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1МУНОЛОГ1ЧНА ХАРАКТЕРИСТИКА ХВОРИХ НА ГЕНЕРАЛ1ЗОВАНИЙ КАТАРАЛЬНИЙ
Г1НГ1В1Т
Шостенко А.А.
ДВНЗ «Буковинський державний медичний утверситет», кафедра стоматологи дитячого в1ку, асистент
IMMUNOLOGICAL CHARACTERISTICS OF 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 мiсцевого секреторного iMyHi-тету в 82 хворих на генералiзований катаральний гiнгiвiт з хрошчним та загостреним перебiгом. Концент-рацiю SIg A, Ig A, Ig G i M визначали методом радiальноl iмyнодифyзil в гелi по G. Manchini. Використо-вували моноспецифiчнi сироватки проти названих iмyноглобyлiнiв. Дослiдження вмiстy ЬЛ-ip, ФНП-а i 1Л-4 y слинi проводилося за допомогою набору реагентiв Pro-Con (Санкт - Петербyрг), iмyноферментним методом, зпдно шструкци. У роботi використовувалися традицшш статистичнi методи. В роботi встанов-лено наявнiсть дефiцитy мiсцевого гуморального iмyнiтетy, дисбалансу в цитокiновiй систем^ як1 нерiдко виявляються своервдним базисом виникнення дисбiозiв та наступного виникнення захворюваня.
Abstract
This article presents the results of a study of local secretory immunity in 82 patients with generalized catarrhal gingivitis with the chronic and acute course. The concentration of SIg A, Ig A, Ig G, and M was determined by the method of radial immunodiffusion in a gel according to G. Manchini. Used monospecific sera against these immunoglobulins. The study of the content of IL-ip, TNF-а, and IL-4 in saliva was performed using a set of reagents Pro-Con (St. Petersburg), enzyme-linked immunosorbent assay, according to the instructions. Traditional statistical methods were used in the work. The presence of deficiency of local humoral immunity, imbalance in the cytokine system, which often turns out to be a kind of basis for the occurrence of dysbiosis and subsequent disease.
Ключов1 слова: катаральний пнпвгт, мюцевий секреторний iмyнiтет, iмyноглобyлiни, пародонт, ци-тошни, запалення.
Keywords: catarrhal gingivitis, local secretory immunity, immunoglobulins, periodontium, cytokines, inflammation.
A large spread of generalized catarrhal gingivitis, especially in young patients, no significant reduction in the incidence of gums, growth of sharpened and resistant to treatment clinical variants of the disease, despite the constant improvement of methods of professional activities, the introduction into clinical practice of new drugs, therapeutic and prophylactic schemes, make the problem of inflammatory gum disease one of the most urgent and not fully resolved in modern dentistry.
In modern literature, there are indications that the background of significant growth of conditionally pathogenic microorganisms of the activation of the monocyte-macrophage level of protection that starts a cascade in a complex network of mediator interactions and is accompanied by the accumulation in the fluids (saliva, blood) proinflammatory cytokines (IL-ip, TNF
- a), which is a key factor in the pathogenesis of inflammatory processes of any localization, including in the gum tissue.
At the same time, in the scientific literature on the role of proinflammatory cytokines and their antagonists (IL-4) in the pathogenesis of various clinical conditions of inflammation in the gums are out, too far from the issues of the objectification of activity therapy of generalized catarrhal gingivitis, in particular, pointed shapes, and forecast of the results of the treatment. In this regard, of particular interest is the study of the peculiarities of the local (local) immunity which would allow clarifying the pathogenesis of both chronic and Agostinho current generalized catarrhal gingivitis.
The aim of the study. Study of the state of local secretory immunity, identification of its most
characteristic features in patients with various clinical manifestations of generalized catarrhal gingivitis.
Materials and methods of research. 82 patients with generalized catarrhal gingivitis and 18 somatically and dentally healthy persons aged 18 to 30 years (25.4 + 0.9 years) were examined - 38 men (46.3%) and 44 women (53.7%). Patients were divided into two groups: group I included patients with the chronic course (33 people); in the second - patients who are in the phase of exacerbation of the inflammatory process in the gums (49 people). The groups were formed on the principle of no statistically significant differences in age and gender.
To assess the state of local immunity of the oral cavity, the levels of secretory immunoglobulin A in unstimulated oral fluid (saliva) SIgA, IgG, IgM, and the content of interleukins - IL - ip, IL-4, and TNF -a were determined.
The concentration of SIg A, Ig A, IgG, and M was determined by the method of radial immunodiffusion in a gel according to G. Manchini. Used monospecific sera against these immunoglobulins. The study of the content of IL-ip, TNF-a, and IL-4 in saliva was performed using a set of reagents Pro-Con (St. Petersburg), enzyme-linked immunosorbent assay, according to the instructions. Traditional statistical methods were used in the work.
Statistical data processing was performed using the software package STATISTICA 6.0 Stat Soft Ine, the USA on a personal computer in a Windows environment using a spreadsheet Microsoft Excel 2000. To assess the probability of differences between groups, the Student's t-test was calculated.
