В останні десятиліття переконливо доведена провідна роль імунопатологічних порушень у патогенезі розсіяного склерозу (РС). Однак, складний і неоднозначний характер клініко-імунологічних взаємовідносин при різних типах перебігу РС, з урахуванням спадкової обтяженості цього захворювання, потребують подальшого вивчення. Матеріал і методи. Проведено аналіз 197 імунограм у хворих з різними типами перебігу РС при спорадичній і сімейній формах: 110 – у хворих з спорадичною і 27 – з сімейною формами при рецидивному перебігу (РП); 41 – з спорадичною і 19 – з сімейною формами при прогредієнтних типах перебігу (ПП) РС. Для визначення клітинної і гуморальної ланок імунітету в сироватці крові досліджували 16 показників у межах нормативних значень, вище і нижче норми. Результати. Проведений аналіз показав, що при двох формах з РП був виявлений виражений дефіцит регуляторної клітинної ланки (СD4 та СD8) і підвищений вміст лімфоцитотоксичних аутоантитіл (р<0,05). При сімейній формі з РП достовірно переважало число досліджень з підвищенням IgМ і комплементу в поєднанні з лейкопенією і В-лімфоцитозом (р<0,05). При ПП РС для спорадичної форми були достовірно підвищені комплемент, імунні комплекси і лімфоцитотоксичні аутоантитіла. За допомогою математичного (метод пермутації) і статистичного (таблиці спряженості) аналізів отримані: достовірні числові відмінності між формами; середня кількість відхилень від норми за всіма імунологічними показниками; зв’язки між парами ознак за критерієм хі-квадрат з перебором всіх можливих пар з 16 імунологічних показників. У результаті проведених досліджень були отримані істотні відмінності в структурній організації імунного дисбалансу для спорадичної і сімейної форм РС, які диференційовано зачіпали як клітинну і гуморальну ланки імунітету, так і інтегральні показники, отримані за допомогою математичних методів.
The relationships between the nature of the prognosis, normal and elevated levels of pro-inflammatory (INF-γ, IL-1β) and anti-inflammatory cytokines (IL-10, IL-12), the prevalence of haplotypes AA and AG in 105 patients with sporadic form (recurrent course (RС) — 72, progressive types of course (PTС) — 33) and in 33 patients with family form (RС — 15, PTС — 18) of multiple sclerosis. Studies have shown that with RС, a favorable and uncertain prognosis in patients with a sporadic form of MS was significantly more likely to occur with a normal level of anti-inflammatory cytokines (IL-10, IL-12), while in a familial form, a normal level of IL-10 was associated with a favorable and IL-12 — with an uncertain forecast. With PTС in patients with a sporadic form, the normal INF-γ content was more likely to occur with an unfavorable prognosis, while its increased content was characteristic of an uncertain prognosis. In the family form, an unfavorable prognosis was more common with an elevated level of the pro-inflammatory cytokine INF-γ and a normal level of anti-inflammatory cytokine IL-10. This suggests that a complex and differentiated interaction of pro- and anti-inflammatory cytokines occurs with the participation of various pathogenetic mechanisms for different forms and types of course. Uncertain prognosis in familial form of RT, unlike sporadic, was more common in patients with AA haplotype. A comparative assessment of the relationship between AA and AG haplotypes revealed the predominance of AA haplotype with an uncertain prognosis in patients with familial form of RT. Haplotype AG was significantly more common in the family form of PTT and did not depend on the nature of the prognosis. Thus, the prevalence of AA and AG haplotypes in both sporadic and familial forms revealed a close relationship with the nature of the prognosis and the type of course. Key words: multiple sclerosis, sporadic and familial form, prognosis, type of course, cytokines, haplotype
For the fi rst time in Ukraine, was explored the eff ect of pregnancy, childbirth and the postpartum period on the further course of multiple sclerosis (MS) in sporadic and family forms of women giving birth at the preclinical stage (group 1) and against the background of the disease (group 2). Through the use of questioning method and clinical and neurological examination the following phenomena were studied. Namely, premonitory history; features of the course of the disease; the duration between labor and development of the onset of the illness in women of the 1st group and between the onset and labor in women of the 2nd group; obstetric and gynecological history; the eff ect of pregnancy and childbirth on the further course of MS. A total of 82 women were examined, 51 of them were giving birth at preclinical stage (group 1) and 31 — against the background of MS (group 2). In the 1st group with remitting course (RC), 26 women had a sporadic form and 5 — a family form; with progressive course (PC) — in 14 — sporadic and in 6 — family form. In the 2nd group with RC, 23 women had sporadic and 1 family form; with PC — 6 had sporadic and 1 family. Research has shown, the disease of majority of women from the first group has been developed after childbirth. Women from the second group with RC were giving birth most often after 5—10 years of the disease onset; with PC — after more than 10 years. According to the obstetric and gynecological history, differences were obtained during pregnancy, childbirth and the postpartum period between two groups of women with different types of course. An assessment of the effects of pregnancy, childbirth and the postpartum period of women from the 2nd group made it possible to identify criteria for various options for the further course of MS (such as improvement, stabilization, improvement through worsening, worsening), which are closely interrelated with the types of course of the disease. To sum up, an integrated analysis of the above mentioned outcome shows a positive eff ect of pregnancy and childbirth in the vast majority of women with RC and a high incidence of decline of women with PC. Key words: multiple sclerosis, types of course, sporadic and familial form, pregnancy and childbirth, obstetric and gynecological history, complications during pregnancy and childbirth
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