FEATURES OF IMMUNE RESPONSE IN PRETERM BABIES WITH BRONCHOPULMONARY DISPLASIA OF VARIOUS SEVERITY

To evaluate the immunity indexes in the children who were born with bronchopulmonary dysplasia (BPD) of varying severity at very early delivery terms (22-27 weeks), dynamic examinations were performed in 35 infants: 17 children were with severe BPD; 18, with mild-severity and moderately severe BPD. The comparison group consisted of seven children born at 22-27 weeks of gestational age without signs of BPD. Relative numbers of lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+, CD16+CD56+, CD4+CD25+), and monocytes (CD14+CD64+, CD14+HLA-DR+) were determined by flow cytometry. The level of cytokines (IL-6, IL-8, IL-4) was measured by enzyme immunoassay technique. The features of immune status in children with BPD of severe, mild and moderate severity were discerned. It was found that the predictors of severe BPD development in the children born at very early terms, are: increased content of IL-8 at birth and at the age of 1 month, reduced level of expression on monocytes (CD64, HLA-DR) on the 1 month of life, and CD14+CD64+ cells at 38-40 weeks post conception. The revealed features of immune status in newborns with BPD can be used to assess the effectiveness of the therapy, which requires further research in this direction

ДИНАМИКА ЛИПОПОЛИСАХАРИДСВЯЗЫВАЮЩЕГО ПРОТЕИНА И ЛАКТАТА В КРОВИ ПАЦИЕНТОВ С ПОЛИТРАВМОЙ

Objective: to estimate the clinical and prognostic value of the blood levels of lipopolysaharidebinding protein (LPSBP) and lactate in critically ill polytrauma patients.Subjects and methods. An analysis was made of the results of an examination in critical ly ill polytrauma victims who were retrospectively classified in accordance with the 1992 ACCP/SCCM criteria: systemic inflammatory response syndrome (n=18), local infection (n=36), sepsis (n=27), severe sepsis (n=12), and septic shock (n=6). A case was regarded as infection when the source of the latter was established and it was microbiologically verified. The investigators determined serum LPSBP levels by an immunochemiluminescence analyzer (IMMULITE ONE, USA) and venous whole blood lactate concentrations by a Roche Omni S analyzer (Germany).Results. The development of infectious complications was notedin 81% of the polytrauma patients by days 5—7; by days 8—10, 45% were diagnosed as having sepsis whose severe course was characterized by the addition of polyresistant gramnegative microorganisms. An early increase in the concentration and frequency of diagnostic levels of serum LPSBP was ascertained in the polytrauma patients before infection was microbiologically verified. There was a strong direct correlation between lactate and LPSBP levels.Conclusion. The findings suggest that LPS BP and lactate are of diagnostic and prognostic value and may be used as early markers of pyoseptic complications.Цель исследования — оценить клиническую и прогностическую значимость уровней липополисахаридсвязывающего протеина (ЛПССП) и лактата в крови пациентов с политравмой в критическом состоянии.Материал и методы. Проведен анализ результатов обследования пострадавших с политравмой в критическом состоянии, которые ретроспективно были классифицированы в соответствии с критериями ACCP/SCCM (1992 г.): SIRS (n=18), локальная инфекция (n=36), сепсис (n=27), тяжелый сепсис (n=12) и септический шок (n=6). Случай считали инфекцией при установлении источника инфекции и его микробиологическом подтверждении. Содержание ЛПССП в сыворотке крови определяли на иммунохемилюминесцентном анализаторе «IMMULITE ONE» (США), лактата в цельной венозной крови — на анализаторе «Roche Omni S» (Германия).Результаты. У 81% пациентов с политравмой к 5—7 суткам отмечается развитие инфекционных осложнений; у 45% к 8—10 суткам диагностируется сепсис, тяжелое течение которого характеризуется присоединением полирезистентной грамотрицательной микрофлоры. Установлено раннее увеличение концентрации и частоты встречаемости диагностических уровней липополисахаридсвязывающего протеина (ЛПССП) в сыворотке крови у пациентов с политравмой до микробиологического подтверждения инфицирования. Показана сильная прямая корреляционная связь между уровнями лактата и ЛПССП.Заключение. Полученные данные свидетельствуют о диагностической и прогностической значимости ЛПССП и лактата и о возможности использования этих показателей в качестве ранних маркеров гнойносептических осложнений

