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Using immunocorrection therapy in patients with chronic pancreatitis
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Suleymanov Suleyman Fayzullaevich, PhD, Senior Researcher, Head of the Chair of Microbiology and Phthisiology of the Bukhara State Medical Institute, Bukhara, Uzbekistan
E-mail: ss-1961@mail.ru
Using immunocorrection therapy in patients with chronic pancreatitis
Abstract: The immune system studied in 36 patients with chronic pancreatitis (CP) and 32 healthy individuals. In patients with CP showed a deficiency of T-lymphocytes and subset tension humoral immunity and cytokine profile. Using Thymopti-num (dose of 0.8-1.0 mg per course) in conjunction with conventional treatment in patients with CP led to an increase in cellular immunity and stabilization of cytokine levels.
Keywords: the immune system, T- and B-link immunity, cellular immunity, humoral immunity, link, immunotherapy, pancreatitis.
Changes in the environment, technology, food industry, lifestyle and spreading "western food" are the reason of growing the diseases of the pancreas. Over the past 30 years, marked by the global trend to an increasing in the incidence of acute and chronic pancreatitis (CP) is more than 2 times [2; 3; 10].
CP prevalence, increasing morbidity and temporary disability due to disability is an important social and economic problem of modern medicine. In the structure of morbidity gastrointestinal organs CP is from 5.1 to 9%, and in general clinical practice — from 0.2 to 0.6% [3, 5-7; 12].
Inflammation in the pancreas can develop due to malfunction of the immune system, which are based on allergic reactions, as well as response to bacterial factor [1; 5; 8].
However, immune disorders and their correction in patients with CP are still poorly studied to the present time.
The purpose of the work — studying of the immune system parameters and conduct immunocorrecting treatment in patients with CP.
Materials and methods. 36 patients were examined (3365 ages) with a diagnosis of CP. The diagnosis was carried out on the basis of complaints, medical history, and objective laboratory tests, instrumental data: ultrasound, fibrogastroduodenoscopy, survey radiography of abdominal organs. The control group consisted of donors from 32 healthy subjects (25-55 ages).
The concentration of serum immunoglobulins (SI) classes A, M and G were determined by radial immunodiffusion (Mancini G., 1965).
The parameters of cellular immunity (T-lymphocytes and a subpopulation, B-lympho-cytes) were identified using monoclonal antibodies (LLC "Sorbent Service", Russia) [4]. Quanti-fication
of levels TNF-a, IL-6, IL-4 in serum performed using reagents set ProCon (LLC "Protein contour", St. Petersburg) by ELISA.
Immunotherapy was carried out in 15 patients. Thymoptinum (Uzbekistan) was used as an Immunological drug. 0.8-1.0 mg per treatment (dose 100 mg/day for 8-10 days). The indicators ofimmu-nity was studied twice: before — and after 1 month after treatment).
Results and discussion. In patients with CP found immunodeficiency cell component: 0.7-times whatever suppression of the total lymphocyte pool — T (CD3) — 35.3 ± 2.6% as compared with the control group — 52.4 ± 1.8% (p<0.001); 0.8-fold decrease in the absolute number of T (CD3)-cells (p<0.05).
Also determined the oppression subpopulations of T-lymphocytes, have the helper-suppressor function — Th (CD4) — 29.5 ± 1.1% (p <0.001) and 341.8 ± 32.1 cells/1 mcl blood (p<0.001) (control in 36.5% ± 0.7 and 616.4 ± 44.3 cells/1 mcl of blood, respectively), the contents of Ts (CD8) — 13.8 ± 1.4% (p<0.05) and 127.3 ± 9.8 cells/1 mcl blood (p<0.01)
On the side of B (CD19) — cell link, opposite, the tendency to increase as the relative parameter — 20.6 ± 2.3% (p<0.05), which was 1.4 times higher than those ofthe control group values, such and totally — 1.7-fold increasing — 385.8 ± 33.4 cells/1 mcl of blood (in the control — 230.1 ± 26.7 cells/1 mcl of blood).
An appreciable activation of B-cell immunity against the background suppression of T cells in CP reflected in the SI spectrum. For example, attention is drawn to the increasing in IgA production to 3.97 ± 0.41 g/l (p<0.05), which may be a reflection of the organism immune adjustment CP patients in response to enzymatic intoxication.
It was found authentically a high content of IgG — 22.42 ± 0.75 g/l (p<0.001) (in control of 15.9 ± 0.94 g/l). IgM concentra-
Section 7. Medical science
tions were within thenormal 1.7 ± 0.2 g/l (p> 0.05). Under the influence of conservative treatment did not happen recovery of T (CD3)-cell, and its subset profile. At the same time there was a tendency in decreasing SI classes IgA and IgG.
Analysis of the spectrum of cytokines has shown that in patients with CP during the aggravations markedly increases the parameters of pro-inflammatory cytokines: TNF-a up to 202.6 ± 22.3 pg/ml (normal — 24.5 ± 5.1 pg/ml, p <0.001) and IL-6 was increased 6 times (317.4 ± 53.5 pg/ml and 47.8 ± 11.2 pg/ml, respectively, at p<0.001). The level of anti-inflammatory cytokine IL-4 have increased by 4.3 times compared with the norm, which was statistically confirmed (157.5 ± 36.7 pg/ml and 32.6 ± 14.3 pg/ml, respectively, p<0.001).
Thus, in patients with CP have found secondary immunodeficiency, for which we used to eliminate Thymoptinum applied in combination with basic therapy (antifermental agents, spasmolytics, antibacterial and other drugs).
Immunotherapy resulted to an increasing in both relative — 54.7 ± 3.2%, and the absolute values of T (CD3)-lymphocytes — 992.3 ± 64.8 cells/1 mcl of blood. At the same time, increasing and stabilization were observed in Th (CD4) and Ts (CD8). This im-munoregulatory index consisted 2.2.
IgA concentration is moderately decreased during the treatment process. There was a trend in increasing IgM to 2.23 ± 0.2 g/l IgG to 23.7 ± 1.62 g/l after 1 month after the treatment, however, it should be noted that in the period of remission was highest IgG levels, that was probably due to the severity and duration of the pathological process, as well as the reduction of reparative processes in the pancreas.
Carrying out traditional treatment in patients with CP was noted moderate decreasing levels of TNF-a, IL-6 (p<0.05; compared with the data before the treatment) and a weak increase in IL-4 and 172.3 ± 41.1 pg/ml. Influenced by immunocorrective therapy conducted on a back-ground of the traditional treatment, in patients with CP was revealed marked reduction of pro-inflammatory cytokines: TNF-a to 118.4 ± 29.1 pg/ml, IL-6 133.6 ± 51.8 pg/ml. Moreover, it was observed the reduction in production of anti-inflammatory cytokine IL-4 95.2 ± 27.4 pg/ml.
It should be emphasized that our data is quite combined with the works of other authors in this research direction [9; 11].
Positive picture of changes in the immune system, in most cases combined with the improvement of the clinical course of CP, which was reflected in the reduction of toxicity, reducing the intensity of pain and improving the condition of patients.
Conclusions:
1. The CP patients was observed significant changes in the functioning of most of the parameters of the immune system, namely the profound suppression of T (CD3)-lymphocyte subpopulations and the tension of immunity.
2. In patients with CP it was revealed a trend in the growth rates of pro- and anti-inflammatory cytokines, to some extent characterized by the pathological process that occurs in the pancreas.
3. The combination of traditional treatment and Thymopti-num is effective in patients with CP, as it contributed to the restoration and stabilization of most of the parameters of the immune system.
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