; P<0.001), in relation to the comparison group (9,8±0,8%; 243,8±12,0 mkl p<0.05). In relation to the group of children with indicators of CB CD16+ lymphocytes was increased 1.2 times and was 1.6 times higher than the normal rates. We determined a significant decrease FAN (in the group of children aged 3-6 years figures were 45,2±1,4% at 58,5±2,3% in healthy children, p<0.001, relative to the comparison group (55,8 ±2,1% p <0.01), in the older age group of 7-15 years — 39,8±1,2% at 58,5±2,3% in healthy children, p<0.001, for relative to the comparison group (52±1,1% p<0.01).
Also determine the inhibition of neutrophil phagocytic function in patients Bab: a significant decrease FAN to 35,2±1,0% at 58,5±2,3% in healthy children, p<0.001, relative to the comparison group (52,1±1.1% p<0.001). In relation to the group of children with HB FAN indicators were reduced by 1.1 times and was 1.7 times lower than the normal values.
In assessing the B-cell population we used as test level 1 determining the number of CD20 + lymphocytes, as well as the levels of immunoglobulins. In the group of children with chronic bronchitis showed a trend to an increase in CD20 + — lymphocytes in the peripheral blood, in relative and absolute terms (in the group
of children aged 3-6 years was 26,8±0,9%; 687,9±13,2 mkl at 16,4±0,5%; 367,4±20,8 mkl in healthy children, p<0.001) relative to the comparison group (17,2±0,7%; 405,0±18,8 mkl p<0.01), in the older age group of 7-15 years — 32,4±0,7%; 857,1±15,0 mkl at 16,4±0,5%; 367,4±20,8 in healthy children, p<0.001, relative to the comparison group (18,1±0,8%; 450,3±17,1 mkl p<0.01).
Beb Patients also tended to increase in CD20+--lymphocytes in the peripheral blood, in relative and absolute terms (35,6±0,6%; 885,2±10,2 mkl at 16,4±0,5%; 367, 4±20,8 mkl in healthy children, p<0.001) relative to the comparison group (18,1±0,8%; 450,3±17,1 mkl p<0.001). On activation of humoral immunity showed increased IgM immunoglobulin concentrations in patients 3-6 years was 1.3 times higher compared with healthy children and averaged 114.5± 3,1mg/% (p<0.01), relative to the control group is 1.2 times (97,2±3,2mg/% p<0.01) in patients 7-15 was an increase of 1.4 times of the average of up to 126, 8±2,5mg/% relative to the control group is 1.2 times (102,5±3,4mg/% p<0.01). Patients Beb also noted an increased concentration of IgM and was 1.7 times higher compared with healthy children and averaged 154.2±2,7mg/% (p<0.001) relative to the control group 1, 5 times (102,5±3,4mg/% p<0.01). In relation to the group of children with HB level of IgM was increased 1.2-fold. At the same time, the content of IgG in the group of patients with chronic bronchitis at the age of 3-6 years was 1.1 times reduced as compared to healthy children and averaged 845.2±17,1mg/% (p<0.01) in relation to the comparison group to 1.0 times (912,6±16,2mg/% p<0.05) in patients 7-15 years have seen a decline in their number is 1.2 times as compared with the healthy children and It averaged 768.9±15,8mg/% (p<0.001). The content of IgG in patients in Bab was reduced 1.3 times as compared with the healthy children and averaged 702,6±16,1mg/% (p<0.001) relative to the control group is 1.3 times (908,7±18,4mg/% p<0.01).
In relation to the group of children with HB IgG level was reduced by 1.1 times. IgA concentration in the examined children with HB decreased in patients 3-6 years by 1.2 times as compared with the healthy children and averaged 87.4±3,9mg/% (p<0.01), in relation a comparison group of 1.2 times (102,5±3,4mg/% p<0.05) in patients 7-15 years have seen a decline in their number is 1.4 times as compared with the healthy children, and the average was 75.2±4,1mg/% (p <0.001) relative to the control group by 1.3 times (104,6±2,8mg/% p<0.01). It should be noted that children of preschool age, there was a greater reduction and than in school-age children. The patients Beb IgA concentration is decreased by 1.7 times compared with healthy children and averaged 64.5±3,4mg/% (p<0.001) relative to the control group by 1.6 times (104, 6±2,8mg/% p<0.01).
