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9MICROBIAL AND TISSUE HYPERSENSITIVITY AS A BASIC PATHOGENETIC COMPONENT OF GENERALIZED PARODONTAL DISEASES IN PATIENTS WITH ANOREXIA NERVOSA
Reshetnyk L.,
Department of Dentistry, Institute of Postgraduate Education Bogomolets National Medical University, PhD student
Antonenko M.,
Head of Department of Dentistry, Institute of Postgraduate Education, Bogomolets National Medical University
Zelinskaya N.
Department of Dentistry, Institute of Postgraduate Education Bogomolets National Medical University, associate professor
Abstract
Generalized periodontal disease (GPD) invariably occupy one of the leading places in the structure of dental diseases. One of the most difficult is the diagnosis of the initial degree of generalized periodontitis, because this is one of the most important factors that determine the adequacy of the treatment algorithm already at the early stages of the development of the disease with further prevention of the rapid progression of the pathological process in the periodontal complex. It is especially difficult to make a diagnosis in the early stages of GPD development in patients with anorexia nervosa (AN), which is due to the absence of pronounced subjective indicators, objective clinical manifestations in this category of individuals and the difficulty of interpreting the obtained X-ray data due to the superposition of systemic changes in the bone tissue, including alveolar process with this pathology. Consideration of the relationship of delayed-type hypersensitivity to microbial antigens and tissue sensitization in patients with GPD in AN was considered important.
Aim. To establish the frequency of hygienic status of the oral cavity and to determine the frequency of de-layed-type hypersensitivity to microbial antigens and tissue sensitization in patients with generalized parodontal diseases, associated with anorexia nervosa.
Materials and methods. Methods - clinical, radiological, hygienic (PMA, Green-Vermillon index and GI bleeding index), microbiological, statistical, evaluation of tissue sensitization to bone antigen was determined in the reaction of inhibition of leukocyte migration (RILM). Materials. The main - (Mi) group consisted of 13 patients with generalized chronic catarrhal gingivitis (GCCG) with AN; the M2 subgroup included 45 people with generalized parodontitis (GP), I-II degree, chronic course of AN. The comparative (Ci) group consisted of 41 people with GCCG without underlying pathology, and the C2 subgroup included 12 people with GP, I-II degree, chronic course without AN. Control group - 30 practically healthy persons without pathology from internal organs and systems and with intact parodont.
Results. It was found that the highest number of patients with unsatisfactory oral hygiene was observed in patients with GP, I-II degree, chronic course and AN - M2 <Mi<Ci <C2. The lowest percentage of patients with satisfactory oral hygiene was observed in patients with GPD in AN, the same tendency was observed in patients with GP, I-II degree, chronic course - Mi <Ci <C2 <M2. The expressed degree of tissue sensitization to bone antigen in the vast majority of patients with GP, initial-I, degree, with AN (61.0±5.72%), which is directly dependent on the nature of the course, and can be considered as an indicative pathognomonic factor in differential diagnosis of GP, primary-I degree and GCCG.
Conclusions. Thus, hygienic condition of the oral cavity and the frequency of delayed-type hypersensitivity to microbial antigens in patients with generalized parodontal diseases, associated with anorexia nervosa was established. Established tissue sensitization to bone antigen in patients with GP associated with AN may serve as a prognostic test for the course of GP and affect the effectiveness of pathogenetic treatment.
Keywords: generalized parodontal diseases, microbial antigens, oral cavity, anorexia nervosa, hygienic condition, delayed-type hypersensitivity.
Despite the increase in dental culture of the population, which has been trending lately and prompts the early treatment of patients, the result of treatment of generalized parodontal diseases (GPD) is often unsatisfactory [i, 2, 3, 4, 5]. This is due to some extent because of the complexity of understanding the etio-pathoge-netic mechanisms of development of these diseases, and the high association of GPD with a number of diseases of the internal organs and systems, including anorexia nervosa (AN), with common points of contact between interdependence and mutual influence [6, 7, 8].
According to native and foreign authors, the prevalence of AN ranges from 0.3% to 5% among both sexes, and the incidence varies from 5 to 5.4 on i00,000
people per year, the mortality rate reaches 18% and tends to increase in young people [9, 10, 11].
