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Bababekova Nigora Bakhtiyarovna, associate professor of Tashkent pediatric medical institute
E-mail: [email protected] Khodjaeva Sabri Makhmudovna, associate professor of Tashkent pediatric medical institute E-mail: [email protected] Nabieva Dilnoza Djuraevna, assistant of Tashkent pediatric medical institute Valiev Abduaziz Abdusmatovich, assistant of Tashkent pediatric medical institute
FEATURES OF CELLULAR IMMUNITY IN PRESCHOOL CHILDREN WITH PSORIASIS BEFORE AND AFTER TREATMENT
Abstract: The article is devoted to the problem of studying the features of cellular immunity in preschool children with psoriasis, before and after treatment. In this study 28 children with psoriasis surveyed, aged 3 to 6 years inclusive. For the control group, comparisons were taken from 12 healthy children of the same age and sex. Personal and family history was thoroughly studied in all patients, general clinical examinations, and immunological methods for studying cellular immunity (CD3 +, CD4 +, CD8 +, CD16 + and CD20 +) were conducted.
It has been found that 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 +), natural killer cells (CD16 +) 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.
Keywords: children, cellular immunity, lymphocytes, immunomodulating therapy, index.
Relevance. Psoriasis is one of the most common diseases psoriasis, aged 3 to 6 years inclusive were examined. Of these,
of the skin of childhood and ranks second in terms of inci- there were 18 girls (64%), and 10 boys (36%). For the con-
dence after atopic dermatitis [1; 3], its share in the structure trol group, comparisons taken from 12 healthy children of the
of pediatric dermatoses ranges from 1 to 8% [4]. same age and sex.
In recent years, the problem of psoriasis is of particular Before starting the study, written permission for the ex-
importance in connection with the increasing incidence of amination taken from the parents or from the guardians of
the disease among children, especially preschool and older, an all the examined children. Personal and family history was
increase in complicated forms and torpid with respect to treat- thoroughly studied in all patients with psoriasis, general clini-
ment [2]. The clinical course of psoriasis in childhood, unlike cal examinations (blood, urine, feces, biochemical studies)
adults, has its own characteristics; therefore, it is important to were conducted, the children were consulted by a pediatri-
study the characteristics of the clinical course of psoriasis in cian, neuropathologist, ENT, ophthalmologist, dentist and, if
children, taking into account the age aspect [6]. necessary, by other specialists. All patients received inpatient
In the multifactorial pathogenesis of psoriasis, the viola- treatment, treatment was prescribed taking into account the
tion of the immune mechanisms takes the leading place [5; 7]. age, stage, severity and clinic of the disease. After treatment
However, objective and informative immunological criteria in the hospital, sick children were regularly (at least once a
for assessing the nature of the course of psoriasis in children, month) observed on an outpatient basis for 3 years. prediction and its outcomes have not yet been developed Immunological methods for studying cellular immunity
[1; 8]. In this regard, the topicality of studying immunity, in included determining the total number of T and B-lympho-
particular cellular immunity in children with psoriasis, is still cytes, their subpopulations (CD3, CD4, CD8 and CD20).
relevant. At the same time, from the total number of lymphocytes,
Materials and methods. The studies were conducted the determination of the percentage of T-lymphocytes peron the basis of the pediatric dermatology department of the formed in the reaction of indirect rosetting (PHRO), respec-Tashkent pediatric medical institute clinic. 28 children with tively, by the detection of populations and subpopulations of
FEATURES OF CELLULAR IMMUNITY IN PRESCHOOL CHILDREN WITH PSORIASIS BEFORE AND AFTER TREATMENT
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 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 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® (Polyoxi-donium) for use in pediatrics, 6 mg 2 times a day. The duration of treatment was 10 days. The obtained data 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 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 j 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 immunoregula-tory index (IRI = t 1.22), (P < 0.05). Accordingly, confirming these changes, an increase 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 1.52 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 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 = =1.27, 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, j 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 ofB-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 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 + immunoregula-tory 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 + ofimmunoregulatory lymphocyte subpopulations.
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