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Peculiarities of immunological indications changes in children ill with chronic bronchitis
4. Ищенко Т. В. Эффективность комплексного санаторно-курортного лечения больных хроническим бронхитом в условиях низкогорья в сочетании с применением иммуномодулятора ликопид, дисс... к. м.н. - М., - 2003. - 113 с.
5. Нестерова И. В., Малиновская В. В., Тараканов В. А., Ковалева С. В. Интрфероно- и иммунотерапия в практике лечения часто и длительно болеющих детей и взрослых. - М., - 2004. - 160 с.
6. Савельева В. В., Николенко Т. А. Влияние мексикора на диастолическую функцию левого желудочка больных хронической сердечной недостаточностью на фоне изометрической нагрузки//Нижегородский медицинский журнал. - 2006. - № 5. -С. 143-137.
7. Цыбенова Б. Ц., Кузник Б. И. Состояние иммунной системы у детей с хроническими воспалительными заболеваниями легких//Бюллетень ВСНЦ СО РАМН. - 2004. - № 2. - Том.1. - С. 281-286.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-83-85
Muhamadieva Lola, Samarkand State Medical Institute, PhD in medicine, department of pediatric disease E-mail: [email protected] Rustamova Gulnoza, Samarkand State Medical Institute, Assistant in medicine, department of pediatric disease E-mail: [email protected]
Peculiarities of immunological indications changes in children ill with chronic bronchitis
Abstract: 100 children with chronic bronchitis and 22 healthy children aged 3-15 years were enrolled in the study. Thus, the study of immune status in children with CB made it possible to reveal deep changes of T — cellular immunity chain as considerable decrease of the amount and functional activity of neutrophils that appears to be predetermining endogenic moment of development and progress of chronic bronchitis is children. The immune status was higher in the group of school — age children. Keywords: children, chronic pneumonia, immunological indicators, bronchitis, lymphocytes.
Urgency of problem. Chronic inflammatory diseases of the lungs are the actual pediatric problem as their frequency has been growing in recent years and clinical manifestation are characterized by severe course and early disability of patients [1; 10; 11]. The complexity of chronic bronchitis problem to a certain degree found its reflexion in International statistic classification of diseases and problems associated with health (the 10th WHO revision) where various variants of chronic bronchitis are listed: simple, mucopurulent, mixed, etc presenting difficulty in clinical distinction that causes certain complexity in every day practice [5; 9]. Impairment of drainage function of bronchi contributes to development of infections process with activity and recurrence depending to a considerable degree on local immunity of bronchi and development of secondary immunological insufficiency [3; 5]. Chronic bronchitis in children may be the manifestation of a whole number of other bronchopulmonary sufferings (acquired, hereditory, congenital) with their differentiation often presenting certain complexities [4; 5; 6; 7; 8; 12].
Among important factors in pathogenesis CB belongs to nonspecific and specific immune reactions. As for immune system the character, depth, duration of inflammation and immune response are regulated by means of cytokins [13].
General changes of children immunological status are probably connected with the fact that in all this pathology bronchopulmonary system is suffering. In deficiency of immunoregulatory cells, antigen -specific effectory reactions of humoral and cellular type develop with strengthening more than once, the level of antigen — specific lymphocytes directed not only against antigens causing the disease but against the pulmonary tissue itself is growing sharply. The decrease of T — suppressors function in various CNDL forms is a
key mechanism in the development of immunopathological reactions in various diseases in children [3; 5].
The aim of the research. To estimate immunological indicators in diagnosis of chronic bronchitis in children.
Material and methods of the research. 100 children with chronic bronchitis and 22 healthy children aged 3-15 years were enrolled in the study. The patients underwent the following medical research: estimation of T-lymphocytes and their subpopulations (CD3+, CD4+CD8+) number, natural killers (CD16+), B- lymphocytes (CD20+) by means of Gurary N. I. method (1981) [2]; concentration of serum immunoglobulin's A, G, M in the peripheral blood according to Manchini G. et al. method (1965);
Results and discussion.