Anorexia nervosa is accompanied by changes in the internal organs and body systems of a person and may be one of the potentiating factors for the occurrence of GPD, particularly, generalized periodontitis (GP) [12, 13].
Scientific works reflecting the hygienic condition of the oral cavity in patients with GPD on the background of anorexia nervosa are not represented.
Despite the presence of more than 1000 species of microorganisms, the hemolytic and green streptococcus and staphylococcus, which play a key role in the initiation of allergy, should be noted [14, 15].
The study of microbial sensitization is of particular importance due to the fact that microorganisms of parodontal focus are not only a powerful antigenic stimulus that affects the formation of the immune response of specific and nonspecific resistance factors, but also the presence of similar and cross-antigens in streptococcus with connective tissue of the parodontal complex, including alveolar process, could help reduce tissue hypersensitivity to bone antigen [16].
There are only single publications in the literature about tissue sensitization in patients with GPD and AN.
Consideration of the relationship of delayed-type hypersensitivity to microbial antigens and tissue sensitization in patients with GPD and AN was considered important.
The aim of the research was to establish the frequency of hygienic status of the oral cavity and to determine the frequency of delayed-type hypersensitivity to microbial antigens and tissue sensitization in patients with generalized parodontal diseases, associated with anorexia nervosa.
Materials and methods. The main - (Mi) group consisted of 13 patients with generalized chronic ca-tarrhal gingivitis (GCCG) with anorexia nervosa (AN) and 2 patients with generalized catarrhal gingivitis (GCG) aggravation course with AN; the M2 subgroup included 45 people with generalized parodontitis (GP), I-II degree, chronic course of AN and 3 people with GP, I-II degree, aggravation course with AN.
The comparative (C1) group consisted of 41 people with GCCG without underlying pathology and 7 people with GCG aggravation course without AN, and the C2 subgroup included 12 people with GP, I-II degree, chronic course without AN and 7 people with GP, I-II degree, aggravation course without AN.
30 practically healthy persons without pathology from internal organs and systems and with intact paro-dont were in the control group.
Methods - clinical (according to the systematics of parodontal diseases after M.F. Danilevsky, 1994), radiological, microbiological (the reaction of inhibition of leukocyte migration - RILM), hygienic (PMA, Green-Vermillona index and GI bleeding index) and statistical (SPSS STATISTICA 6.0 and MS Excel 2010 (license number K9366093I 2016) were used. Statistical analysis of the data included the calculation of mean values, standard deviation, and mean error).
Evaluation of tissue sensitization to bone antigen was determined in the reaction of inhibition of leukocyte migration (RILM). In the RILM reaction, an aqueous-salt extract of bone tissue of group 0 (I) Rh (D) was used. The migration index was calculated by the formula:
j-^- _ area of migration with antigen
area of migration without antigen'
where MI, equal to 0.1-0.5, corresponded to a high degree of sensitization. The reaction was recorded 24 hours after blood collection.
The use of RILM was due to its high specificity and informativeness. It is included in the list of reactions recommended by the WHO. Given that the reaction takes place outside the body (in vitro), conditions are created for multiple examination of the patient for diagnosis and treatment.
The research was carried out in compliance with the principles of bioethics and the rights of the patient in accordance with the Helsinki Declaration (2000) and the Fundamentals of Ukrainian legislation on health care (1992).
The results of research. To determine the role and place of oral hygiene in patients with GPD and AN, it was considered appropriate to analyze the data in patients with satisfactory and unsatisfactory oral health.
Data of the hygienic condition of the oral cavity in patients with GPD and AN are presented in fig. 1, 2.
90 80 70 60 50 40 30 20 10
I PMA
Green-Vermillion GI
Patients with Patients with Patients with Patients with Practically GCCG+AN GCCG without GP, I-II degree,GP, I-II degree, healthy AN chronic chronic course
course+AN without AN
0
Fig. 1 - Frequency of unsatisfactory condition of the oral cavity in patients with GPD and AN.
Fig. 2
Frequency of satisfactory condition of the oral cavity in patients with GPD without underlying pathology AN.
