CC BY
16UDC 612.017.1:616.248]-053.6.7
Shumko Halyna Ivanivna,
Ph.D., Associate Professor of the Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases, Higher State Educational Establishment of Ukraine "Bukowinian State Medical University",
Chernivtsi, Ukraine Shuper Vira Olexandrivna,
Ph.D., Associate Professor of the Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases, Higher State Educational Establishment of Ukraine "Bukowinian State Medical University",
Chernivtsi, Ukraine Trefanenko Iryna Valentinivna
Ph.D., Associate Professor of the Department of Internal Medicine, Clinical Pharmacology and Occupational Diseases, Higher State Educational Establishment of Ukraine "Bukowinian State Medical University",
Chernivtsi, Ukraine DOI: 10.24411/2520-6990-2019-10469 SELECTED INDICATORS OF CYTOKIN PROFILE IN YOUNG PATIENTS WITH BRONCHIAL
ASTHMA
Abstract
In present work we studied the state of individual indicators of the cytokine profile in young patients with bronchial asthma. The increase in the content of interleukin-1ß, tumor necrosis factor-a and immunoglobulin E in the blood we detected. The factor contributing to the progression of bronchial asthma was the violation of the cytokine profile due to the growth of interleukin-1ß, tumor necrosis factor-a, which is accompanied by the increase in the content in blood immunoglobulin E.
Key words: bronchial asthma, young age, interleukin-1ß, tumor necrosis factor-a, immunoglobulin E.
Topicality. An effector cells and cytokines play the important role in the development and progression of bronchial asthma (BA), as well as in the maintaining of inflammation and formation of hyperreactivity of bronchi. Pathochemical and pathophysiological changes occurring in patients with asthma lead to activation of the system of cytokines, which contribute to different cellular responses and participate in the immune and inflammatory processes [1, 3, 6, 9].
Antigen, entering the body, activates macrophages and secretion of number of mediators, including inter-leukin-ip (IL-ip), which stimulates the proliferation of T-cells and becomes the main mediator of the development of local inflammatory reactions in any type of inflammation. IL-ip promotes the differentiation of "zero" T- helpers into T- helpers of the first and second class. The highest stimulatory activity of IL-ip in patients with atopy associates with T-helpers of the 2-nd grade, which produces IL-4, causing hyperproduction of immunoglobulin E (Ig E) [2, 4, 7].
As it is known, cytokine-mediated Ig E hyperpro-duction plays an important role in the pathogenesis of the immune stage of atopic inflammation. Ig E, according to literature, is the main pathogenic link in the mechanism of development of various atopic inflammatory reactions, including inflammation of the bronchi in most forms of asthma [1, 5, 7].
In parallel with the activation of the macrophage level of the immunity, the antigen and Ig E-antibody interaction, fixed on the membrane of mast cells, leads to the activation of the synthesis of inflammatory mediators, including the tumor necrosis factor-a (TNF-a), which activity is close IL -ip. In atopic inflammation, TNF-a controls the degree of infiltration of the bronchial wall by neutrophil granulocytes, participates in the regulation of the expression of adhesion of molecules responsible for the selective adhesion of eosinophils in the inflammatory site, so, it is the mediator responsible for the development of the late phase of the
atopic reaction. It is believed that TNF-a is responsible for the chronization of atopic inflammation [2, 7, 8].
In patients with asthma, a complex determination of serum levels of IL-ip, TNF-a and Ig E may become a marker of severity and systemicity of inflammatory response, which determines the severity of the attack and the aggravation of the disease.
The aim of the study was the investigation of the status of cytokine profile indicators of patients with bronchial asthma.
Material and methods. We examined 76 patients with atopic and mixed with predominance of atopic asthma. The control group consisted of 14 practically healthy persons without acute or exacerbation of chronic diseases and allergic history. The patients, depending on the diagnosis, were divided into two groups: I group (36 people) - patients with asthma with intermittent BA, II group (40 persons) - patients with asthma with mild persistent BA.
