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ДИСБАЛАНС ЦИТОКIНОВОÏ СИСТЕМИ ТА МЕТОДИ ЙОГО УСУНЕННЯ У ХВОРИХ НА ГЕНЕРАЛ1ЗОВАНИЙ КАТАРАЛЬНИЙ Г1НГ1В1Т
Шостенко А.А.
ДВНЗ «Буковинський державний медичний утверситет», кафедра стоматологи дитячого в1ку, асистент
IMBALANCE OF THE CYTOKINE SYSTEM AND METHODS OF ITS ELIMINATION IN PATIENTS WITH GENERALIZED CATARRHAL GINGIVITIS
Shostenko A.
HSEE "Bukovinian state medical university", department of pediatric dentistry, assistant
Анотащя
У данш статп наведеш отримаш результати дослщження показнишв цитошново! системи до i шсля комплексного л^вання у 82 хворих на генералiзований катаральний гiнгiвiт з хрошчним та загостреним перебiгом. Вмiст концентраци 1Л-4, ЬЛ-ip i ФНП-а визначали в ротовiй рiдинi наборами реагенпв «Протеиновый контур», «Цитокин» (Санкт-Петербург, Роая) методом твердофазного iмуноферментного ана-лiзу. Розроблено та впроваджено комплексну терапiю, яка передбачае використання на рiзних етапах ль кування професшних гiгiенiчних заходiв, протизапальних, антибактерiальних, iмуномоделюючих препа-ратiв та пробiотикiв. В робот встановлено, що позитивна динашка показникiв цитокiнового профiлю бiльш чгтко прослiдковувалась, по вiдношенню до вивчаемих цитошшв, у хворих з загостреним перебтем генералiзованого катарального гiнгiвiту, за рахунок використання в них запропонованого методу комплексного лiкування.
Abstract
This article presents the results of the study of indicators of the cytokine system before and after complex treatment in 82 patients with generalized catarrhal gingivitis with chronic and exacerbated course. The content of the concentration of IL-4, IL-1P and TNF-а was determined in the oral fluid by the sets of reagents "Protein circuit", "Cytokine" (St. Petersburg, Russia) by enzyme-linked immunosorbent assay. Complex therapy has been developed and implemented, which involves the use at various stages of treatment of professional hygiene measures, anti-inflammatory, antibacterial, immunomodulatory drugs and probiotics. It was found that the positive dynamics of the cytokine profile was more clearly traced in relation to the studied cytokines in patients with acute course of generalized catarrhal gingivitis, due to the use of the proposed method of complex treatment.
Ключов1 слова: катаральний пнпвгт, iмунокорегуюча терашя, пародонт, цитокши, запалення.
Keywords: catarrhal gingivitis, immune corrective therapy, periodontal disease, cytokines, inflammation.
It is known that in the process of implementation of inflammation in periodontal tissues involves a number of local immune mechanisms, and its development is the result of a complex intracellular cooperation, which is an important nonspecific granulocytes and macrophages.
Secretion of activated cells phagocytosis a large set of biologically active substances, mediators of cell interactions (IL-1, IL-1P, TNF-a ol), potentiates the availability of new neutrophils and monocytes-macro-phages into the site of inflammation. These processes are crucial in the initial stage of development of the immune response.
It is known that cytokines are produced by cells of the monocyte-macrophage level and lymphocytes during the development of inflammatory processes. They
stimulate the immune response and provide intercellular cooperation [1], but in some cases go beyond the only mediator functions, and by acquiring a systemic nature, trigger a cascade of pathological reactions [2]. It is proved that the accumulation in the blood serum and mixed saliva proinflammatory and reduced anti-inflammatory cytokines, is a leading factor in the patho-genesis of inflammatory and destructive processes in the organism [3].
Today zastarelosti the provision that the formation of inflammatory-destructive process in the periodon-tium is associated with a pronounced rise in blood and oral fluid proinflammatory cytokines IL-1ß and TNF-a that play a major role in the development of the progressive variant of the disease. Found a significant in-
crease in anti-inflammatory IL-4 while not able to compensate for the proinflammatory potential of IL-1P and TNF-a [4].
