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The influence of gastroesophageal reflux disease comorbidity on biochemical markers, data of ambulatory blood...
2. When plegia and violations of the pelvic conducted early 3. The use of titanium mesh Cage — piramesh provides
surgery to decompress the spinal cord holds the best results. good immobilisation of the operated segment and enables early
activation of patients.
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Fadieienko Galyna Dmytrivna, SE «National Institute for Therapy named after LT Malaya NAMS of Ukraine», D. med.sci., Professor, E-mail: info@therapy.gov.ua Gridnyev Oleksiy Ievgeniovych, SE «National Institute for Therapy named after LT Malaya NAMS of Ukraine», PhD, Senior Researcher, E-mail: alex-gridnev@yandex.ru
The influence of gastroesophageal reflux disease comorbidity on biochemical markers, data of ambulatory blood pressure monitoring and echocardioscopy in patients with hypertension
Abstract: The article presents the characteristics of biochemical parameters, data of daily profile of blood pressure and echocardioscopy in patients with comorbidity of gastroesophageal reflux disease and hypertension. Particular attention is paid to the characteristics of the "lipid peroxidation-antioxidant protection."
Keywords: gastroesophageal reflux disease, hypertension, ambulatory blood pressure monitoring, echocardioscopy, lipid profile, lipid peroxidation, apelin.
The features of the disease in case of comorbid pathologies are in the epicenter of the problems in modern medicine [1, 102107]. Hypertension is one of the most common non-communicable diseases in countries with high economic level, and one of the major risk factors for cardiovascular diseases [2, 5-7].
In addition, special attention is paid to the study of gastroesophageal reflux disease (GERD). In 1998 GERD has been included in the «five» diseases with the greatest degree of reducing of the quality of life in patients. According to recent reports 40% of US adults and up to 10-25% in Europe suffer from the primary symptom of GERD — heartburn [3, 323-331]. According to numerous population-based studies, GERD is common with prevalence also in developed countries (10-20%) [4, 1-37].
The combination of hypertension and GERD is a frequent situation [5, 155-162], first of all, it is explained by not only their prevalence, but also by common risk factors of these diseases:
psycho-emotional stress, smoking, alcohol abuse, irrational eating with increased consumption of saturated fats, refined carbohydrates, insufficient consumption of micronutrients, obesity, physical inactivity, etc. Thus, the study Moraes-Filho JP et al. (2009) hypertension was detected in 29% of patients from non-erosive reflux disease group and 20.6% of patients with erosive reflux disease [6, 785790]. In connection with the above the study of pathogenetic links and features of the mutual influence of these two diseases is very topical.
The purpose of research is to study the effect of concomitant GERD on data of blood pressure profile, echocardioscopy, lipid profile, apelin level and condition of the system "lipid peroxidation-antioxidant protection" for persons suffering from hypertension.
The study was performed at the GI "The National Institute of Therapy named after LT Malaya of National Academy of Medical Sciences of Ukraine".
Methods of research
The study enrolled 126 patients with a combination of essential hypertension II stage 1-3 degrees and GERD (1st group) and 95 patients with isolated hypertension (2nd group). The control group consisted of 20 healthy individuals.
Determination of the stage and degree of hypertension and risk stratification for prognosis were performed according to clinical guidelines for hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) 2013 [2, 2-7]. The diag nosis of GERD was established according to The Montreal Consensus (2006) [7, 1900-1920]. The patients with symptoms of heartburn (2 times a week or more) were selected in the study.