To study the changes in the proinflammatory potential of cytokines, the plasma IL-ip level was determined using a set of reagents ProConIL-ip, Protein Contour (Russia). Plasma TNF-a level was detected, using a set of a-TNF-IFA-Best JSC "Vector-Best" (Russia) by immunoassay. The level of total Ig E was determined using the reagent kit of the Chem-Medica Ltd (Russia) by immunoassay.
Studies conducted using the "case-control" method and corresponded to the bioethical aspects of medical research. The statistical analysis of the obtained results were carried out by the method of variation statistics with the definition of the average (M), the average error (m), with the subsequent assessment of the reliability of differences using the Student's criterion by the computer program Excel, Statistics. The critical level of significance of differences was if p <0,05.
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Results of the research and their discussion.
The results of the study of contents of plasma IL-ip, TNF-a and Ig E are presented in Table 1.
Table 1
The content of interleukin-1ß, tumor necrosis factor-a and immunoglobulin E in plasma of young people __with bronchial asthma (M ± m)__
Groups IL-1ß, pcg / ml TNF-a, pg / ml Ig E, MO / ml
Healthy 40,36 + 2,72 2,28 + 0,14 51,61 + 5,2
(n = 14)
I group 79,32 + 1,79 6,22 + 0,15 136,56 + 1,81
(n = 36) p < 0,001 p < 0,001 p < 0,001
(n = 34) (n = 34) (n = 36)
II group 109,11 + 2,37 10,25 + 0,32 209,03 + 2,56
(n = 40) p < 0,001 p < 0,001 p < 0,001
P1 < 0,001 P1 < 0,001 p: < 0,001
(n = 36) (n = 36) (n = 40)
Notes: 1. p - is the reliability of difference of indicators in comparison with a group of practically healthy persons; 2. pi - is the reliability of difference of the indicators between patients of groups I and II.
Analysis of the data shows significant deviations from the norm in the examined patients.
Thus, the content in the plasma of IL-ip in the 1st and 2nd groups of the subjects was higher in comparison with practically healthy subjects, respectively, in 2 and 2.7 times (p <0.001). In addition, the significant reliable difference (37.6% (p <0.001)) was found between the patients from groups I and II, indicating the prominent activation of the proinflammatory cytokines system with the progression of the pathological process.
In patients of group I, TNF-a was in 2.7 times higher than that of practically healthy subjects (p < 0.001). In patients of group II, this indicator was significantly higher (in 4.5 times) compared to the group of practically healthy persons (p < 0.001) and in 1.6 times higher compared with patients from group I (p < 0.001). These changes indicate the significant inflammatory process in asthma patients, especially with progression of the disease severity.
The content in plasma Ig E blood was significantly higher of the predicted in all examined groups (see Table 1). Thus, in I and II groups of patients, Ig E level was higher, respectively, in 2.6 and 4.1 times (p <0.001), compared with practically healthy persons. In addition, the difference between the patients of I and II groups was detected of 1.5 times (p < 0.001). Results show, that in all patients atopic signs were observed, which are manifested in the increasing of the total Ig E plasma content, especially in patients with persistent asthma.
Thus, in patients with asthma, the activation of investigated cytokines and cytokine-mediated hyperpro-duction of Ig E plays an important role in the pathogen-esis of the immune stage of atopic inflammation, supports and promotes the progression of bronchial hyperresponsiveness. The most significant changes were found in patients with the mild persistent asthma. This indicates progression of the pathological process by the increase of activity of the cytokines' system and Ig E hyperproduction. Therefore, it would be advisable to make correction of the detected changes as soon as possible in order to prevent the progression of the pathological process.
Conclusions. 1. In patients with bronchial asthma, the content of interleukin-1p in the blood, tumor necrosis factor-a and immunoglobulin E definitely increase.
2. Factors, contributing to the progression of bronchial asthma, are the impairment of the immunocyto-kine profile due to increase in the level of interleukin-1 P, tumor necrosis factor-a, which are accompanied by the immunoglobulin E level increase.
Prospects for further research. The prospective may become the further expansion of research on the state of other cytokine profile's indicators in patients with bronchial asthma and the correction of the revealed changes in order to prevent the progression of the pathological process.
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