CC BY
35
Integrated immunotherapy when nosocomial pneumonia in infants
activity remained low. Apparently, a significant decrease in the level of nitric oxide in the background of continuing high activity of nitric oxide synthase, is associated with accelerated its interaction with active forms of oxygen and the formation ofperoxynitrite. This is confirmed by peroxynitrite maintaining high values in the blood serum of experimental animals. In our view, a more efficient system in terms of nitrogen oxide correction it is advisable to use a dose of 25 mcg/kg .
The following conclusions can be drawn from the data:
1. On the basis of the development of endothelial dysfunction at HCS play an important role decrease the synthesis of endothelial nitric oxide and increase its active radicals, stipulated modification of low density lipoproteins.
2. Sulfated chitosan reduces high levels of peroxynitrite and endothelin-1, increase the activity of eNOS and nitric oxide.
References:
1. Mallika V. Atherosclerosis pathophysiology and the role of novel risk factors: A clinicobiochemical perspective//Angiology. - 2007. -Vol. 58, № 5. - P. 513-522.
2. Шляхто Е. В., Беркович О. А. Клеточные и молекулярно-генетические аспекты эндотелиальной дисфункции//Вестник РАМН. -2004. - № 6 - С. 50-52.
3. Brevetti G., Schiano V., Chiariello M. Endothelial dysfunction: a key to the pathophysiology and natural history of peripheral arterial disease?//Atherosclerosis. - 2008. - Vol. 197. - Р. 1-11.
4. Kawashima S., Yokoyama M. Dysfuncthion of endothelial nitric synthase and atherosclerosis//Atheroscler Thromb Vasc Biol. -2004. - Vol. 24. - Р. 998-1015
5. Дисфункция эндотелия. Причины, механизмы, фармакологическая коррекция/Под ред. Н. Н. Петрищева. - СПб.: Изд-во СПбГМУ, 2003. - 184 с.
6. Рашидова С. Ш., Милушева Р. Ю. Хитин и хитозан Bombyx mori. Синтез, свойства и применение. - Ташкент: «Фан», 2009. - 246 с.
7. Азимов Р. К., Комарин А. С. Патофизиология обмена монооксида азота. Методические рекомендации. - Ташкент, 2005. - 29 с.
8. Сумбаев В. В., Ясинская И. М. Влияние ДДТ на активность синтазы оксида азота в печени, легких и головном мозге крыс//Совр. пробл. токсикол. - 2000. - № 3. - С. 3-7.
9. Вавилова Т. П., Петрович Ю. А. Определение активности нитратредуктазы в смешанной слюне//Вопр. мед. химии. - 1991. -№ 2. - С. 69-74.
10. Абесадзе И. Т. Функциональное состояние эндотелия и оксидантная активность лейкоцитов у больных ишемической болезнью сердца после коронарногошунтирования//Автореф. дис. ... к. м. н. - СПб., 2008. - 21 с.
Movlanova Shakhnoza Sobirovna, senior staff scientist of Republican Specialized Scientific and Practical Medical Center of Pediatric, Republic of Uzbekistan
E-mail: evovision@bk.ru
Integrated immunotherapy when nosocomial pneumonia in infants
Аbstract: In the present study we examined 150 patients, including 110 children with NoP and 40 children with community-acquired pneumonia. There was a significant decrease in CD3+ lymphocytes to 43.4 ± 0.8 % (61.5 ± 1.2 %) (P < 0.001), CD4+ lymphocytes to 27.1 ± 0.7 % (39.1 ± 0.5 %), CD8+ lymphocytes to 15.2 ± 0.5 % as compared to the indices CAP 19.5 ± 1.1 % (P < 0.01), a significant increase in the relative number of CD20+ lymphocytes, which amounted to 28.6 ± 0.5 % compared with CAP index — 16.4 ± 1.1 % (P < 0.01) and CD16+ lymphocytes to the 16.8 ± 0.4 % compared with the CAP 10.2 ± 0.5 (P < 0.001). From the humoral immunity, which is expressed in a decrease in the level of serum IgA and IgM, which amounted to 44.5 ± 2.5 mg., %; 92.4 ± 3.1 mg., % respectively, compared with CAP (78.4 ± 3.2 mg., %; 121.4 ± 4.9 mg., %, P < 0.01).
