В настоящее время предпринимают попытки выявить взаимосвязь между генотипом пациентов с целиакией и тяжестью и течением заболевания Цель исследования-изучить серологические и морфологические особенности слизистой оболочки двенадцатиперстной кишки (СОДПК) у детей с целиакией, имеющих генотип DQ2 2 Материал и методы. Обследованы 47 детей, которым диагноз целиакия верифицирован согласно критериям ESPHGAN У всех детей определены антитела к тканевой трансглутаминазе-2 (ТТГ) и деамидированным пептидам глиадина, выполнены морфометрическое исследование биоптатов СОДПК и генотипирование По результатам генотипирования дети были разделены на две группы: 1-ю группу составили 18 детей с генотипом DQ2 2; 2-ю группу-29 детей с другими генотипами Результаты. Повышение антител к ТТГ наблюдалось у всех больных в 1-й группе Причем умеренное повышение в 1-й группе составило 55,6%, а во 2-й-27,6% (р=0,07) Наблюдался значительно повышенный уровень антитела к ТТГ в 1-й группе-44,4% (во 2-й-3,4%; p=0,001) Кроме того, морфологические изменения СОДПК, соответствующие степени атрофии Marsh 3b, чаще наблюдались в 1-й группе-27,8%, чем во 2-й-0% (р=0,006) Морфометрические показатели СОДПК в 1-й группе демонстрировали более выраженные атрофические изменения Заключение. Предполагается, что выявление генотипа DQ2 2 может служить прогностическим фактором более выраженных серологических (значительное повышение уровня антител к ТТГ-2) и морфологических изменений при целиакии у детей
Proliferation and hyperactivation of B-lymphocytes in the salivary glands is a feature of primary Sjцgren's syndrome (pSS). Detection in saliva of proteins synthesized by B-lymphocytes may be important in the diagnosis of this disease.Objective: to evaluate the diagnostic value of measuring the concentration of immunoglobulin free light chains (FLC) in saliva in patients with pSS.Material and methods. The cross-sectional study included 24 patients with pSS over the age of 18 years. PSS was diagnosed according to the 2016 ACR/EULAR classification criteria. The control group consisted of 11 healthy volunteers. Blood-salivary glands histohematic barrier permeability ratio for albumin, FLC was measured. Quantitative determination of FLC and in blood and saliva was performed by enzyme immunoassay. An immunohistochemical study of biopsies of minor salivary glands (MSG) was carried out with a quantitative assessment of CD3+, CD4+, CD8+, CD20+, CD21+, CD68+, CD138+ cells. The Mann–Whitney U-test was used to compare quantitative traits. Identification of diagnostic thresholds for the concentration of FLC in saliva for the diagnosis of pSS was carried out using the ROC analysis method. An operating characteristic curve was plotted, the area under the curve, indicators of diagnostic specificity, diagnostic sensitivity, and diagnostic accuracy were calculated.Results and discussion. The obtained values corresponded to the low permeability of the histohematic barrier of the salivary glands for albumin and FLC in patients with pSS and healthy individuals. The median concentrations of FLC ê and ë in the saliva of patients with pSS and healthy volunteers were 1.08 [0.58; 1.91], 1.038 [0.55; 2.03] mg/l and 0.36 [0.32; 0.54], 0.35 [0.21; 0.52] mg/l, respectively. The concentration of FLC in the saliva of patients with pSS was statistically significantly higher than in the control group (p<0.01). The amount of FLC ê and ë in saliva correlated with the rate of unstimulated saliva flow: rs=-0.483 (p=0.02), rs=-0.491 (p=0.017), respectively.A relationship was found between the concentration of ê-chains in saliva and the specific number of CD138+ cells: rs=0.733 (p=0.025). Statistically significant correlations between the concentration of ë-chains and the number of mononuclear cells in the MSG have not been established.Based on the results of ROC analysis, diagnostic thresholds for FLC concentrations in the saliva of patients with pSS were determined. Concentrations of ê- and ë-type FLC in saliva of 0.56 and 0.68 mg/l correspond to area under the curve values of 0.84 (95% confidence interval, CI 0.69–0.98) and 0.83 (95% CI 0.71–0.97), sensitivity 79.2% (95% CI 59.5–90.8) and 75% (95% CI 55.1–88), specificity 81.8% (95% CI 52.3–96.8) and 90.9% (95% CI 62.3–99.5), respectively.Salivary FLC concentrations were compared in patients with pSS receiving and not receiving glucocorticoids (GC). The groups did not differ in a statistically significant way in terms of clinical and laboratory parameters. The median daily dose of GC was 10 [5; 10] mg in prednisolone equivalent. There were no significant differences between the concentrations of saliva FLC in patients of these groups.Conclusion. Salivary-fixed FLCs are most likely produced by cells localized in the stroma of the salivary glands. Determination of the concentration of FLC in saliva can be proposed as a diagnostic test for the pSS. The concentration of free ê-chains in saliva can be considered as a surrogate marker of benign B-cell proliferation in the MSG. Therapy with low and medium doses of GC in pSS does not affect the concentration of FLC in saliva.