In this regard, testing the levels of cytokine production in patients with infectious-inflammatory process covers only the gum tissue is important at the stage of clarifying their significance in the pathogenesis and in the search for diagnostic and prognostic criteria necessary to use this knowledge in the clinic.
The purpose of this study is the results of the study indicators Titano system before and after the complex therapy of patients with generalized catarrhal gingivitis with chronic and acute course.
Materials and methods. The study involved 82 patients aged from 19 to 31poKy, women - 44 (54,7%), 38 men (45.3 per cent). Depending on the clinical manifestations of the disease, all patients in the i stage of the study were divided into two groups: i group - 33 patients with chronic generalized catarrhal gingivitis; II group - 49 patients with acute course of the disease.
At the stage of clinical testing of the developed schemes of treatment (stage II studies) patients of group II with acute disease were divided into equivalent sex and age composition and clinical picture of subgroup -basic (II-b, 27 people), which used the developed methods of treatment and comparison with traditional medical schemes (II-a, 22 individuals).
All patients were identical to the clinical examination, including the clarification of complaints, history taking, visual and instrumental evaluation of dental status. The objective state of the mouth and gums was established on the basis of the dynamics of the following tests: a simplified index of oral hygiene (OHI - S) by J. C. Green, J. R. Vermillion (1960), bleeding index (IR) of Meuleman (H. Muhlemann, 1971), in the modification Koala (I. Cowell, 1975), popularno-marginal-alve-olar index (PMA) (Parma, 1960) [5,6].
The content of IL-4, IL-1P and TNF-a were determined in the oral fluid kits "Protein contour", "Cyto-kine" (Saint-Petersburg, Russia) by ELISA.
Along with General clinical examination we used standard digital orthopantomography.
Taking into account the identified etiologic and pathogenetic links diseases for each of the identified programs have been developed restorative treatment and subsequent maintenance treatment and preventive measures for their staged implementation.
In the preparatory phase in patients i, II-a and II-b groups local treatment GCG conducted according to a single plan, carried out professional hygienic measures in combination with irrigation of interdental spaces and an application of the mucous membranes of the gums chlorhexidine-containing means.
In the second phase of treatment, patients of the first group (33 persons) received basic treatment: standard antibiotic therapy chlorhexidine-containing means. Additionally prescribed a probiotic (the «Bifidumbacterin» 5 doses 2 times a day course to 10 days) and Monochoria («Cycloferon» oral 300 mg. per day, course 10 days).
In the II-a group of patients (22 - comparison group) acute chronic generalized catarrhal gingivitis
used the same antibacterial and monaragala therapy for the same program, that in patients of I group.
Scheme of complex therapy, which was applied in 27 patients, II-b groups (the main group), involved the expansion of the Arsenal used by means of etiological treatment. Together with the antibacterial drugs used topically prescribed nonsteroidal anti-inflammatory drug "Nimesil" 1 dose 2 times a day course to 7 days; antibiotics "Amoxiclav" at 500/125 mg 2 times a day course to 7 days; the probiotic "Biosporin" in 2 oral vial 2 times a day 30 minutes before meal, course till 10 days. After the elimination of active inflammation in the gums was used an immuno corrector «Likopid» 1 mg per day, course 10 days.
The third final stage included the prevention of recurrence of the disease in the remote period after treatment, by carrying out professional hygienic measures and repeated course of General or local immune laptop, every 6 months after completing comprehensive treatment.
Statistical data processing was performed using software package STATISTICA 6.0 Stat Soft Ine, USA on a personal computer in a Windows environment using tabular processor Microsoft Excel 2000. To assess the likelihood of differences in the indicators between groups was calculated by student's t-test [7].
The results of the study and their discussion
As can be seen from table 1, before the treatment of patients with chronic generalized catarrhal gingivitis, were primarily statistically significant deviations of IL-1P, TNF-a and IL-4 from control values (p<0.05). However, the violations do not indicate the presence of imbalance in the functioning Titano system, since the level of indicators, which are studied, increased or decreased significantly a little and not go beyond the generally accepted range of reference values.