To assess the lipid peroxidation and antioxidant systems it was used the definition of malondialdehyde and SH-groups in the serum and of glutathione peroxidase in the blood hemolysate using standard procedures. The metabolism of nitric oxide was determined by the content of its stable metabolites — nitrites and nitrates — in plasma and in daily urinary excretion (by day and night) by using spectrophotometric method with Gris reaction after reduction of nitrate to nitrite by zinc powder. Content of apelin-12 in the plasma was determined by ELISA using a kit of reagents "Apelin-12 (Human, Rat, Mouse, Bovine) EIA Kit" Phoenix Pharmaceuticals (USA). To assess the lipid profile it was used the determination of total cholesterol (TC), high density lipoprotein cholesterol (HDLC), triglycerides (TG), according to standard conventional procedures, followed by calculation of low density lipoprotein cholesterol (LDLC) and very low density lipoprotein cholesterol (VLDLC) in serum.
The evaluation of daily blood pressure (BP) profile was carried out by ambulatory blood pressure monitoring (ABPM). The average duration of the study was (24.2±1.6) hours. BP measurement were performed at intervals of 15 minutes during wakefulness and 30 minutes while sleeping. All patients in the study filled in personal diaries, which displays features of physical activity, psycho-emotional and mental stress, sleeping time and time of morning awakening, sleep quality and their complaints. The criterion verification of BP increase according to ABPM was daily average BP > 130/80 mmHg (at day > 135/85 mmHg, at night > 120/70 mmHg) as recommended ESC/ESH (2013).
Echocardioscopy study was performed according to standard procedures at the unit Vivid 3. The end-diastolic and end-systolic dimensions of the left ventricle (LV) (LVEDD and LVESD), the thickness of the posterior wall of LV (left ventricular end-diastolic posterior wall dimension — LVPWd) and the thickness of the interventricular septum (interventricular septal end-diastolic dimension — IVSd) in systole and diastole were evaluated, left ventricular mass index (LVMI), left ventricular relative wall thickness (RWT), left ventricular ejection fraction, anteroposterior dimensions of the right ventricle, left and right atria were calculated.
Analysis of the results was performed using a computer program IBM SPSS Statistics 21.0. For the purpose of mathematical data processing the following methods were used: primary descriptive statistics, t-Student test for dependent and independent samples, correlation analysis.
Results and discussion
Depending on the level of hypertension patients of first group (with a combination of hypertension and GERD) were distributed in the following way: hypertension 1st degree was diagnosed in 13 (10.3%) patients, 2nd degree — 43 (34.1%) and 3d degree — 70 (55.6%) persons. Patients of groups differed significantly by age. As
for persons in group 2, to hypertension 1st degree was diagnosed in 12 patients (12.6%), 2nd degree — 31 (32.6%), 3d degree — 49 persons (54.8%).
According to ABPM the daily average values of SBP/DBP in the first group of patients with 1st degree of hypertension were (141.2±0.8)/(90.4±0.4) mmHg, for patients of second group with 1st degree of hypertension — (153.7±0.7)/(95.2±0.4) mmHg, p=0.001. A similar pattern was observed in the comparison of patients with 2nd degree of hypertension: for patients of first group — (163.3±0.9)/(101.0±0.5) mmHg, for patients with isolated hypertension — (172.3±0.5)/(103.0±0.4) mmHg, p=0.001, despite the fact that the duration of hypertension in patients with comorbidity was significantly higher ((10.3±1.1) years), than in the group of isolated hypertension ((6.7±0.7) years), p=0.015. In patients with 3 degree of hypertension with GERD were registered the daily average values of SBP/DBP: (185.6±0.8)/(112.1±0.5) mmHg, in the group with isolated hypertension — (193.8±1.6)/(114.6±0.9) mmHg, p<0.05. In the control group the average daily level of SBP was (114.40±1.29) mmHg, of DBP — (66.30±0.95) mmHg. The findings suggest the higher values of blood pressure in a group of patients with isolated hypertension, while the presence of concomitant GERD is beneficial to the daily average daily average values of ABPM. In support of the above indicators of variability in blood pressure at night wewe significantly different between the comparison groups: for those with comorbidity (hypertension + GERD) BP variability at night was (24.6±3.5) mmHg (which exceeds the reference values <15.5 mmHg), for patients with isolated hypertension — (64.5±5.1) mmHg, p=0.001. In the control group BP variability during the day — (12.8±0.6), at night — (10.3±0.6) mmHg, and the total percentage of those with normal BP variability in healthy was 60%.
