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The aim of the study was to identify differences in the immune response in chronic opisthorchiasis with or without clinical manifestations of hepatobiliary system diseases. A comparison of laboratory parameters of immune system functioning (lymphocyte phenotypes detected by flow cytometry, concentrations of immunoglobulins and cytokines, indicators of nonspecific resistance) in patients with chronic opisthorchiasis (caused by Opisthorchis felineus) lacking clinical manifestations and with manifestations of cholecystitis, cholangitis, pancreatitis, gastritis, gastroduodenitis, confirmed by ultrasound and FGDS. It was found that the immunological parameters of the innate immune response were increased in all patients with chronic opisthorchiasis compared with the control group of apparently healthy subjects, which indicates activated macrophage-phagocytic arm in patients with opisthorchiasis invasion. The indicator of the stimulated HCT test is maximal in chronic opisthorchiasis without hepatobiliary system diseases, in case of comorbidity with such diseases it declines, but remains significantly higher than the values of the control group. This may be due to the exhaustion in the reserve capabilities of bactericidal neutrophil systems in patients with symptoms of damage to the hepatobiliary system due to prolonged inflammation. Indicators of the cellular arm in patients with chronic opisthorchiasis without clinical manifestations of hepatobiliary system diseases demonstrate a decrease in the absolute and relative level of cytotoxic T-lymphocytes. In the group with picture of hepatobiliary system disorders, an even deeper imbalance of indicators is revealed: the relative and absolute level of lymphocytes, the absolute count of T-lymphocytes are reduced, which may indicate about involvement of cellular immunity in the pathogenesis of complications of chronic opisthorchiasis. In all examined patients with chronic opisthorchiasis, the humoral immune response was also activated the total immunoglobulin E was significantly increased; at the same time, in patients with hepatobiliary system lesions, this parameter increases even more and a decrease in B-lymphocytes is detected. In all patients with chronic opisthorchiasis, there is also an increased level of proinflammatory cytokine IL-8, which rises even more in the group with hepatobiliary system diseases. The data obtained indicate the involvement of all arms of the immune response in a prominent inflammatory process when chronic opisthorchiasis is complicated by clinically overt hepatobiliary system diseases: the degree of deviation in the indicators of the innate and adaptive immune response from the norm and from those in uncomplicated opisthorchiasis increases.
The aim of the study was to identify differences in the immune response in chronic opisthorchiasis with or without clinical manifestations of hepatobiliary system diseases. A comparison of laboratory parameters of immune system functioning (lymphocyte phenotypes detected by flow cytometry, concentrations of immunoglobulins and cytokines, indicators of nonspecific resistance) in patients with chronic opisthorchiasis (caused by Opisthorchis felineus) lacking clinical manifestations and with manifestations of cholecystitis, cholangitis, pancreatitis, gastritis, gastroduodenitis, confirmed by ultrasound and FGDS. It was found that the immunological parameters of the innate immune response were increased in all patients with chronic opisthorchiasis compared with the control group of apparently healthy subjects, which indicates activated macrophage-phagocytic arm in patients with opisthorchiasis invasion. The indicator of the stimulated HCT test is maximal in chronic opisthorchiasis without hepatobiliary system diseases, in case of comorbidity with such diseases it declines, but remains significantly higher than the values of the control group. This may be due to the exhaustion in the reserve capabilities of bactericidal neutrophil systems in patients with symptoms of damage to the hepatobiliary system due to prolonged inflammation. Indicators of the cellular arm in patients with chronic opisthorchiasis without clinical manifestations of hepatobiliary system diseases demonstrate a decrease in the absolute and relative level of cytotoxic T-lymphocytes. In the group with picture of hepatobiliary system disorders, an even deeper imbalance of indicators is revealed: the relative and absolute level of lymphocytes, the absolute count of T-lymphocytes are reduced, which may indicate about involvement of cellular immunity in the pathogenesis of complications of chronic opisthorchiasis. In all examined patients with chronic opisthorchiasis, the humoral immune response was also activated the total immunoglobulin E was significantly increased; at the same time, in patients with hepatobiliary system lesions, this parameter increases even more and a decrease in B-lymphocytes is detected. In all patients with chronic opisthorchiasis, there is also an increased level of proinflammatory cytokine IL-8, which rises even more in the group with hepatobiliary system diseases. The data obtained indicate the involvement of all arms of the immune response in a prominent inflammatory process when chronic opisthorchiasis is complicated by clinically overt hepatobiliary system diseases: the degree of deviation in the indicators of the innate and adaptive immune response from the norm and from those in uncomplicated opisthorchiasis increases.