As it is seen from Table I in children with CB changes in both cellular and humoral immunity system are noted. They have one- directed immunological shifts characterized by T- cellular immunodeficiency. Reliable decrease of leucocytes in both groups to 6482 ±320.0 and 5362±625.0, accordingly (p<0,001) is established in children with chronic bronchitis during the period of exacerbation of the disease.
Such indications as relative and absolute number of lymphocytes 32.1 ±0,2 and 31.8 ± 1.1 accordingly , decrease reliably compared to normal ones and there is no different nature between two groups.
As it is seen from the presented data in children with CB in the period of exacerbation of the disease the following deviations have been revealed: reliable decrease of T - lymphocytes (CD3+) (44.8±0.2% in children aged 7 -15 years and 49.1 ±0.3 % at the age of 3-6 years in 61.5±2.2% in practically healthy children, p< 0,001; p<0,001, their subpopulations: T- helpers (CD4+) (21.2±3.2% in children aged 7-15 years and 24.6±1.9% in children aged 3- 6 years; 39.2±2.1%
Section В. Medical science
in practically healthy children p<0,001; p<0,001; p< 0,001) and T- were more marked in the group aged 7-15 years compared to children
suppressors (CD8+) (15.7±0.4% in children under school age; 13.0 aged 3-6 years (p<0.01; p<0.001). in this category of patients T- cel-
±0.1% in school-age children, in 19.5±1.8% in practically healthy chil- lular immunodeficiency had hyposuppressive purposefulness, that
dren , p< 0.01, p<0.01. changing of CD3+CD4+CD8+ lymphocytes was confirmed by low level of F- suppressors.
Table 1. - Immunological indications of children with chronic bronchitis (M±m)
Analyzed indications Practically healthy children n=22 (I) Period of exacerbation of the disease P P1 P2
3-6 age n=38(II) 7-15 age n=62 (III)
Leucocytes, abs. 8540±421,0 б482±320,0 53б2±б25,0 <0,05 <0,001 <0,001
Lymphocytes, % 34,6±2,3 32,1±0,2 31,8±1,1 <0,05 <0,01 <0,01
Lymphocytes, abs. 2948±234,0 2080±432,0 1705±105,0 <0,05 <0,01 <0,01
CD3+, % 61,5± 2,2 49,1±0,3 44,8±0,2 <0,001 <0,001 <0,001
CD3+ abs 1676±193,0 1021±45,0 7б3±49,0 <0,001 <0,01 <0,01
CD4+ % 39,2±2,1 24,б±1,9 21,2±3,2 <0,001 <0,001 <0,001
CD4+ abs 1032±98,0 512±98,0 3б1±35,0 <0,05 <0,001 <0,001
CDS+, % 19,5±1,8 15,7±0,4 13,0±0,1 <0,01 <0,01 <0,001
CDS+, abs 595±75,0 493±19,2 473±38,0 <0,05 <0,01 <0,01
IIR (CD4/CDS) 2,0±0,2 1,б±0,3 1,б±0,5 >0,05 >0,05 >0,05
CD 16+,% 10,2±1,3 1б,8±1,7 19,7±2,1 <0,001 <0,001 <0,01
CD 16+, abs 278±32,0 349±11,0 335±11,0 <0,05 <0,05 <0,01
Phagocytosis, % 58,5±2,3 4б,4±1,2 43,7±0, 8 <0,001 <0,001 <0,01
CD20+ % 16,4±0,5 35,б±1,б 37,3±2,2 <0,001 <0,001 <0,01
CD20+ aoc. 774±97,0 б23±23,0 587±21,0 <0,01 <0,01 <0,05
IgG. Mg / % 938,3±17,6 1901,1±33,5 2118,2±40,7 <0,001 <0,001 <0,001
IgA mg / % 107,9±3,6 1б8,4±4,0 184,4±3,2 <0,001 <0,001 <0,01
IgM, mg, % 90,7±2,8 202,4±5,0 212,3±4,2 <0,001 <0,001 <0,05
CIC 1,01±0,1 1,31±0,1 1,42±0,1 <0,05 <0,001 <0,05
ASL, % 1,1±0,1 3,2±0,8 4,9±0,б <0,01 <0,01 <0,001
Note: P - reliability of differences between groups I and II;
P1 - reliability of differences between groups I and III;
P2 - reliability of differences between groups II and III.