BACKGROUND: Coronavirus disease 2019 (COVID-19) is often complicated by cytokine storm syndrome. Although many interleukins (IL) have predictive value, the sensitivity and specificity of a single marker is limited. AIM: The purpose of the study is to develop an objective and informative cytokine storm scale for assessing the risk of developing a critical course in patients with COVID-19 associated pneumonia. MATERIALS AND METHODS: A total of 226 cases of COVID-19 were investigated, 36 (16 %) of which were with poor outcomes. The cytokines IL-1b, IL-2, IL-6, IL-8, IL-10, IL-18, TNF-, IFN, IFN- were studied by enzyme immunoassay, commercial kits manufactured by Vector-Best, RF. RESULTS: Since IL-6, IL-10, IL-18, and procalcitonin were associated with disease severity and death, these indicators were integrated into a 12-point scale called the cytokine storm scale. The patients who scored more than 6 points had a high risk of a poor outcome of the disease. According to ROC analysis, the area under the curve for the cytokine storm scale was larger than for each of the four markers separately [AUC 0.90 (95% CI 0.84550.9592), p 0.001]. CONCLUSIONS: Thus, the cytokine storm scale system presents superior performance in determining patients with favorable and fatal outcomes to each individual cytokine.
Background:Genetic predisposition takes one of the main parts at pathogenesis of axial spondyloarthritis (axSpA). Currently, HLA-B27 is a single genetic marker that used in classification criteria of axSpA. However, the presence of HLA-B27 does not affect the activity of the disease. An alternative biomarker of axSpA activity could be an immunoglobulin (Ig) A antibody to an invariant chain peptide associated with class II human leukocyte antigen (HLA) (anti-CD74).Objectives:The goal is to determine genetic polymorphisms of IL17 alleles prevalence in patients (pts) with axSpA and their interrelations with the disease activity and concentration of IgA to CD74.Methods:In 48 patients with a reliable diagnosis of axSpA, aged 18 to 69 years ASDAS, BASDAI, BASFI were calculated. The polymorphisms of alleles of interleukin (IL)-17A197 a/g, IL-17F7 histidine (His)/arginine (Arg), IL-17F11139 c/g, HLA-B27 were evaluated. Serum concentration of IgA to CD74 was measured (the normal reference interval according to the instructions for the laboratory kit for serum IgA to CD74 is 0-12.0 U/L).Results:The mean age of pts was 45.1±14.2 years, male 72.9%, BASDAI 2.99±0.28, ASDAS 2.29±0.16 (Cronbach’s alpha for the scales – 0.830), IgA to CD74 16.9±11.0 mg/L. The most often found polymorphisms of interleukin-17 alleles demonstrated intable 1.Table 1.Interleukin-17 alleles’ polymorphisms in patients with axial spondyloarthritis, n=48IndicatorPts with presence of polymorphism, nIndicatorPts with presence of polymorphism, nIL-17A-197 AA14IL-17F7 his/his45IL-17A-197 GG18IL-17F7 his/arg 2IL-17A-197 GG16IL-17F7 arg/arg 1IL-17F-11139 CG26IL-17F-11139 CC22Exceeded levels of IgA to CD74 were identified at 96 pts (70.1%). The factor analysis showed a relationship between ASDAS (R=0.857), BASDAI (R=0.842), BASFI (R=0.857) and level of IgA to CD74 (R=0.667),(table 2).Table 2.Interrelations between serum concentration of IgA to CD74, the activity indices and genetic polymorphisms of interleukin-17 alleles in axSpA patients (factor loads), n=48IndicatorFactor loading (R)FactorFactor 1FactorFactor 1IgA аnti-CD740.5250.9250.667BASDAI0.7340.8160.842ASDAS0.6570.5760.857BASFI0.5450.820IL-17 F7 His/His-0.421IL-17F7 His/Arg0.6310.544An increase in the factor load indices for IgA to CD74 (R=0.925) was established, provided that the IL-17F genotype is homozygous for the his / arg allele (R=0.544). The genotypes IL-17F his/his showed an inverse interrelation with the increase in serum IgA to CD74 level (R=-0.421).Conclusion:Serum concentration of IgA to CD74 exceeded normal reference level in axSpA patients in 70.1% of cases that was associated with ASDAS and BASDAI levels. Presence of heterozygote IL-17F polymorphism in his/arg allele was associated with increasing serum concentration of IgA to CD74 and with increased disease activity (ASDAS and BASDAI). Decreasing of serum IgA to CD74 concentration, less axSpA activity (ASDAS and BASDAI) were found in patients with presence of heterozygote IL-17F polymorphism in his/his allele.Disclosure of Interests:Elizaveta Vasilenko: None declared, Maxim Korolev: None declared, Sergey Lapin: None declared, Irina Kholopova: None declared, Anna Dadalova: None declared, V Mazurov: None declared, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi
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