On the contrary, in patients with acute course of the disease the initial levels of proinflammatory cyto-kines were elevated: IL-1P - 6.2 times and TNF-a - 4.8 times in comparison with the control. It is characteristic that the increase in anti - inflammatory IL- 4 while in the oral fluid of patients with pointed for generalized catarrhal gingivitis was to a lesser extent (1.5 times).
As a result of complex treatment of patients with chronic manifestation of inflammatory process in gum tissues, which have minor changes in the concentrations of the main cytokines IL-1P, TNF - a and IL - 4 relative to healthy individuals achieved a significant decrease of IL-1P and TNF - a, increased levels of IL - 4 in saliva to the boundaries of conventional norms.
The materials presented in table.1 shows that achieving a significant reduction in IL-1P and TNF - a after comprehensive treatment, was performed in patients II-a and II-b groups (respectively 1.8 times and 2.4 times). It should be noted that only persons of the II-b group, the levels of anti-inflammatory cytokines in the saliva, after the step of using LAPD approached control values (p<0.05), which indicates the effectiveness of the tactics of complex treatment of patients with acute course of the disease. The content of IL-1P and TNF-a in patients of II-a group were less likely to decline after treatment was statistically less reduced than in patients with I and II-b groups (p<0.05).
Indicators of the cytokine system in patients with generalized catarrhal gingivitis at the stages of complex exami-_nation (M ± m)_
Indicators of the cytokine system Groups of patients
I group (n=33) II-a group (n=22) II-b group (n=27) Control group (n=18)
Before treatment After treatment Before treatment After treatment Before treatment After treatment
IL-ip (pg/ml) 24,1± 0,3* 12,2± 0,6 79,6± 16,1* 33,2± 3,1*** 79,6± 16,1* 10,6± 0,5*** 12,8± 0,3
TNF - a (pg/ml) 34,6± 2,7* 22,6± 1,2 98,4± 10,7* 58,8± 4,4*** 98,4± 10,7* 26,3± 5,1*** 20,3± 4,2
IL- 4 (pg\ml) 68,7± 4,2* 68,4± 2,0* 30,8± 2,2* 44,1± 3,0*** 30,8± 2,2* 60,7± 2,3*** 19,9± 3,1
Notes: * p<0.05 - significance of differences to the control group; ** p <0.05 - significance of differences after treatment.
The level of IL-4, after the introduction of therapy, in both groups of patients with acute course of generalized catarrhal gingivitis, significantly increased compared with the initial (in group II - in 1,43 times and in group II-b in 1,9 times). In the future there was a gradual decrease in its content in the oral fluid to the levels of healthy individuals. After 1 - 1.5 months, the level of IL-4 in patients in group II-b decreased compared with the data after, but did not differ from the control values (10.9 ± 2.3 pg / ml; p <0.05). During this period of observation in patients of group II-a this indicator also decreased, but to a lesser extent (according to 26,8 ± 3,2 pg / ml p <0,05).
Thus, the presented materials indicate that the positive dynamics of the cytokine profile was more clearly traced, with respect to the studied cytokines, in patients with acute course of generalized catarrhal gingivitis, due to the use of the proposed method of complex treatment. This fact is associated with faster elimination of the inflammatory process and the absence of disease recurrence in the overwhelming number of patients treated (93.3% of cases).
Conclusions
1. Patients with chronic generalized catarrhal gingivitis showed statistically significant deviations of IL-1p, TNF-a and IL-4 from control values (p <0.05). However, the disorders did not indicate an imbalance in the functioning of the cytokine system. In patients with exacerbated disease, high production of IL-1p and TNF-a was observed against the background of decreased synthesis of IL-4.
2. Completed stage treatment of generalized ca-tarrhal gingivitis provides elimination of imbalances in the cytokine system, leads to elimination of inflammatory phenomena in the gums after 6-7 visits in 93.3%
of patients with chronic course and in 96.3% of patients with exacerbated manifestation of the disease.
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