Метаболические и реологические нарушения в остром периоде ишемического инсульта

Objective: to study the specific features of metabolism and blood rheological properties in the acute period of ischemic stroke (IS) in patients aged less than 50 years.Subjects and methods. Thirty patients (mean age 45.1±1.1 years) having acute IS were examined. According to its severity, the patients were divided into 3 groups: 1) 8 patients with mild IS; 2) 11 patients with moderate IS; 3) 11 with severe IS. All Group 3 patients were treated at an intensive care unit. A control group comprised 20 healthy individuals (mean age 44.7±1.0 years). In all the patients, fasting blood homocysteine concentrations were measured on an IMMULITE One immunochemiluminescent analyzer (USA). The rheological properties of blood were examined, by measuring its viscosity on a rotary viscometer (Russia) at a shear rate of 10 to 200 sec-1. Fibrinogen concentrations were determined on an ACL-100 coagulograph.Results. The patients who had experienced ischemic stroke at the age of under 50 years were found to have atherogenic dyslipidemia, elevated homocysteine and fibrinogen levels and considerably increased blood viscosity, which correlated with the severity of their condition and the outcome of stroke. The highest values were noted in patients with severe ischemic stroke and a poor outcome.Conclusion. Studies of homocysteine and fibrinogen concentrations and blood viscosity may be used as additional criteria for evaluating the severity of ischemic stroke and predicting its outcome in patients aged less than 50 years. Цель исследования — изучить особенности метаболизма и реологические свойства крови в остром периоде ишемиче-ского инсульта (ИИ) у пациентов в возрасте до 50 лет.Материалы и методы. Обследовано 30 пациентов в остром периоде ИИ (средний возраст 45,1±1,1 лет). По степени тяжести пациентов распределили на три группы: 1-я группа — пациенты с ИИ легкой степени тяжести (n=8), 2-я — пациенты с ИИ средней степени тяжести (n=11), 3-я — пациенты с ИИ тяжелой степени тяжести (n=11). Все пациенты третьей группы находились на лечении в отделении реанимации. Контрольную группу составили 20 здоровых лиц (средний возраст 44,7±1,0 лет). У всех пациентов натощак определяли в крови концентрацию гомоцистеина на иммунохемилюминесцентном анализаторе «IMMULITE One» (США). Показатели липидного обмена (общий холестерин, холестерин липопротеидов различной плотности, тригли-цериды) определяли автоматизированными методами на анализаторе «HITACHI-912». Реологические свойства крови изучали, измеряя ее вязкость на ротационном вискозиметре (Россия) при скоростях сдвига в диапазоне от 10 до 200с-1. Концентрацию фибриногена определяли на коагулографе ACL-100.Результаты. У пациентов, перенесших ишемический инсульт в возрасте до 50 лет, обнаружено наличие атерогенной дислипидемии, а также коррелирующие со степенью тяжестью состояния и исходом инсульта повышенный уровень гомоцистеина, фибриногена и значительное увеличение вязкости крови. Наиболее высокие значения отмечены у больных с ишемическим инсультом тяжелой степени тяжести, с неблагоприятным исходом.Заключение. Исследования концентрации гомоцистеина, фибриногена и вязкости крови могут использоваться в качестве дополнительных критериев при оценке степени тяжести и прогнозирования исхода ишемического инсульта у пациентов в возрасте до 50 лет.

Aldosteroma of the adrenal gland with a syndrome of secondary arterial hypertension (description of clinical observation)

The article provides a clinical analysis of the case of examination and treatment of a patient with primary hyper aldosteronism, secondary arterial hypertension.В статье приводится клинический разбор случая обследования и лечения пациента с первичным гиперальдостеронизмом, вторичной артериальной гипертензией

Time course of changes in proinflammatory cytokines in infants born to women with complicated pregnancy in relation to the course of an early adaptation period

Objective: to estimate the time course of changes in proinflammatory cytokines during early neonatal adaptation in infants born to women with complicated pregnancy. The authors examined 57 full-term infants born to women with complicated pregnancy, including 12 babies with the uncomplicated course of an early neonatal period, 24 neonates with the initial manifestations of maladjustment, and 21 infants with the complicated course of an early adaptation period that culminated in perinatal abnormality. A comparison group included 42 babies with the physiological course of an early adaptation period. The umbilical cord and peripheral blood levels of IL-ip, IL-6, and TNF-a were determined by an enzyme immunoassay on 1-3 and 5-7 days of life. The highest umbilical cord blood concentrations of IL-6 and TNF-a were noted in the uncomplicated course of an early neonatal period. At the same time, the level of IL-6 decreased within the first week of fife and that of TNF-a was unchanged. The concentration of IL-ip did not differ from that in the healthy babies. With the initial manifestations of maladjustment, the umbilical cord blood content of IL-ip was comparable with that in the healthy infants, the elevation in the concentrations of IL-6 and TNF-a was less pronounced than that in the neonates with an uncomplicated adaptation period. There was a statistically significantly increase in IL-ip, IL-6, and TNF-a levels in the dynamics of an early neonatal period. Obvious early maladjustment culminating in a disease was accompanied by elevated umbilical cord blood IL-ip and IL-6 levels with no changes in TNF-a. IL-6 hyperproduction persisted as long as 5—7 days of fife; the level of TNF-a significantly increased in the dynamics of an early neonatal period and that of IL-ip decreased at 5—7 days of fife