Similar results were obtained in the study [8, 5-23]: according to the results of ABPM, patients suffering from isolated hypertension were characterized by significantly higher hypertonic load compared to patients with a combination of hypertension and GERD. At the same time the risk of complications such as acute coronary syndromes and disorders of cerebral circulation was slightly higher in isolated hypertension, as evidenced by the values and speed of the morning rise in BP. As for blood pressure variability, in isolated hypertension group 50% of patients had abnormal BP variability, whereas in comorbidity it was found only in 30% of cases.
In order to assess the severity of left ventricular remodeling in patients with arterial hypertension ultrasound examination of the heart was conducted. When comparing patients with 1st degree of hypertension in groups hypertension+GERD and isolated hypertension the following differences were revealed: LVEDD — (4.79±0.08) and (5.20±0.09) cm, respectively, it means that LVEDD was higher in isolated hypertension (p=0.002), norm is (4.6-5.7) cm; LVMI — (144.79±3.41) and (181.88±5.93) g/m2, p=0.001 (norm is: up to 125 g/m2 — for males, and up to 110 g/m 2 — for females); left ventricular ejection fraction was significantly lower in patients with isolated hypertension (53.7±2.2)% compared with the group hypertension+GERD (64.2±0.6)%, p=0.003. The indicator RWT that calculated by the formula RWT = (IVSd + LVPWd)/LVEDD) was higher in the group with combined pathology (0.495±0.007) than in group of isolated hypertension (0.468±0.008), p=0.019 (norm is less than 0.45).
The results of comparison of ultrasound examination data in the group of persons with 2nd degree of hypertension also revealed a tendency to more pronounced left ventricular remodeling in patients with isolated hypertension: LVEDD — (4.95±0.05)
The influence of gastroesophageal reflux disease comorbidity on biochemical markers, data of ambulatory blood.
and (5.23±0.05) cm, p=0.001; LVMI — (158.45±2.57) and (178.27±3.66) g/m 2, p=0.001; left ventricular ejection fraction did not differ significantly — (59.7±0.8) and (61.9±1.3)%, p>0.05. RWT in the group of combined pathology — (0.487±0.007), in the group of isolated hypertension — (0.467±0.004), p=0.013.
As for patients with 3d degree of hypertension ultrasound examination data in the compared groups were: LVEDD — (5.00±0.05) and (5.32±0.04) cm, p=0.001; LVMI — (164.05±2.57) and (190.30±2.91) g/m 2, p=0.001; left ventricular ejection fraction did not differ significantly — (58.7±0.6) and (58.0±0.8)%, p>0.05. RWT in the group of combined pathology — (0.484±0.006), in the group ofisolated hypertension — (0.461±0.004), p=0.001. It is noteworthy that in patients with 3d degree of isolated hypertension significantly higher rates of atrial septal thickness were set (1.229±0.011) cm compared with persons from hypertension+GERD group (1.196±0.005) cm, p=0.003, and LVPWd — (1.224±0.006) and (1.202±0.005) cm, p=0.005, respectively.