Research results and their discussion
As can be seen from the data in the table.1, in patients with generalized catarrhal gingivitis, both at the stage of chronic and in the stage of exacerbation, mostly statistically significant deviations of a number of indicators of local secretory immunity from the values in healthy patients. The established violations indicated the presence of immunodeficiency in the examined patients because the level of SIgA was outside the range of reference values in the downward direction.
During the analysis of the levels of basic immunoglobulins in oral fluid (saliva) in patients of both groups, the most significant are the results of SIgA and immunoglobulins of class G and M. A significant increase in IgG and a decrease in SIg A, indicating a deficiency of antibacterial protection oral mucosa in both patients with chronic and acute disease. But to a greater extent the deficiency of antibacterial protection was observed in patients with generalized catarrhal gingivitis with an acute course (see Table 1).
Table 1
Indicators of local immunity in patients with generalized catarrhal gingivitis with various manifestations of the
Groups of subjects
Indicators of The first group of patients The second group of Normative values
immunity (n=33), patients(n=49), (n=18)
M ± M M ± m
SIgA (g\l) 0,76±0,03* 0,32±0,02*** 1,24±0,23
IgG (g\l) 0,88±0,02* 0,59±0,02*** 0,47±0,02
IgM (g\l) 0,46±0,03* 0,28±0,03*** 0,23±0,01
m-ip (pg/ml) 24,1±0,3* 79,6±16,1*** 12,8±0,3
®Hn-a (pg/ml) 34,6±2,7* 98,4±10,7*** 20,3±4,2
in-4 (pg\ml) 68,7±4,2* 30,8±2,2*** 19,9±3,1
Notes: * p <0,05 - the probability of differences in relation to healthy indicators; ** p <0.05 - the probability of differences in relation to the indicators of group I.
In patients with acute generalized catarrhal gingivitis, a significantly greater decrease in SIg A and Ig M and a smaller increase in IgG were found compared with patients with chronic manifestations of the inflammatory process in the gum tissue. The lack of increased Ig G and Ig M, as well as various suppression of sIgA production, indicates the inadequacy of the local immune response to bacterial infection and may be one of the factors leading to the emergence of aggressive infections in this category of patients. In addition, the more pronounced nature of inflammatory disorders in the group of patients with a sharp decrease in the content of SIg A in the oral fluid confirms the importance of this indicator in the differential diagnosis of clinical variants of generalized catarrhal gingivitis.
It was found that in the pathogenesis of various variants of clinical manifestations in addition to specific pathogens, a significant role belongs to the state of local immunity, which provides primarily biocidal of the oral mucosa in general and gum tissue in particular. The obtained results once again substantiate the need to include in complex methods of
treatment of patients with generalized catarrhal gingivitis immunoprotective drugs.
An important section of this study was to profile in patients with generalized catarrhal gingivitis. In table 1. the results of the study the content of cytokines IL-ip, TNF-a, and IL-4 in restimulating saliva in patients with a chronic and acute course of the disease.
As can be seen from table 1, patients with chronic generalized catarrhal gingivitis were statistically significant deviation of IL-ip, TNF-a, and IL-4 from control values (p<0.05). However, the violations do not indicate the presence of an 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 an acute course of the disease deviations indicate more significant changes in concentrations of the studied cytokines relative to healthy individuals. the Initial levels of proinflammatory cytokines were elevated: IL-ip - 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).
Identified controversial production of IL-ip and TNF-a in patients with different manifestations of generalized catarrhal gingivitis, indicated the presence of significant differences in the mechanism of development of inflammatory reaction in patients with a chronic and acute course of the disease.
It was found that the local humoral protection in patients with generalized catarrhal gingivitis in the acute stage suffers to a greater extent than in patients with active manifestations of the inflammatory process in the gums. This is demonstrated by a local decrease in the concentration of SIg A, increased levels of proinflammatory cytokines (IL-ip and TNF-a), and levels of IL-4. Obviously, in the pathogenesis of pointed forms of generalized catarrhal gingivitis lies, on the one hand, the growth of proinflammatory cytokines, and with another - insufficient production of anti-inflammatory, which in turn indicates a lack of activation of monocyte-macrofouling parts of the immune system, which is aimed at the removal of bacterial agents into the gingival sulcus.
Thus, the study of cytokines and local humoral immunity has brought us closer to a better understanding of immunological processes, the presence of local humoral immune deficiency, imbalance in the cytokine system, which are often a kind of basis for dysbiosis and subsequent disease.
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НЕФРО - ЦЕРЕБРОПРОТЕКЦИЯ ПРИ ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК
Абдурашитова Д.И.
Кандидат медицинских наук, доцент, медицинского факультета ОшГУ,
г. Ош, Кыргызстан Маматов С.М. Доктор медицинских наук, профессор, Зав. каф. госпитальной терапии, профпатологии с курсом гематологии, Кыргызская государственная медицинская академия им. И.К. Ахунбаева,
г. Бишкек, Кыргызстан Умурзаков Ш.Э. Врач-кардиолог отдела интенсивной терапии Национального центра кардиологии и терапии имени академика Мирсаида Миррахимова,
г. Бишкек, Кыргызстан Жамилова Г.К.
Преподаватель Международной школы медицины,
г. Бишкек, Кыргызстан Юлдашев А.А.
Аспирант кафедры неврологии, нейрохирургии и психиатрии
медицинского факультета ОшГУ, г. Ош, Кыргызстан