IMMUNOLOGICAL PARAMETRS OF UMBILICAL CORD BLOOD FROM CHILDREN BORN TO WOMEN WITH UROGENITAL INFECTIONS

Significant incidence of chronic urogenital diseases, both of viral and bacterial origin in women of reproductive age leads to an increase in the frequency of intrauterine infections. These disorders lead to disturbances of postnatal adaptation of newborns and increased numbers of infectious complications. In order to assess the state of immune system, we examined forty-eight children born to women with urogenital infection, including twenty-nine infants with complicated course of early adaptation period (study group) and twenty children diagnosed as healthy upon discharge by the day 3 to 5 after birth (comparison group). By means of flow cytometry, the following subpopulations were assayed in cord blood: CD3+, CD3+CD4+, CD3+CD8+, CD19+, CD3CD16+CD56+ cells, expression levels of markers specific to activated monocytes CD14 (HLA-DR), and lymphocytes (CD25+, CD69+), like as markers of functionally mature cells (CD45R0, CD45RA), both in total lymphocyte pool and among T cell populations. Contents of IL-1β, TNFα, IFNγ, IL-4, IL-6, IL-8, IL-10 were assessed by ELISA technique. Our studies have shown that umbilical cord blood samples from the main group of newborns showed a statistically significant decrease in relative content of CD3+, CD4+, CD8+ and CD4+CD25+ cells, along with increase in the absolute numbers of leukocytes and lymphocytes, B-cells and NK cells, as well as expression of CD45RO+, CD45RA+ and CD3+CD45RO+ receptors, CD69+ and CD14+HLADR+ activation markers, accompanied by a significant increase of IL-8 production. Numerical determination of CD45RO+, CD3+CD45RO+, CD69+ and CD14+HLA-DR+ cells, and IL-8 contents in newborns, may serve as prognostic criteria for assignment of risk group for early adaptation disturbances and development of infectious diseases

Gender-related clinical and immunological features of extremely low birth weight infants

Examinations were made in 35 boys and 39 girls with extremely low birth weight in order to identify gender-related clinical and immunological features. A comparison group consisted of 31 full-term newborns with early uncomplicated adaptation. The investigators determined the number of lymphocyte subpopulations and cytokine-producing cells (CD3+INF-γ+, CD3+IL-4+) by flow cytometry and the serum levels of cytokines (IL-4, IFN-γ) and neopterin by enzyme immunoassay. A study of immunological parameters revealed that the boys had a smaller number of CD3+, CD4+, and CD8+ subpopulations, a reduced content of CD3+IL-4+ cells at birth, and low IL-4 production on the first day of life compared to the full-term neonates. The girls were recorded to have higher levels of neopterin and B cells on the first day of life, the quantitative characteristics of T lymphocytes were consistent with those in the full-term infants. The findings are indicative of the greater functional immaturity of the immune system in the preterm boys

Features of the immune system of children born to women with gestational diabetes mellitus

Objective: to assess the state of the immune system in children born to women with gestational diabetes. Forty-two of umbilical cord blood samples from full-term infants, including 22 babies born to women with gestational diabetes mellitus (GDM) (a study group) and 20 born to those without this condition (a comparison group), were explored. Flow cytofluorometry was used to measure the counts of major T- and B- lymphocyte population, the level of expression of activation markers on monocytes (CD14+ HLA-DR+) and lymphocytes (CD25, CD69), as well as markers characterizing the functional maturity of cells (CD45R0, CD45RA) in both the total lymphocyte pool and T cell population. The serum levels of IL-1β, IL-4, IL-6, IL-8, IL-10, TNF-α, and IFN-γ were estimated by ELISA. The immune system of the infants born to women with GDM was established to be characterized by a decrease in the relative count of CD3+, CD4+ and CD3+CD45RA+ cells and in the expression of activation markers (CD25+, CD4+ CD25+ and CD14+ HLA-DR+) in conjunction with an increase in the absolute count of primed T lymphocytes and in the levels of natural killer cells and IL-8. This investigation provides a way of identifying a group at risk for postnatal infectious diseases. The decline in the indicators of innate and adaptive immunity in the umbilical cord blood may be a ground for ultrasonography in newborn babies born to women with GDM to detect thymic abnormalities