Significant differences in lipid spectrum were revealed only in patients with 2nd and 3d degrees of hypertension. Thus, in patients with 2nd degree ofhypertension depending on whether it was the combination "hypertension+GERD" or it was isolated hypertension the levels of total cholesterol (TC) were (5.03±0.08) and (5.55±0.22) mmol/l, p=0.35. At the same time levels of LDLC were significantly different: (2.95±0.10) and (3.58±0.24) mmol/l, p=0.19, and atherogenic coefficient (AC): (2.98±0.13) and (3.54±0.17), p=0.008. In patients with 3d degree of hypertension the TC levels were also higher in the group of isolated hypertension (6.27±0.18) mmol/l compared with group of comorbidity (5.46±0.10) mmol/l, p=0.001, by increasing of LDLC ((3.62±0.23) and (3.06±0.09) mmol/l, respectively, p=0.027), and by decreasing of HDLC levels ((1.20±0.02) and (1.35±0.02) mmol/l, p=0.001). It's obvious that in patients with isolated hypertension AC was higher (4.34±0.18), than in patients with combination "hypertension+GERD" (3.11±0.09), p=0.001. It possible to assume that the characteristics of the lipid profile in patients with combination "hypertension+GERD", namely the tendency to decrease levels of LDLC and AC, are connected with a special diet, which the patients with disorders of motor-evacuation function of the stomach have to comply.
In order to examine disorders in the "lipid peroxidation-antiox-idant protection system" the following parameters were evaluated: malonic dialdehyde (MDA) — endogenous aldehyde formed as a result of polyunsaturated fatty acids metabolism and is the marker of oxidative stress, the concentration of nitrogen oxide (NO) in the blood plasma, and as markers of antioxidant protection the level of SH-groups in the serum and the concentration of glutathione peroxidase (GPO) in the hemolysate were considered. It is known that oxidative stress plays a significant role in the formation of endothelial dysfunction and is a significant pathogenetic link of development of both hypertension and GERD. The activity of the oxidative stress directly affects the severity of inflammation in GERD, there is an imbalance between the constitutive and inducible links of nitric oxide synthesis which creates the conditions for realizing its cytotoxic properties with subsequent tissue damage.
In the group of patients with 1st degree of hypertension and concomitant GERD the MDA level was (4.07±0.12) mcmol/l, in patients with 1st degree of isolated hypertension — (5.25±0.33) mcmol/l, p=0.003. The tendency was preserved when comparing both the patients with 2nd degree of hypertension: (4.19±0.18) and (5.73±0.22) mcmol/l respectively, p=0.001, and the patients with 3d degree of hypertension: (4.57±0.09) and (6.26±0.24) mcmol/l, p=0.001. It is evident that the activity of oxidative stress increases
while increasing degree of hypertension, at the same time the expression of oxidative stress was significantly lower in patients with GERD. In the group of healthy individuals the concentration of MDA was lowest (2.71±0.06) mcmol/l (p<0.001).
Changes in the concentration of NO in patients with comor-bidity were: in persons with 1st degree of hypertension the NO concentration — (25.39±0.12) mcmol/l, with 2nd degree of hypertension — (24.76±0.10) mcmol/l, with 3d degree of hypertension — (24.80±0.08) mcmol/l. In patients with isolated hypertension NO levels varies depending on the degree of hypertension, respectively: (23.06±0.31), p=0.001, (22.72±0.12), p=0.001 and (21.49±0.05) mcmol/l, p=0.001. In the control group, the level of NO in blood was (23.72±0.65) mcmol/l.
Activation of oxidative stress accompanied by some exhaustion of SH-groups level in the group of isolated hypertension compared with a group "hypertension+GERD" in persons with 1st degree of hypertension ((456.04±23.26) and (535.86±16.89) mcmol/l respectively, p=0.01) and in persons with 2nd degree of hypertension ((460.13±8.79) and (491.58±10.15) mcmol/l, p=0.022). While comparing individuals suffering from third degree of hypertension significant difference between the levels of SH-groups was not found ((493.65±7.90) and (489.61±6.59) mcmol/l, p>0.05). The levels of SH-groups were highest in control group, indicating the stability of antioxidant protection — (676.92±21.75) mcmol/l (p<0.001).