45 40 35 30 25 20 15 10 5 0
I PMA Green-Vermillion GI
Patients with Patients with Patients with Patients with Practically GCCG +AN GCCG withoutGP, I-II degree,GP, I-II degree, healthy AN chronic coursechronic course + AN without AN
As a result of the research, we found that the highest percentage of unsatisfactory oral hygiene in its indicators (PMA, Green-Vermillona index and GI bleeding index) was generally observed in the group of patients with GPD and AN and was 68-83+1.1, 65-77+1.5, 6979 +1.3% respectively.
Detailing indices of unsatisfactory oral hygiene in the main (M1 - patients with GCCG with AN) and comparative groups (C1 - patients with GPD without basic pathology), no significant differences were found between the hygiene indices (fig. 1).
The final analysis of the frequency of unsatisfactory oral hygiene in patients with both main M2 and comparative groups C2 with GP, I-II degree, chronic course was significantly different from these parameters in patients in M1, C1 subgroups (fig. 1). It should be noted that the most significant changes were observed in patients affiliated with basic pathology and amounted to 83+2,3, 77+3,1, 79+1,8%, respectively.
Indicators of the frequency of unsatisfactory oral hygiene in the control group differed significantly in the main (M1, M2 subgroups) and comparative (C1, C2 subgroups) groups and were in terms of PMA, Green-Vermillon and bleeding index GI 10+1,3, 9 +1.5, 8+1.2%, respectively (fig. 1).
Data on the frequency of satisfactory condition of the oral cavity in patients with GPG are presented in fig. 2.
It was found that the highest percentage of patients with satisfactory oral hygiene was noted in the C1 subgroup (patients with GCCG), while in patients with the
Mi subgroup (patients with GCCG with AN), this proportion was significantly lower. Thus, according to PMA, Green-Vermillona index and GI bleeding index, this frequency in the Ci group was 35+1.9, 39+2.3, 41+1.8%, respectively, while in patients of the O1 group it was determined in 32+2,1, 35+1,7, 31+1,3% of cases.
It was noted that the lowest percentage of people with satisfactory oral health was observed in the M2 group (fig. 2).
Indicators of the frequency of satisfactory oral hygiene in the control group were significantly different from those in the main (M - patients with GPD with AN), and in the comparative (C - patients with GPD without underlying pathology) groups and were in terms of PMA, Green-Vermillon and GI bleeding index 3+1.9, 2+1.5, 1+1.6%, respectively (fig. 2).
Thus, it was found that the highest number of patients with unsatisfactory oral hygiene was observed in patients with GP, I-II degree, chronic course and AN -M2 <M1<C1 <C2.
The lowest percentage of patients with satisfactory oral hygiene was observed in patients with GPD in AN, the same tendency was observed in patients with GP, III degree, chronic course - M1 <C1 <C2 <M2.
The aim of our research was also to determine microbial allergy in patients with generalized periodontal disease with anorexia nervosa.
The results of immunological research in individuals of different groups are presented in the table 1.
Table 1
Frequency of microbial allergy in patients with generalized parodontal diseases with anorexia nervosa
Groups of patients The form of the disease Character of the Number of Microbial allergy, (RILM), % patients
course patients to streptococcus to staphylococcus
s 1 Generalized catarrhal gingivitis + AN (M1) Chronic Aggravation 13 2 69,2+12,8 P<0,01 0 P>0,05 46,2+13,8 P<0,01 100 P>0,05
H GP, I - II degree + AN (M2) Chronic Aggravation 45 3 95,6+3,1 P<0,01 33,3+27,2 P>0,05 46,7+7,4 P<0,01 100 P>0,05
<D iv iatr Generalized catarrhal gingivitis without AN (C1) Chronic Aggravation 41 7 46,3+7,8 P<0,01 71,4+17,1 P>0,05 31,7+7,3 P<0,01 42,9+18,7 P>0,05
t o O GP, I - II degree without AN (C2) Chronic Aggravation 12 5 75+12,5 P<0,01 80+17,9 P>0,05 33,3+13,6 P<0,01 100 P>0,05
Control Practically healthy 30 3 10+5,5 P>0,05 0 P>0,05
* 0,1-0,5 - high level of sensitization
As can be seen from the table, the response of inhibition of leukocyte migration (RILM) to the microbial streptococcal antigen in patients with GPD of different course with AN was generally found in 84.1+4.6% of patients.