Aim. To assess the clinical and immunological features in patients with chronic opisthorchiasis, depending on the duration of the infection. Methods. The first group consisted of 19 patients with the duration of the infection up to 1 year, the second group consisted of 21 patients with the duration of the infection between 1 and 5 years, the third group was formed of 23 patients with the duration of the disease more than 5 years, the control group 20 healthy individuals. Immunological research was carried out at the Clinical Diagnostic Center. Statistical processing was performed using Microsoft Excel 2010 and Statistica 6.0 software. The statistical significance of differences was determined by using the MannWhitney test (U-test) at the level of significance of p 0.05. The correlations were assessed by calculating Spearman's rank correlation coefficients.Results Clinical features of chronic opisthorchiasis were revealed in the disease duration groups of up to 1 year, from 1 year to 5 years, more than 5 years: the subclinical course was most common in the group of up to 1 year; cholangiohepatitis prevailed in the group of between 1 to 5 years, allergic skin syndrome, cholangiocholecystitis and pancreatitis dominated in the group of more than 5 years. The immune response in chronic opisthorchiasis was characterized by: up to 1 year lymphocytosis, increased levels of immunoglobulins M (IgM) and circulating immune complexes (CIC), a decrease in the number of T-lymphocytes (CD3+), as well as an increase in bactericidal activity of leukocytes (BAL); between 1 and 5 years monocytosis, increased levels of immunoglobulins M, immunoglobulins G and circulating immune complexes, a decrease in T-cytotoxic lymphocytes (CD8+) and nitro blue tetrazolium (NBT test), as well as an increase in NK cells and phagocytic activity of monocytes, more than 5 years eosinophilia. Conclusion. Common features of rearrangement of the immune system in opisthorchiasis: inflammatory changes in the hemogram, activation of humoral immunity with parallel suppression of the cellular component of the immune system, and increased phagocytosis.
Введение. Одна из важных эпидемиологических проблем Сумщины — описторхоз. Социальная и медицинская значимость инвазии велика в связи с высокой пораженностью населения, развитием тяжелых осложнений.Цель. Проанализировать заболеваемость и определить параметры эпидемического процесса описторхоза в Сумской области Украины, установить особенности его клинического течения в природном очаге.Материалы и методы. Объект исследования — больные описторхозом, медицинские карты стационарных больных (ф. 003/у), отчетная документация Сумской областной санитарно-эпидемиологической станции. Методы исследования: клинико-анамнестические, лабораторные с использованием клинического (Сobas Micros) и биохимического (Сobas Emira) анализаторов; иммуноферментный анализ для определения антител к возбудителю; копроовоскопия формалин-эфирным методом, исследование дуоденального содержимого; инструментальные — фиброгастродуоденоскопия, ультразвуковое исследование, фракционное исследование желудочного сока. Результаты. Проведен анализ эпидемиологической ситуации по описторхозу в Украине и Сумской области, на территории которой находится крупнейший природный очаг инвазии. Заболеваемость составляет 23,0 на 100 тыс. населения, что превышает заболеваемость по Украине более чем в 20 раз. Изучены клинические особенности течения заболевания в эндемическом очаге, установлено преобладание латентной формы описторхоза, что существенно влияет на своевременную диагностику инвазии.Выводы. Заболеваемость описторхозом в Сумской области высокая и значительно превышает среднеукраинские показатели. Стойкое функционирование очага инвазии обусловлено особенностями гидрологического режима региона, высокой пораженностью описторхисами карповых рыб, которые имеют значительный удельный вес в пищевом рационе населения. Группу риска составляют рыбаки и члены их семей (72,3 %). Основным фактором передачи является соленая и вяленая рыба (58,7 %). Из клинических форм преимущественно регистрируется хронический описторхоз с латентным течением. При манифестном течении инвазии у больных чаще всего выявляется холецистит (82,6 %). Решающую роль в диагностике описторхоза играет копроовоскопия (100 %).
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