Finally, the concentration of the GPO in the hemolysate differed significantly only in patients with mild hypertension. Thus, in the group with concomitant GERD this indicator was (114.54±4.95) mcmol/min/gHb, in the group of isolated hypertension — (162.30±6.20) mcmol/min/gHb), p=0.001. Increasing of the GPO in the second group while the more pronounced oxidative stress indicates the retaliatory activation of antioxida-tion, which is less pronounced in group of comorbidity. However, while increasing of severity of arterial hypertension the differences in GPO concentration becomes invalid: for 2nd degree of hypertension — (175.36±9.08) and (166.36±4.56) mcmol/min/gHb respectively, for 3d degree of hypertension — (162.45±5.53) and (177.58±5.34) mcmol/min/gHb, p>0.05. In the control group, the GPO concentration in hemolisate was highest — (261.88±5.79) mcmol/min/gHb, p<0.001.
A general tendency to increase of NO level in daily urine in all patients with comorbidity was revealed. Thus, in group of 1st degree of hypertension the concentration of NO in the daily urine was (89.3±0.5) mcmol/l, at day — (31.4±0.3) mcmol/l, at night — (57.9±0.3) mcmol/l; for patients with 2nd degree of hypertension NO in daily urine — (88.7±0.3) mcmol/l, at day — (31.3±0.1) mcmol/l, at night — (57.6±0.3) mcmol/l. Finally, in patients with the highest level of hypertension (3d degree) and GERD the indices were indices respectively: (89.0±0.2), (31.2±0.1), (57.7±0.2) mcmol/l. The relevant data in patients with isolated hypertension were significantly lower in all positions (p=0.001): in group with 1st degree of hypertension the NO concentration in daily urine — (41.5±1.0) mcmol/l, at day — (18.6±0.4) mcmol/l, at night — (22.9±0.7) mcmol/l; in patients with 2nd degree of hypertension the NO concentration in daily urine — (41.6±0.6) mcmol/l, at day — (18.4±0.2) mcmol/l, at night — (23.2±0.4) mcmol/l; in patients with high arterial hypertension, respectively: (42.2±0.5), (18.2±0.2), (24.1±0.4) mcmol/l. In the control group the level of nitric oxide metabolites in daily urine — (66.43±0.13) mcmol/l, at day — (25.68±0.04) mcmol/l, at night — (40.70±0.12) mcmol/l, that differed significantly only in comparison to data of the group "hypertension+GERD", p<0.05.
At present one of the protective biochemical markers is the level of apelin. Apelin has many points of application: stimulation of gastric mucosal cells proliferation, secretion of cholecystokinin, a decrease of insulin secretion, histamine, hydrochloric acid by the parietal cells, etc. Apelin is an important regulator of gastrointestinal tract functioning which contributes to the restoration of the mucosa and is involved in the regulation of smooth muscles functioning and metabolism. The vasodilator effect of apelin by the NO-dependent mechanisms of APJ-receptor stimulation was revealed [9, 105-110]. Furthermore, preventing the degradation of superoxide dismutase apelin is able to inhibit the production of free radicals [10, 203-207].
In the group of patients with mild hypertension apelin levels in the blood did not differ significantly: in case of combination with GERD — (930.58±56.27) pg/ml, without GERD — (955.24±6.49) pg/ml, p>0.05. In patients with higher levels of BP (2nd degree of hypertension) apelin level was significantly higher in group "hypertension+GERD": (880.56±17.97) pg/ml compared with a group of isolated hypertension (755.77± 18.84) pg/ml, p=0.001. In the group with high levels of hypertension apelin levels respectively were (650.91±12.87) and (560.21±5.01) pg/ml, p=0.001. Thus, the highest apelin concentration was observed in the control group — (1133.42±17.85) pg/ml (p<0.001).
Conclusions
1. According to the ABPM the higher average daily blood pressure values characterized the persons with isolated hypertension, while the presence of concomitant GERD had beneficial effect on daily average ABPM. The obtained differences were independent of the hypertension duration in groups of patients with 1st and 2nd degrees of hypertension, as for the patients with 3d degrees of hypertension the duration of hypertension in patients with combined pathology was significantly higher ((10.3±1.1) years), than in the group of isolated hypertension ((6.7±0.7) years), p=0.015.