Analyzing the data obtained, patients in M1 and M2 subgroups with chronic course showed microbial sensitization to streptococcus antigen in 69.2+12.8% and 95.6+3.1% of patients, respectively, at that time in comparative group Ci and C2 with chronic course mi-crobial sensitization to streptococcus antigen was significantly lower and was found in 46.3+7.8% and 75+12.5% of patients, respectively.
In practically healthy people sensitization to streptococcus antigen was detected in only 10+5.5% of the examined.
In the analysis of RILM with the microbial antigen of staphylococcus, pronounced sensitization was revealed in patients with different course of GPD with AN in general in 50,8+6,3% of the examined.
In the analysis of the data obtained in different subgroups, microbial allergy to staphylococcus antigen in patients M1 and M2 subgroups with chronic course was found in 46.2+13.8% and 46.7+7.4%, respectively, while in C1 and C2 chronic subgroups, these indicators were 31.7+7.3% and 33.3+13.6%, respectively.
It should be noted that the expressed sensitization to the microbial antigen of staphylococcus in the group of practically healthy persons was in no case established.
In addition to determining the hypersensitivity of the delayed type to microbial antigens, we conducted an additional analysis regarding the presence of mono-or diallergy.
As a result of the conducted immunological research, we revealed a pronounced microbial diarrhea in 34.2+6.3% of patients of the Mi subgroup, while in the M2 subgroup it was 41+4.5%. In patients of Ci subgroup, the diallergy was in no case established unlike the patients of C2 subgroup, where it was 33.3+13.6%.
It is appropriate to emphasize that the diallergy did not occur at all in healthy persons.
Note, that in all patients with simultaneous sensitization, there was a profound pathological process (II-III stages of AN), a long duration of underlying pathology (9-12 years) and a long course of GPD.
It was established that microbial sensitization to streptococcus antigen in patients of Mi subgroup (patients with generalized catarrhal gingivitis with aggravation who suffered AN) was not observed in any case unlike patients with Ci subgroup (patients with GCG aggravation course of disease without underling pathology) was found in 71.4+17.1%.
In the analysis of the data obtained in patients of subgroup M2 (patients with GP, I-II degree, aggravation course with AN) microbial sensitization to streptococcus antigen was found in 33.3+27.2% (p> 0.05), while in patients of C2 subgroup (patients with GP, I-II degree, acute course without underlying pathology) it was observed in 80+17,9%.
As a result of the research, all patients of M1, M2, C2 subgroup had pronounced microbial sensitization to staphylococcus antigen (p> 0.05), while in patients of subgroup C1 it was detected only in 42.9+18.7%.
Data on the degree of tissue sensitization to bone antigen in patients of the main, comparative and control groups are given in table 2.
Table 2
Frequency of tissue sensitization to bone antigen in generalized parodontitis and generalized chronic catarrhal __gingivitis in the main, comparative and control groups_
Groups of examined patients Diagnosis Tissue allergy
Number of examined Bone antigen, (RGML) *
Main group GCCG + AN 13 23,1±11,7
GP, initial-I degree, chronic course + AN 12 61,0±5,72
GP, I-II degree, chronic course + AN 45 89,4±4,84
Comparative group GCCG without AN 37 0
GP, initial-I degree, chronic course without AN 10 58,3±5,27
GP, I-II degree, chronic course without AN 12 85,8±5,74
Control group Almost healthy 30 0
* -% of positive reactions
Conclusions.
* Thus, in a result of our research, the highest number of patients with unsatisfactory oral hygiene was observed in patients with GPD associated with AN.
* It was found that the highest number of patients with unsatisfactory oral hygiene was observed in patients with GP, I-II degree, chronic course and AN - M2 <Mi<Ci <C2.
* The lowest percentage of patients with satisfactory oral hygiene was observed in patients with GPD and AN, the same tendency was observed in patients with GP, I-II degree, chronic course - Mi <Ci <C2 <M2.
