The relevance of the study is due to the lack of data to determine the pathogenetic significance of cytokine profile specifics and correlation pleiades in patients with acute otitis media (AOM) on the background of disorders of glucose metabolism and dyslipidemia manifestations.
The aim of our research: to determine the peculiarities of cytokine profile of peripheral blood in the amount of IL-4, IL-6 and TNF-α and to investigate the correlation pleiades in patients with AOM on the basis of glucose metabolism disorders with regard to the processes of glucose formation, dyslipidemia, and bone tissue metabolism.
Materials and methods: We examined 73 patients with AOM aged 18 to 79 (29 males and 44 females), who were randomized into 4 groups.1 and 2 groups (comparison) (17 patients with acute AOM and 15 patients with AOM with paranasal sinus pathology in groups accordingly) and groups 3 and 4 (main groups) (20 patients with AOM with type 2 diabetes and 21 patients with AOM with glucose metabolism disorders accordingly). Apart from the clinical examination, all patients were tested for glucosylated hemoglobin (HbAlc), IL-4, IL-6, TNF-α and low-density lipoproteins (LDL). The pathogenetic significance of the observed changes was assessed by determining the correlations of the indices given, taking into account the previously established metabolism of bone tissue in the amount of parathormone, osteocalcin, and calcium.
Results of the study and discussion: In patients with acute otitis media with impaired glucose metabolism there was a significant (p˂0.001) increase in the pool of proinflammatory cytokines IL-6 (10.26±0.46 pkg/ml and 10.94±0.5 pkg/ml in groups 3 and 4 accordingly) and TNF-α (11.05±0.5 pkg/ml and 9.7±0.5 pkg/ml accordingly in groups 3 and 4).The increase in the level of TNF-α was 1.9 times greater in patients with type 2 diabetes and 1.7 times greater in patients with transient disorders of glucose metabolism, in relat ion to the increase in the amount of IL-6 (1.1 to 1.3 times in groups 3 and 4, respectively).The amount of antiinflammatory cytokine IL-4 was within the reference norms for the methodology used, but was consistent ly lower in patients with glucose metabolism disorders (7.27±0.2 pkg/ml and 7.79±0.2 pkg/ml in groups 3 and 4 respectively, p˂0,001).We also found a significant (p˂0,001) increase in low density lipoproteins as a manifestation of dyslipidemia in patients with AOM against the background of impaired glucose metabolism 1.8 times in group 3 patients (4,6±0,25 mmol/l) and 1.7 times in group 4 patients (4,27±0,2 mmol/l). Influence of carbohydrate metabolism disorders on formation of cytokine profile and significance of dyslipidemia in pathogenesis of AOM is confirmed by the determined authenticity of variations in glucose content, HbAlc and these indices in patients in the main groups (groups 3 and 4) and the comparison groups (groups 1 and 2) due to the absence of differences in the data between groups 1 and 2 and 3 and 4 (p˃0,05). The study of the correlat ion pleiades of the indices with the markers of bone tissue metabolism revealed the inimitability of their presence, number and strength in patients in groups 1-2 due to the lack of correlation with indicators of glucose and HbAlc, IL-6, LDL and parathormone, which may indicate that in these patients only the mucous membrane of the middle ear is involved in the process. In patients with AOM with type 2 diabetes mellitus, multiple interactions of moderate strength, both direct (glucose – TNF-α, IL-6; HbAlc – LDL, TNF-α, IL-6; parathormone – IL-6, LDL; LDL – TNF-α) and inverse (calcium – TNF-α, LDL; IL-6 – calcium, IL-4), with the effect on bone tissue metabolism
were found. In patients of group 4, the presence and strength of the interrelationships were similar to the above on the background of type 2 diabetes with a decrease in their number and a strong direct correlation of HbAlc – parathormone, IL-6; parathormone – IL-6, LDL; LDL – IL-6.
Conclusions: Blood cytokine profile in patients with acute otitis media with impaired glucose metabolism is characterized by a significant increase in the pool of proinflammatory cytokines ІL-6 and TNF-α, a decrease in the level of anti-inflammatory cytokine ІL-4 in dyslipidemia by indicators of a significant increase in LDL. Multiple interrelationships of the studied indicators in patients with AOM on the background of type 2 diabetes characterize the complex proinflammatory background with an impact on the indicators of bone tissue metabolism.
Similar interrelations on the background of transient disorders of glucose metabolism indicate their importance in the pathogenesis of a particular AOM, which is also confirmed by the validity of differences in the indicators and observed correlations in patients of groups 1-2 and 3-4. Taking into account the presence and peculiarities of the influence of any disorders of carbohydrate metabolism, including transient ones, is valuable for increasing the efficiency of diagnosis and treatment of AOM in adults.