Differentiated methods of treatment potentiate the efficacy of antibiotic treatment of NoP, allowing faster return to normal changes in laboratory and immunological parameters of blood, reducing the number of bed-days, reduced the risk of severe and protracted forms of adverse outcomes NoP.
Keywords: nosocomial pneumonia, immunology, cytokines.
Actuality
The nosocomial pneumonia (NoP), which develops against the background of secondary immunodeficiency states, worsens the prognosis and creates threat to a child's life. It is known that the immune response includes multidirectional types of effector mechanisms, each of which is optimal in respect of certain pathogens. Analysis of published data shows that in the children's NoP dysfunction of the immune system are varied, complex, contradictory and not fully understood.
The purpose of study is to develop treatment regimen of nosocomial pneumonia in young children based on interdependence received clinical and laboratory data.
Material and methods
In the present study we examined 150 patients, including 110 children with NoP and 40 children with community-acquired pneumonia (CAP) who treated at the intensive care units and intensive therapy, pulmonology of infants departments of RSSPMC Pediatrics MoHRoUz. Conducted clinical, laboratory methods of research, studied in detail immunological methods by immunoferment method.
Depending on the type of therapy examined children were divided into three groups: I — group consisted of 40 children patients with NoP which had received basic therapy. II — group consisted of 35 children patients with NoP which had received with basic therapy
Section 4. Medical science
polioksidony 3 mg. on scheme. Group III consisted of 35 patients with NoP of children which had received basic therapy included polioksidony and Vitrum baby.
The results of study. Analysis of the study showed that 60 children (54.5 %) admitted to the department of pulmonology on 3-4 day after discharge from the other hospitals (after acute bronchitis, laryngitis and intestinal infection), and 50 (45.4 %) admitted to the RITD with hyperthermia and respiratory failure of varying severity. The main clinical manifestations of the disease were: severe respiratory and cardio — vascular insufficiency in 100 % resistant, study hyperthermia to 38.5 °C was observed in 35 (31.8 %), above 38.5 °C — in 40 (36.3 %), persistent dry — 62 (56.3 %) participated, and sometimes wet cough observed in 38 (34.5 %) participated, involvement in the act of respiration auxiliary muscles was observed 100.0 % cases. The children received from other hospitals in the form of complicated and protracted course ofpneumonia plated Pseudomonas aeruginosa. The characteristic features of NoP caused by Pseudomonas aeruginosa and Enterobacteriaceae, had steady progression and high percent for death (30 %).
The results of X-ray examination showed the following character of lung disease in children with NoP: localization of infiltration — two-sided in 74 (67.2 %) patients, one-sided — in 36 (32.7 %); infiltrate allocation — in the upper right lobe — in 45 (40.9 %), in the middle lobe — in 22 (20 %) patients. Sufficiently frequent complications have been destruction oflung tissue in 6 (5.4 %) as a form ofpul-monary edema in 11 (10 %). It should be noted at the NoP, caused by Pseudomonas aeruginosa and Enterobacteriaceae, in more than half of the cases there is bilateral lung damage, while increasingly involved in the process right upper lobe.
In previous publications were presented immunological data: there was a significant decrease in the relative number of CD3+ lymphocytes to 43.4 ± 0.8 % (61.5 ± 1.2 %) (P < 0.001), CD4+ lymphocytes to 27.1 ± 0.7 % (39.1 ± 0.5 %) of CD8+ lymphocytes to 15.2 ± 0.5 % compared with CAP index 19.5 ± 1.1 % (P < 0.01), a significant increase in the relative number of CD20+ lymphocytes, which amounted to 28.6 ± 0.5 % compared with CAP index — 16.4 ± 1.1 % (P < 0.01) and CD16+ lymphocytes to 16.8 ± 0.4 % compared with CAP index 10.2 ± 0.5 (p < 0.001). From the humoral immunity, which is expressed in a decrease in the level of serum IgA and IgM, which amounted to 44.5 ± 2.5 mg., %; 92.4 ± 3.1 mg., % respectively, compared with CAP (78.4 ± 3.2 mg., %; 121.4 ± 4.9 mg., %, P < 0.01).
In the present study discusses analysis results of the various therapeutic approaches in the treatment of children with NoP.