IIR (CD4 /CD8 ) in both groups of patients was descreased to 13 times mainly due to the number CD4+of lymphocytes.
There was noted reliable increase of natural killers in comparison with practically healthy children - CD16+ - lymphocytes and makes 16,8 ± 1,7% in children aged 3 - 6 years and 19,7 ± 2,1 % at the age of7 - 15 years accordingly (10,2 ± 1,3 in practically healthy children; P< 0,001)
There was tendency to increase of B - lymphocytes (CD20+) in peripheral blood in absolute numbers to 623 ± 230 and 587 ±21,0 P < 0.001, P < 0.05. It was particularly marked in the group of elder children.
In the study of phagocytosis level we noted that phagocytosis in most children aged 3- 6 years with CB had been considerably decreased to46.4 ± 1.2% (within the norm of 58.5 ± 2.3, P< 0.001). It is known that immunoglobulin's of the blood serum are considered to be one of the main indications of humoral immunity. Entering the chain of immunological reactions, immunoglobulin's have a certain significance in CB pathogenesis. From the side of humoral immunity in children ill with CB there was noticed marked hypoimmunoglobulinemia, sharp increase of IgM level (202,4 ± 5.0mg/% and 212.3 ± 4.2mg/% against 90.7 ±
2.8 mg/% in practically healthy children, P<0.001), IgA and IgG levels increased more in the group of under - school age children (P<0.001) CIC concentration in children ill with CB was also much higher than in practically healthy children (1.32 ± 0.1 and 1.4 ± 0.1, P<0.01; P<0.05), that is the evidence of inflammatory process activity.
In children ill with chronic bronchitis ASL was revealed in the blood in the period of exacerbation that was the evidence of presence of autoimmune reaction. With this, ASL increased 4-5 times in a group of school age children and made 4.9±0.6% and 3.2±0.08% in comparison with practically healthy children (1.1 ± 0.1%, P<0.001; P<0.01).
Conclusion. Thus, the study of immune status in children with CB made it possible to reveal deep changes of T-cellular immunity chain as considerable decrease of the amount and functional activity of neutrophils that appears to be predetermining endogenic moment of development and progress of chronic bronchitis is children. The immune status was higher in the group of school - age children. Probably, the main disturbance in the work of immune system is caused by autoimmune process which in complex with inflammatory reactions destroys the organs and tissues.
References:
1. Бубнова Н.И. Хронические неспецифические заболевания легких у детей. //в кн. Клеточная биология легких в норме и при патологии (под редакцией Ерохина В.В., Романовой Л.К.) - М. - 2000. - С. 351-357.
Intrabronchial laser therapy in children with chronic bronchitis and chronic pneumonia
2. Гурарий Н.И. Количественный анализ Т- и В - лимфоцитов и их антиген связывающих субпопуляций у здоровых и больных пневмонией детей.//Автореф. дисс... канд. мед.наук.- Самарканд. - 1981. - 23 с.
3. Калуцский П.В., Шварцкопф Е.С., Окушко Р.В. //Педиатрия. - 2011. - 90. - №1. - С. 124-126.
4. Капранов Н.И. Фармакотерапия при бронхолегочных поражениях у детей, больных муковисцидозом: // Руководство по фармакотерапии в педиатрии и детской хирургии. - М. - 2002. - 267 с.
5. Кушелевская О.В., Зубкова И.В., Сенцова Т.Б. Частота микоплазменной и хламидийной инфекции у детей с врожденными пороками развития легких и бронхов. //Вопросы совр. педиатрии. - 2006. - Т. 5. - №1. - С. 321.
6. Латыпова Ш.А. Роль NO-ергической системы в формировании рецидивирующих форм бронхитов у детей и принципы их лечения. // Автореф. дисс... канд.. мед.наук. - Ташкент, - 2011.