Conclusions. In patients with chronic diseases of the lower respiratory tract as a result of the research found that deforming chronic bronchitis and bronchiectasis mostly in children is accompanied by pronounced changes in immune status, confirming the presence of a chronic inflammatory process. It is important to establish immunity defects in terms of not only clarify the mechanisms of the pathogenesis of the disease, but also raising funds to facilitate correction of the broken links of immunity.
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Peculiarities of immunological indications changes in children ill with chronic bronchitis
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DOI: http://dx.doi.org/10.20534/ESR-17-1.2-83-85
Muhamadieva Lola, Samarkand State Medical Institute, PhD in medicine, department of pediatric disease E-mail: mlola@bk.ru Rustamova Gulnoza, Samarkand State Medical Institute, Assistant in medicine, department of pediatric disease E-mail: pbim.uz@gmail.com
Peculiarities of immunological indications changes in children ill with chronic bronchitis
Abstract: 100 children with chronic bronchitis and 22 healthy children aged 3-15 years were enrolled in the study. Thus, the study of immune status in children with CB made it possible to reveal deep changes of T — cellular immunity chain as considerable decrease of the amount and functional activity of neutrophils that appears to be predetermining endogenic moment of development and progress of chronic bronchitis is children. The immune status was higher in the group of school — age children. Keywords: children, chronic pneumonia, immunological indicators, bronchitis, lymphocytes.
Urgency of problem. Chronic inflammatory diseases of the lungs are the actual pediatric problem as their frequency has been growing in recent years and clinical manifestation are characterized by severe course and early disability of patients [1; 10; 11]. The complexity of chronic bronchitis problem to a certain degree found its reflexion in International statistic classification of diseases and problems associated with health (the 10th WHO revision) where various variants of chronic bronchitis are listed: simple, mucopurulent, mixed, etc presenting difficulty in clinical distinction that causes certain complexity in every day practice [5; 9]. Impairment of drainage function of bronchi contributes to development of infections process with activity and recurrence depending to a considerable degree on local immunity of bronchi and development of secondary immunological insufficiency [3; 5]. Chronic bronchitis in children may be the manifestation of a whole number of other bronchopulmonary sufferings (acquired, hereditory, congenital) with their differentiation often presenting certain complexities [4; 5; 6; 7; 8; 12].
Among important factors in pathogenesis CB belongs to nonspecific and specific immune reactions. As for immune system the character, depth, duration of inflammation and immune response are regulated by means of cytokins [13].
General changes of children immunological status are probably connected with the fact that in all this pathology bronchopulmonary system is suffering. In deficiency of immunoregulatory cells, antigen -specific effectory reactions of humoral and cellular type develop with strengthening more than once, the level of antigen — specific lymphocytes directed not only against antigens causing the disease but against the pulmonary tissue itself is growing sharply. The decrease of T — suppressors function in various CNDL forms is a
key mechanism in the development of immunopathological reactions in various diseases in children [3; 5].
The aim of the research. To estimate immunological indicators in diagnosis of chronic bronchitis in children.
Material and methods of the research. 100 children with chronic bronchitis and 22 healthy children aged 3-15 years were enrolled in the study. The patients underwent the following medical research: estimation of T-lymphocytes and their subpopulations (CD3+, CD4+CD8+) number, natural killers (CD16+), B- lymphocytes (CD20+) by means of Gurary N. I. method (1981) [2]; concentration of serum immunoglobulin's A, G, M in the peripheral blood according to Manchini G. et al. method (1965);
Results and discussion.
As it is seen from Table I in children with CB changes in both cellular and humoral immunity system are noted. They have one- directed immunological shifts characterized by T- cellular immunodeficiency. Reliable decrease of leucocytes in both groups to 6482 ±320.0 and 5362±625.0, accordingly (p<0,001) is established in children with chronic bronchitis during the period of exacerbation of the disease.
Such indications as relative and absolute number of lymphocytes 32.1 ±0,2 and 31.8 ± 1.1 accordingly , decrease reliably compared to normal ones and there is no different nature between two groups.
As it is seen from the presented data in children with CB in the period of exacerbation of the disease the following deviations have been revealed: reliable decrease of T - lymphocytes (CD3+) (44.8±0.2% in children aged 7 -15 years and 49.1 ±0.3 % at the age of 3-6 years in 61.5±2.2% in practically healthy children, p< 0,001; p<0,001, their subpopulations: T- helpers (CD4+) (21.2±3.2% in children aged 7-15 years and 24.6±1.9% in children aged 3- 6 years; 39.2±2.1%
