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22IMPORTANCE OF IMMUNOLOGICAL PARAMETERS IN THE CLINICAL COURSE OF PURULENT OTITIS MEDIA
Firangiz Suleymanovna Ikramova
Bukhara State Medical Institute
ABSTRACT
Between 2020-2021 years we examined 53 patients who applied to Bukhara Regional Children's Multidisciplinary Medical Center ENT department. Of these, 32 people suffered from chronic purulent otitis media and 21 people acute purulent otitis media. All patients underwent a standard examination: clarification of complaints and anamnestic data. Examination of the ENT organs was carried out according to the generally accepted scheme. We also studied the indices of local immunity of the mucous membranes of the middle ear using immunohistochemically studies with antibodies to T-helper lymphocytes (CD4 +), suppressor T-lymphocytes (CD8 +) and B-lymphocytes (CD20) in patients of different groups. the indices of local immunity of the mucous membrane of the middle ear in the first two weeks of the acute purulent otitis media correspond to an adequate response of local immunity to an infectious agent; the third week is characterized by an imbalance in the local immune defense, which indicates a high activity of the inflammatory process, which is a milestone stage in the course of the disease.
Keywords: chronic purulent otitis media, acute purulent otitis, T-lymphocytes, B-lymphocytes.
Relevance: Despite the achievements of modern medicine, the number of patients suffering from chronic infection of the upper respiratory tract over the past decades does not tend to decrease, which makes the problem of chronic inflammation extremely urgent. at the moment, among all ENT diseases, ear diseases account for 31.5%, where the share of chronic suppurative otitis media accounts for 27.2% [1, 6].
Despite the increasing achievements of modern medicine, the development and introduction of new medical technologies, the number of patients suffering from acute otitis media, a large part of whom, with the development of chronic suppurative otitis media over the past decade, does not decrease, and chronic purulent otitis media remains the most frequent pathology among all chronic ENT diseases - bodies. At the same time, practically insufficient data in the modern otiatric literature on changes in local and general immunity, leading, ultimately, to the chronicity of the inflammatory process, gives particular importance and interest to this problem.
In the works of recent years, it has been shown that the state of both systemic and local immune mechanisms is of great importance in the development of acute otitis
media and chronic otitis media. The middle ear cavity has a latent immune system with rare plasma cells and lymphocytes, and a small number of organized lymphoid follicles [2,7]. With decompensated inflammatory processes, the activity and number of macrophages increases, since they produce chemotactic factors for leukocytes. So, "the macrophage system or the system of mononuclear phagocytes is a powerful defense apparatus that takes part in both general and local defense reactions" [3,4,5].
Purpose of the study. In this regard, the purpose of this research work was to study the local immunity of the mucous membrane of the middle ear in children with different durations of the inflammatory process in the middle ear.
Materials and methods. The methodology of the work is based on systematic and complex data analysis.
Between 2020-2021 years we examined 53 children who applied to Bukhara Regional Children's Multidisciplinary Medical Center ЕNТ department. Of these, 32 children (60.4%) suffered from chronic purulent otitis media and 21 children (39.6%) -acute purulent otitis media. Among the examined patients there were 19 (35.8%) boys and 34 (64.1%) girls aged 2 to 18 years. The duration of the disease ranged from 2 days to 20 years or more.
1- group (5 children; 9.4%) - first week of illness; 2- group (6 children; 11.3%) -second week of illness; 3-group (6 children; 11.3%) - third week of illness; 4-group (4 children; 7.5%) - fourth week of illness; 5-group (32 children; 60.4%) - children with a disease duration of 6 months and more.
All children underwent a standard examination: clarification of complaints and anamnestic data. Examination of the ENT organs was carried out according to the generally accepted scheme. Statistical analysis of the data was performed using Microsoft Excel 2010 and STATISTICA 10.0.
We also studied the indices of local immunity of the mucous membranes of the middle ear using immunohistochemical studies with antibodies to T-helper lymphocytes (CD4 +), suppressor T-lymphocytes (CD8 +) and B-lymphocytes (CD20) in patients of different groups.
Results of the study. Analyzing the data obtained, it can be stated that in the 1st group of children (first week of illness) there was a tendency for an insignificant increase in CD8 + T-suppressor lymphocytes (17.0 ± 4.9) and B-lymphocytes (CD20) (2,6 ± 1.9), with simultaneously unchanged indicators of CD4 + T-helper lymphocytes (32.4 ± 12.9), which is associated with an adequate response of local immunity to a foreign agent. The ratio of indicators of CD4 + T-helper lymphocytes to CD8 + T-suppressor lymphocytes in children of this group reflects the normal state of local immune defense [7-15].
