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Sectiom 6. Medical science
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-134-135
Sirozhiddinova Khiromon Nuriddinovna, senior research worker, 3 nd year competitor on "Pediatrics" specialty,
Samarkand State Medical Institute Abdullaeva Muhiba Nigmatovna, d. m.s., professor, Head of the Chair of Neonatology of Samarkand State Medical Institute E-mail: [email protected]
Formation of circulating immune complexes (CIC) and immunoglobulins in intrauterine infection (IUI)
Abstract: The results of examination of 140 newborns with neonatal pathology on CIC contents and three classes of immunoglobulins (A, M, G) in the blood serum have been presented in the article. The highest CIC indices have been noted in the newborns with intrauterine pneumonia (IUP) that makes 143,5 ± 0,87 cond. un. The same CIC indices have been noted in the newborns with neonatal pneumonia (NP) (140,7 ± 0,89 cond. un.) and purulent inflammatory diseases (PID) (136,4 ± 0,83). High CIC indices prove that there is excessive amount of antigens in the newborns body which invaded there in the intrauterine period. Complement concentration (CH50) decreases in adverse proportion to a high CIC level (43,4 un.- IUI, 42,7. un. — NP, 39,6 un. — PID, 49,3 un. in the norm), that can be explained by complement consumption in antigen — antibody reaction in CIC formation. Low indices of Ig G in comparison with the norm in the newborns in neonatal pneumonia (3,9 ± 0,29), purulent inflammatory diseases (3,76 ± 0,3) admit the thought that placental transmission of Ig G and intrauterine infection take place.
Keywords: Circulating immune complexes, complement, immunoglobulins, newborns.
Introduction. Criteria of IUI are numerous. No doubt that discovery of the causative agent from the focus of the newborn damage is the main criterion [2]. Serological study of the newborns on antibody presence using IFA gives insufficient information. In IUI immunoglobulin synthesis increases by the fetus first of all due to immunoglobulins of Ig M class but with this " collection" of monomers into pentamers is disturbed. Sometimes in IUI Ig G, Ig A syntheses sharply increase and in these cases in prolonged circulation of the causative agent abundance of immune complexes is formed and they cause damage to the tissue [5].
The study of the role of immunological mechanisms in IUI pathogenesis is being continued. Pathogenetic mechanisms of CIC are studied in various pathological conditions in recent years [1]. Formation of antigen + antibody + complement complexes (CIC) is a natural immunological reaction of a healthy body directed to the discharge of foreign antigen and persistence of homeostasis. In the norm these complexes are rapidly eliminated of the blood by mononuclear phagocyte system but in continuous effect of antigens to the body CIC level in the blood increase [6; 7].
The aim of the research — to study pathogenetic, prognostic aspects of circulating immune complexes and three classes of immunoglobulins (A, M, G) in intrauterine infection.
Material and methods of the research
The blood serum has been studied on presence of CIC, CH50 and three classes of immunoglobulins (A, M, G) of 140 newborns hospitalized to DPN RCMMC of Samarkand city. CIC have been determined by precipitation of polyetilglycol (PEG) according to V. Gashkova et al. method (1979), the complement level according to the method proposed by F.Yu.Garib and A. I. Sharapova (1973). Quantitative definition of A. M.G. immunoglobulins fractions were studied according to Mancini G., Carbon A. O., Hage-man's I. F. (1965).
The received figures have been processed by variation statistical method with calculation of arithmetic mean (M), arithmetic mean error (m) on the computer by means ofMicrosoft Excel 2007 program.
The results of the research and their discussion
140 newborns have been examined. Of them 52 (37,1%) developed intrauterine pneumonia during 72 hours following the birth, burdened obstetric anamnesis was noted and bacterial inoculation was confirmed during 1-2 days of life. Neonatal pneumonia was marked in 45 (32,1%) examined newborns.
The performed immunological studies show that CIC contents in the blood serum of the studied groups exceeds vibratory number of CIC in healthy newborns. The highest CIC indices have been noticed in the newborns with intrauterine pneumonia that makes 143,5 ± 0,87 cond. un. The same high indices in comparison with the normal ones are noted in the other groups of newborns with neonatal pneumonia (140,7 ± 0,89) and purulent inflammatory diseases (136,4 ± 0,83) (table 1).