2. The results of comparison of ultrasound data in a group of persons with 2nd degree of hypertension showed a tendency to more pronounced left ventricular remodeling in patients with isolated hypertension compared to the group "hypertension+GERD": LVEDD — (5.23±0.05) and (4.95±0.05) cm, p=0.001, LVMI — (178.27±3.66) and (158.45±2.57) g/m2, p=0.001; in the patients with 3d degree of hypertension: LVEDD — (5.32±0.04) and (5.00±0.05) cm, p=0.001; LVMI — (190.30±2.91) and (164.05±2.57) g/m 2, p=0.001.
3. Significant differences in lipid spectrum revealed only in patients with 2nd and 3d degrees of hypertension. It possible to assume
that the characteristics of the lipid profile in patients with combination "hypertension+GERD", namely the tendency to decrease levels of LDLC and AC, are connected with a special diet, which the patients with disorders of motor-evacuation function of the stomach have to comply.
4. With increasing degree of hypertension the activity of oxidative stress also increased, while in patients with concomitant GERD its expression was significantly lower: in group of patients with 1st degree of hypertension and concomitant GERD the MDA level was (4.07±0.12) mcmol/l, in patients with isolated hypertension for 1st degree — (5.25±0.33) mcmol/l, p=0.003; for 2nd degree of hypertension: (4.19±0.18) and (5.73±0.22) mcmol/l respectively, p=0.001, for 3d degree of hypertension: (4.57±0.09) and (6.26±0.24) mcmol/l, p=0.001. Activation of oxidative stress accompanied by some exhaustion of SH-groups level in the group of isolated hypertension compared with a group "hypertension+GERD" in persons with 1st degree of hypertension, p=0.022.
5. A general tendency to increase of NO level in the daily urine was observed in all patients with comorbidity. In group of 1st degree of hypertension the concentration of NO in the daily urine was (89.3±0.5) mcmol/l, for patients with 2nd degree of hypertension — (88.7±0.3) mcmol/l, for patients with 3d degree of hypertension — (89.0±0.2) mcmol/l. The relevant data in patients with isolated hypertension were significantly lower in all positions (p=0.001): in group with 1st degree ofhypertension — (41.5±1.0) mcmol/l, in patients with 2nd degree ofhypertension — (41.6±0.6) mcmol/l, in patients with high arterial hypertension — (42.2±0.5) mcmol/l.
6. In patients with 2nd degree of hypertension apelin level was significantly higher in group "hypertension+GERD": (880,56±17,97) pg/ml compared with a group of isolated hypertension (755.77±18.84) pg/ml, p=0.001. In the group of patients with severe hypertension apelin levels in the blood, respectively, were (650.91±12.87) and (560.21±5.01) pg/ml, p=0.001.
Prospects of research:
Because of the high frequency of occurrence of "hypertension+GERD" comorbidity, pronounced impact of these disorders on quality of life, community of etiological trigger factors and pathogenesis it is necessary to investigate the features of mutual influence of these diseases on the nature of clinical manifestations and progression in the future. The problem of the development of adequate methods of correction and effective preventive measures for patients with hypertension and GERD is relevant and should serve as a topic for future researches.
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The state of general and local immunity in patients with urogenital chlamydiosis
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Fattakhov Bobir Shavkatovich, Republican Specialized scientific -practical medical Centre of Dermatology and Venereology of the Health Ministry of the Republic of Uzbekistan, Tashkent
E-mail: fattahov_bob@mail.ru
The state of general and local immunity in patients with urogenital chlamydiosis
Abstract: The state of general and local immunity was studied in patients with urogenital chlamydiosis in this scientific work. It was found that patients with chlamydia the immune system disorder are observed which is reflected by the imbalance of cellular and humoral immune system as well. The most expressed changes of immunity, as on systemic and local levels are noted in patients in association with urogenital chlamydiosis and ureomycoplasmosis. Keywords: chlamydia, the immune system, the local immunity.