In the 2-group of children (second week of illness) in comparison with the 1-group, the indicators of CD4 + T-helper lymphocytes (32.4 ± 12.9 and 31.7 ± 8.1)
remain at the same level as and a week ago, with a simultaneous significant increase in the indicators of CD8 + T-suppressor lymphocytes (17.0 ± 4.9 and 31.4 ± 9.2, p <0.05). B-lymphocytes (CD20) (2.6 ± 1.9 and 12.4 ± 7.3, p <0.05) have a tendency to moderate growth in comparison with the previous period of the disease. During this period, the ratio of indicators of CD4 + T-helper lymphocytes to CD8 + T-suppressor lymphocytes tends to 1, which indicates a severe course of the inflammatory process and a high activity of the immune system aimed at combating a foreign agent. Changes in the local immunity of the mucous membrane of the middle ear in the third group of children (third week of the disease) in comparison with the 2nd group are characterized by the fact that the indicators responsible for the development of acute inflammation, namely, the indicators of CD4 + T-helper lymphocytes (31 , 7 ± 8.1 and 18.9 ± 9.2; p <0.05) and CD8 + T-suppressor lymphocytes (31.4 ± 9.2 and 10.3 ± 6.5; p <0.05 ) decrease, and the B-lymphocyte count (CD20) (12.4 ± 7.3 and 11.7 ± 14.6) remains approximately at the same level as a week ago. When analyzing the indicators of the ratio of CD4 + T-lymphocytes-helpers to CD8 + T-suppressor lymphocytes, a sharp increase was revealed, almost corresponding to the level of this indicator at the first week of the disease, the normal state of local immune defenses [16-25].
Thus, at this time, there is a clear imbalance in the local immune defense, which most likely indicates a high activity of the inflammatory process and is a turning point in the course of the entire disease, leading in the future, in the absence of adequate, timely started treatment, in conditions of bacterial superinfection, to the transformation of an acute inflammatory process into a persistent, irreversible chronic, inflammatory process.
In the 4-group of children (fourth week of illness), in comparison with the 3-group, an interesting tendency of changes in all parameters responsible for local immunity is revealed. Indicators of both T-lymphocytes (CD4 + T-helper lymphocytes (18.9 ± 9.2 and 151.3 ± 14.9, p <0.05), CD8 + T-suppressor lymphocytes (10.3 ± 6.5 and 107 , 1 ± 27.1, p <0.05) and B-lymphocytes (CD20) (11.7 ± 14.6 and 126.1 ± 42.3; p <0.05) sharply increase at this time At the same time, the ratio of indicators of CD4 + T-lymphocytes-helper cells to CD8 + T-suppressor lymphocytes is again lower than the values indicating a normal state of local immune defense, which indicates a severe course of the inflammatory process on the one hand, and on the other hand, about the available reserve in local immune protection [26-35].
In patients of the 5-group with a disease duration of 6 months and more in comparison with the 4-group, signs of suppression of the immune response were revealed, as evidenced by an increase in B-lymphocytes (CD20) (126.0 ± 42.3 and 214.4 ± 114.4, p <0.05). The existing excess of T-lymphocytes (CD4 + T-helper lymphocytes, CD8 + T-suppressor lymphocytes) and B-lymphocytes (CD20) in comparison with the onset of the disease indicates that, despite the age of the process
and the presence of subjective signs of remission, inflammatory the process is not completed and, apparently, the disease acquires the features of an autoimmune pathology. Confirmation of the above is the approximation of the ratio of CD4 + T-helper lymphocytes to CD8 + T-suppressor lymphocytes to the indicator corresponding to hyperactivity.
Conclusion. Thus, the indices of local immunity of the mucous membrane of the middle ear in the first two weeks of the acute purulent otitis media correspond to an adequate response of local immunity to an infectious agent; the third week is characterized by an imbalance in the local immune defense (CD4 T-helper lymphocytes and CD8 T-suppressor lymphocytes decrease by 40.4% and 67.2%, respectively, while the B-lymphocyte count (CD20) remains approximately the same level), which indicates a high activity of the inflammatory process, which is a milestone stage in the course of the disease.
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