Formation of circulating immune complexes takes place by means of complement. In our observations the average complement index in the observed patients was low in comparison with healthy newborns. In the newborns with intrauterine pneumonia the average complement index makes 43,4 un., neonatal pneumonia — 42,7 un. and purulent inflammatory diseases — 39,6 un.; M ± m — 43,4 ± 0,56; 42,7 ± 0,57; 39,6 ± 0,52 un. accordingly.
In reverse proportion to a high CIC level complement concentration decreases that can be explained by its consumption in antigen — antibody reaction in formation of immune complexes. The increase of circulating immune complexes number is the evidence that there is excessive amount of antigens in the newborns body which penetrated there in the intrauterine or perinatal period. Thus, the observed CIC accumulation on the background of complement consumption coordinates with literature information [4].
In the norm in the newborns under one month Ig A in the blood serum makes from 0,01 to 0,5g/l, Ig M — 0,2-0,9 g/l and Ig G — 2,5-9,0 g/l. According to our observations the largest amount of Ig A makes 0,8g/l that is higher than normal. It is considered that the level of serous Ig A and Ig M increases in perinatal infections, diseas-
Formation of circulating immune complexes (CIC) and immunoglobulins in intrauterine infection (IUI)
es of the respiratory and intestinal tracts. In the newborns intrauterine, neonatal pneumonia and purulent inflammatory diseases had a complicated course with sepsis, diarrhea and increase of immuno-
globulins contents (Ig A — 0,8g/l; o,6g/l; 0,7g/l; IgM — 1,9g/l; 5,6g/l; 1,8g/l accordingly) that may be considered as natural body reaction (table 2).
Table 1. - The level of circulating immune complexes (CIC) and complement in the blood serum of the newborns IUP, NP and PID
Newborn groups Indices CIC in cond. un. Complement H50 in un.
Intrauterine pneumonia n M ± m 52 143,3 ± 0,88 52 43,4 ± 0,55
Neonatal pneumonia n M ± m 45 140,7 ± 0,87 45 42,7 ± 0,56
Purulent inflammatory diseases n M ± m 43 136,4 ± 0,81 43 39,6 ± 0,51
In healthy newborns Norm 60-120 38-60
Note: The received figures have been processed by variation statistical method with calculation of arithmetic mean (M) and arithmetic mean error (m).The average meanings of the received results have been pointed out — p<0,05.
Table 2. - The level of A, M, G immunoglobulins in the blood serum of the newborns with IUP, NP and PID
Newborn groups Indices The number of immunoglobulins g/l
A M G
Intrauterine pneumonia n M ± m 52 0,36 ± 0,03 52 1,2 ± 0,06 52 5,0 ± 0,30
Neonatal pneumonia n M ± m 45 0,4 ± 0,02 45 2,0 ± 0,22 45 4,0 ± 0,29
Purulent inflammatory diseases n M ± m 43 0,3 ± 0,03 43 1,0 ± 0,06 43 3,8 ± 0,29
In healthy newborns The norm from birth to 1 month 0,01-0,5 0,2-0,9 2,5-9,0
Note: The received figures have been processed by variation statistical method with calculation of arithmetic mean (M) and mean error (m). The average meanings of the received results have been pointed out — p<0,05.
High Ig G contents in the blood serum has been marked in the newborns with intrauterine pneumonia. It is known that Ig G globulin contains the basic mass of antibodies, fixes the complement. It is the only of immunoglobulins which can pass through placenta.
Low Ig G indices in comparison with the normal in the newborns with neonatal pneumonia (3,9 ± 0,29) purulent inflammatory diseases (3,76 ± 0,3) and high indices with intrauterine pneumonia (4,9 ± 0,3) admit the thought that placental transfer of Ig G and in-trauterine infection take place.
Conclusions
1. High CIC indices in the newborns with neonatal pathology are the evidence of excessive amount of antigen in their body which penetrated their due to intrauterine infection.
2. In reverse proportion to a high CIC level complement concentration decreases that can be explained by its consumption in antigen — antibody reaction in formation of immune complexes.
3. Low Ig G indices in comparison with normal in the newborns with neonatal pneumonia (7,4 ± 1,6), purulent inflammatory diseases (7,6 ± 1,6) and high indices in intrauterine pneumonia (11,8 ± 2,9) admit the thought that placental transfer of Ig G and intrauterine infection take place.
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