The general spread of urea plasma and chlamydia infection is revealed by frequent preservation of reservoir of the pathogen in the asymptomatic course of the disease [9]. However, despite the information about the urogenital infections, sexually transmitted diseases in recent years has changed and expanded. [1] As it is well known, 60% of nongonococcal inflammatory processes of the genitourinary system is settled for urogenital chlamydiosis, ureaplas-mosis and their associations. Currently, with these agents connect not only the defeat of urogenital organs, but also the eyes, joints, respiratory injuries and a number of systemic manifestations [8]. Research and clinical observations show that chlamydia may be a cause of infertility, decrease of fertility, cause the pathology of pregnancy, disease of the newborns and young children [1; 5].
However, only patients with severe clinical manifestations go to medical aid, so the number of chlamydia carriers is much more. An increasing number of patients with urogenital chlamydiosis make the disease very serious problem of modern medicine.
At present stage some features of inflammatory process course of lower part of the urogenital tract, caused by sexually transmitted infections were revealed [7].
1. The role of conditionally pathogens is increasing. It is known that normal conditionally pathogenic microorganisms may be in small amounts in human body and do not cause disease, and only under certain conditions they become true pathogens. In particular, conditional pathogens include Escherichia coli, Staphylococcus, Streptococcus, yeast-like fungi, etc.
2. Along with the increase of morbidity the development of incidence of drug resistance to most antibiotics has been marked. Large-scale and numerous studies conducted by clinicians and microbiologists have shown that drug stability is more complicated in treatment of the patients with different infectious processes, particularly with mixed etiology.
3. Currently, the prevalence of self-medication is the bane of modern medicine, as self treatment without medical supervision contributes to the stability of various microorganisms or other factor of therapeutic exposure, and sometimes deals with irreparable harm.
4. Currently, infectious diseases are rarely caused by single pathogen. Mixed infections compose about 20-30% of the infec-
tions of the lower genital tract, nearly in every third patients is revealed infectious process caused by several pathogens [2]. In such cases clinical manifestations of the disease are atypical and determined by character of interaction between different pathogens, leading to oppression or stimulation of one type of microorganism by others.
5. Another feature that reduces the body's resistance is the immunological change of reactivity. It is connected with quite number of reasons, particularly with avitaminosis, malnutrition, environmental conditions and difficult living conditions, and others.
6. In addition, the widespread phenomena such as alcoholism, smoking, drug addiction, which reduce the resistance of the body; its immune features often contribute the generalization of infectious process. In turn, immune deficiencies contribute to the development of immunopathological reactions.
Various authors have studied cellular and humoral immunity in urogenital chlamydiosis, which were characterized by variability and ambiguity [3; 6]. Certain violations of quantitative and functional characteristics of T- lymphocytes (including changes in the index CD4 +/CD8 +), increase the level of IgM and the increase in peripheral blood phagocytes specific to any infectious process have been noted in many studies on the problems of urogenital infections. In a number of cases, there were no marked differences of arithmetic values of some immunological parameters in the group of healthy and sick. Apparently, this is due to the fact that the results reflect the immune status of patients in total, without taking into account the clinical form, has significant impact on immunological parameters [9].
Furthermore, it was established that the general immunity is an extremely important in anti-infection protection and local immune mechanisms play an important role in localization of pathogenesis and inflammatory processes. In particular, the main content of the immunoglobulin classes A, M, G, is a component of the normal immune response, which play an important role in the rehabilitation of the body from pathogens and depend on functional activity of B-lymphocytes. Violation of the state of the local immune response can lead to prolonged chronic diseases mucous membranes, accompanied by a deficit of locally synthesized immunoglobulins and especially IgA.