It was traced the dynamics of changes in immune system influenced by differential treatment of patients with NoP. The children of group II was observed activation of cellular immunity, as evidenced by increase in the relative number of CD3+ lymphocytes, 52.5 ± 1.8 % at a norm (61.5 ± 1.2 %), valid with respect to the I group patients (P < 0.01). Subpopulations CD4+ lymphocytes were increased in children in group II after treatment relative indicators of group I patients (P < 0.01).
Lymphocyte subpopulation bearing markers CD8+ were have also positive dynamics influenced combined therapy, while in group I in terms of significant changes were no observed (P > 0.05). A similar trend is occurring at the initial stage of humoral immunity, there is an increase of CD20+ lymphocytes in comparison with group I (P < 0.01), which was in a relative value of 19.5 ± 0.58 %.
There was positive dynamics of natural killer cells — CD16+ lymphocytes. Moreover, the difference in terms of CD16+ before and after treatment was significant in group II patients (P < 0.01), while in group I, these indices had no reliable trend (P > 0.05). After treatment in children treated with conventional therapy in combination polioksidony and Vitrum baby, (group III) observed activation of cellular immunity, as evidenced by the increase in the relative number of CD3+ lymphocytes, constituting 62.1 ± 1.8 %, a reliable performance against group I patients (P < 0.001). Subpopulation of CD4+ and CD8+ also increases after treatment in group III, in relation to the initial data (P < 0.001), and indicators of group II patients (P < 0.01). Subpopulations of lymphocytes bearing markers CD8+, also had positive dynamics under the influence of combined therapy, while in group II significant changes in performance was no observed. Accordingly, the immunoregulatory index in the group of patients who had receive differentiated treatment approaching the normal range, in contrast to the performance of IRI in group II, where it's remained consistently low. The IRI in patients with NoP after treatment was 1.8 ± 0.08 and 1.6 ± 0.04 respectively (P < 0.05). In group III patients who received differential treatment, the level of CD20+ lymphocytes decreased to 16.4 ± 0.9 %, whereas in group II after treatment it was 10.6 ± 0.8 % (P < 0.01). Differential treatment has had a positive effect on blood levels of natural killer cells — CD 16+ lymphocytes. The differences in CD 16+ before and after treatment was significant only in the group III patients (P < 0.01), while in group II patients these indices had no reliable differences (P>0.05). The positive impact of the complex therapy on the activity of humoral immunity in children their contents II and III groups, more significantly closer to standard indicators and it was 801.0 ± 20.0 mg., %; 1 mg. of 60.0 ± 5.0 %; 100.0 ± 5.0 mg., % and 990.0 ± 14.0 mg., %; 120.0 mg. ± 5.0 %; 121.0 mg. ± 6.0 % respectively, in contrast to the group I (from P < 0.05 and P < 0.01).
Analysis of the cytokine profile in differential treatment showed that children of groups II and III there is a decrease in IL- 1p and IL-4. Levels IL-1p decreased after treatment in both groups is on average 125.6 ± 10.5 pg/ml and 120.1 ± 9.6 pg/ml, respectively (P < 0.01; P < 0.001), while in group I, these indices had no reliable differences (P>0.05). The concentration of IL-4 in children groups II and III after the combined treatment was 70.1 ± 0.8 pg/ml and 69.4 ± 4.4 pg/ml, respectively, relative to the group I (P < 0.05). Thus, the differentiated treatments potentiate the efficacy of antibiotic treatment of NoP, so quickly normalize altered laboratory and immunological parameters of blood, reducing the number of bed days, reduced the risk of severe and protracted forms of adverse outcomes NoP.
References:
1. Белоусов Ю. Б. О создании российского национального формуляра по лечению основных заболеваний//Лечащий врач. - 1999. -№ 4. -С. 45-48.
2. Европейское руководство по клинической оценке противоинфекционных лекарственных средств/Под ред. T. R. Beam Jr., D. N. Gilberd, C. M. Kunin. Пер с анг. - Смоленск: Амипресс, 1996. - 320 с.
3. Гельфанд Б. Р., Гологорский В. А., Белоцерковский Б. З. Лечение нозокомиальной пневмонии, связанной с искусственной вентиляцией легких, у хирургических больных//Со^Шит medicum. - 2001. - № 3. - С. 62-64.
4. Сотников А. В., Попа А. В., Салтанов А. И. Нозокомиальные пневмонии в отделение реанимации и интенсивной терапии//Вест-ник интенсивной терапии. - 2011. - № 3. - С. 28-32.