* The expressed degree of tissue sensitization to bone antigen in the vast majority of patients with GP, initial-I, degree, with AN (61.0±5.72%), which is directly dependent on the nature of the course, and can be considered as an indicative pathognomonic factor in differential diagnosis of GP, primary-I degree and GCCG.
* Established tissue sensitization to bone antigen in patients with GP associated with AN may serve as a prognostic test for the course of GP and affect the effectiveness of pathogenetic treatment.
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СТРУКТУРНО-ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ СОННЫХ АРТЕРИЙ ПРИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У ЛИЦ ПОЖИЛОГО ВОЗРАСТА
Цой Л.Г.
Старший преподаватель кафедры терапии, ГОУ ВПО Кыргызско-Российский Славянский университет,
г. Бишкек, Кыргызстан ORCID: 0000-0001-6116-2933
STRUCTURAL AND FUNCTIONAL STATE OF THE CAROTID ARTERIES IN CHRONIC HEART
FAILURE IN THE ELDERLY
Tsoi L.
Senior teacher of chair of therapy Faculty of Medicine of Kyrgyz Russian Slavic University,
Bishkek, Kyrgyzstan ORCID: 0000-0001-6116-2933
Аннотация
Ригидность магистральных артерий является одним из важнейших компонентов формирования и про-грессирования сердечной недостаточности. Состояние жесткости аорты обладает независимым прогностическим значением в отношении фатальных и нефатальных сердечно-сосудистых заболеваний (ССЗ) [21,27] и сахарным диабетом 2 типа (СД2) [17]. При этом установлена способность показателей жесткости аорты предсказывать, что неблагоприятные события (сердечно-сосудистые осложнения и летальность) выше у пациентов с исходно высоким сердечно-сосудистым риском (ССР) (с ишемической болезнью сердца (ИБС), артериальной гипертензией (АГ), СД2, метаболическим синдромом [9], заболеваниями почек [6,7], цереброваскулярными заболеваниями [23]) чем в общей популяции [27]. В ряде клинических исследований была также продемонстрирована прогностическая значимость показателей жесткости общих сонных артерий (ОСА) в различных группах пациентов, в том числе с СД2 [18], с хронической болезнью почек (ХБП) [6,7,13]. В исследовании SMART (Second Manifestations of ARTerial disease) было отмечено, что увеличение показателей жесткости и толщины интима-медиа (ТИМ) ОСА является маркером ССР как у пациентов с факторами риска ССЗ (в том числе с СД2), так и у пациентов с уже имеющимися ССЗ (атеросклеротическим поражением периферических артерий, АГ) [26]. В обзорной статье представлены данные научных исследований по изучению взаимосвязи состояния магистральных артерий, в частности сонных, при хронической сердечной недостаточности у больных пожилого возраста.
Abstract
The rigidity of the main arteries is one of the most important components of the formation and progression of heart failure. The state of aortic stiffness has an independent prognostic value in relation to fatal and nonfatal cardiovascular diseases (CVD) [21,27] and type 2 diabetes mellitus (DM2) [17]. At the same time, the ability of aortic stiffness indicators to predict that adverse events (cardiovascular complications and mortality) are higher in patients with an initially high cardiovascular risk (CVR) (with ischemic heart disease (IHD), arterial hypertension (AH), DM2, metabolic syndrome [9], kidney disease [6,7], cerebrovascular diseases [23]) than in the general population [27]. A number of clinical studies have also demonstrated the prognostic significance of common carotid artery stiffness (CCA) indicators in various groups of patients, including those with type 2 diabetes [18], with chronic kidney disease (CKD) [6,7,13]. In the SMART (Second Manifestations of ARTerial disease) study, it was noted that an increase in intima-media stiffness and thickness (TIM) of CCA is a marker of CVD in patients with risk factors for cardiovascular diseases (CVD) (including type 2 diabetes), and in patients with pre-existing CVD (atherosclerotic lesions of peripheral arteries, AH) [26]. The review article presents data from scientific research on the relationship between the state of the main arteries, in particular the carotid ones, in chronic heart failure in elderly patients.
Ключевые слова: хроническая сердечная недостаточность, сонные артерии, жесткость сосудов, пожилой возраст.
Keywords: chronic heart failure, carotid arteries, vascular stiffness, old age.