7. Палеев Н.Р., Ильченко В.А. Хронический бронхит. //Болезни органов дыхания. //В кн. "Руководство по внутренним болезням" (под редакцией Палеева Н.Р.) - М. -Медицина. - 2000.-287 с.
8. Рачинский С.В., Таточенко В.К, Волков И.Б. Место хронической пневмонии и хронического бронхита в бронхолегочной патологии у детей. //Педиатрия. - 2004. - №1. - С. 58-66.
9. Резолюция конгресса XIV конгресса Педиатров России с международным участием "Актуальные проблемы педиатрии» // Российский педиатрический журнал. - 2010. - №3. - С. 61.
10. Розинова Н.Н. «Трудный пациент» Клинические формы хронических воспалительных заболеваний лёгких у детей: критерии диагностики и принципы терапии. - Архив. - № 10. - 2007.
11. Шамсиев Ф.М., Каримов УА., Азизова Н.Д. Структура заболеваемости органов дыхания в регионах республики. //Вестник врача общего профиля. - Самарканд. - 2004. - №4. (32) - С. 113-115.
12. Dombi V.H., Walt H., Primary ciliary dyskinesia, immotile cilia Syndrome, and Kartagener Syndrome: diagnostic criteria. //Schweizerische Medizinisch Wochenschrift. J. Suisse de Med. - 1996. - V.126. - Nil. - P. 421-433.
13. Kitz R. Immunoglobulin levels in bronchoalveolar lavage fluid of children with chronic chest disease. //Pediat. Pulmon. - 2000.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-85-86
Muhamadieva Lola, Samarkand State Medical Institute, PhD in medicine, department of pediatric disease E-mail: [email protected] Rustamova Gulnoza, Samarkand State Medical Institute, Assistant in medicine, department of pediatric disease E-mail: [email protected]
Intrabronchial laser therapy in children with chronic bronchitis and chronic pneumonia
Abstract: The observation studied 29 children with purulent endobronchitis at the age from 1 to 13 years old. Among them-there were 17 boys and 12 girls. 9 of children had recurrent bronchitis, 10 children bad chronic pneumonia, and 10 children were with foreign bodies II the bronchus. The results obtained after treatment in children with CB receiving laser therapy show reliable decrease of neutrophils number to 73,1±3,5 in comparison with the data before treatment-90,4±6,3 (p<0,01). The number of alveolar macrophages increases to 15,1±3,1 in comparison with the data before treatment -2,8±0,1 (p<0,01), the amount of cytosis decreases in comparison with the data before treatment 6,9±1,2 (p<0,01). Keywords: children, chronic bronchitis, chronic pneumonia, laser therapy.
Intrabronchial inflammatory lung diseases are considered to be 17 boys and 12 girls. 9 of children had recurrent bronchitis, 10 chil-an actual pediatric problem as their frequency increases in recent dren bad chronic pneumonia, and 10 children were with foreign years and clinical manifestations are characterized by severe course bodies II the bronchus.
and early disability of patients (2-6). The lung washing out (lavage) of 10 children with urolithia-
Treatment of nonspecific lung diseases (NLD) is provided with sis served as a model ofbconchoalveolar-lavage fluid (BALF) in traditional sanation bronchoscopy with use of different medications "healthy lung".
(antibiotics, steroids, enzymes, etc.) (1,7-9). For the treatment of The children had not pathology of the respiratory tract, the
purulent endobronchitis in NLD it is also used helium-neon laser. lavage was taken during the surgical operation through the intuba-The aim of the presented investigation was the improvement tion tube. In the comparison group there were children with chronic of the treatment results of the purulent endobronchitis in children pneumonia, recurrent bronchitis and foreign bodies of the bronchus. with nonspecific lung diseases with intrabonchial use of gallium- These children receivedtraditional therapy, during their bron-
arsenide laser. choscopy it was not used laserotherapy. In order to perform endo-
The observation studied 29 children with purulent endobron- bronchial laser irradiation it was used low-intensive semi-conduct-chitis at the age from 1 to 13 years old. Among them-there were ing laseronthe gallium-arsenide base (ALT "Sogdiana", Uzbekistan),
