Urogenital tract microbiocenosis and quantitative features of papillomavirus infection depending on the severity of HPV-associated cervical lesions
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Taking into account the literature data on the significance of the mucous membranes in providing an immune filter, and cervical mucus in providing an immune response due to the high content of the main mediators of the development of a local inflammatory response, i.e. anti-inflammatory cytokines, which play a major role in the regulation of the immune response and the formation of local antiviral and antitumor immunity, we studied the cytokine profile in patients with HPV-associated cervicitis and the effect of the combined use of polarized light and an immunomodulator on their content, depending on the viral load. The purpose of the work is to study the effect of the combined exposure to blue monochromatic polarized incoherent light and polychromatic visible and infrared polarized light in combination with Imiquimod 5% cream for external use on the state of the cytokine profile in the cervical mucus in patients with HPV-associated cervicitis. Material and methods. The study included 60 patients with an HPV-associated cervicitis with the history of at least 1 year, aged 20 to 35 years, who were randomly divided into three groups: the main group of 20 patients who underwent course exposure to blue monochromatic polarized incoherent light on the projection of the carotid arteries and polychromatic visible and infrared polarized light on the cervix in combination with Imiquimod 5% cream for external use (complex 1); a comparison group of 20 patients who underwent the exposure to polychromatic visible and infrared polarized light on the cervix in combination with the topical cream, Imiquimod 5% (complex 2); a control group of 20 patients who underwent a course of local effects on the cervix with the cream Imiquimod 5% and 20 healthy women of similar age, whose the survey data were taken as a norm. To assess the cytokine state in patients with HPV-associated cervicitis, the levels of IL-1β, IL-2, IL-10, IFNa, IFNy, and TNFa in the cervical mucus were studied before and after the course of treatment by the enzyme immunoassay method. The results of the research and the discussion. Prior to the treatment, certain differences were found depending on the viral load. In patients with a low viral load, interferon levels of IFNα and IFNγ were increased by 55% (p < 0.05) and 93%, respectively (p < 0.01), compared with those of healthy women, with a significant decrease in the content of IL-10 — by 85% (p < 0.01), IL-2 — by 53% (p < 0.05) and TNFα — by 56% (p < 0.05), the content of IL-1β was increased only by 8% (p > 0.05). When analyzing cytokine levels in patients with an increased viral load, IFNα was increased by 48% (p < 0.05) and IFNγ — by 62% (p < 0.05), as well as IL-1β — by 59% (p < 0.05), and TNFα — by 37% (p < 0.05), compared to healthy women, with a significant decrease in IL-10 and IL-2 — by 53% and 56%, respectively (p < 0.05). The increase in the concentration of TNFα and IFNγ with an increased viral load was slightly lower. In patients with a significant viral load, interferons IFNα and IFNγ were increased by 35% and 40%, accordingly (p < 0.05), IL-1β — by 17.9% (p < 0.05) and IL-10 — by 14.1% against the background of a slight decrease in the content of TNFα — by 14.5% (p >0.05) and a highly significant 2.26-fold decrease in IL-2 — (p < 0.05), which play an important role in the regulation of the Th1 immune response. After the treatment, in patients of the main group (complex 1) and a comparison group (complex 2) with no significant differences, the positive dynamics was observed, manifested in lowering the initially increased concentrations of TNFα and IFNγ, IL-1β and IL-10 approaching the level of healthy individuals; in the control group, the decrease of the initially increased IL-2 and TNFα was noted, and, although there was a positive dynamics of all the studied indicators, it was less pronounced. Conclusion. The obtained data indicate a pronounced immunocorrective effect of the combined use of blue monochromatic polarized incoherent light on the projection of the carotid arteries and polychromatic visible and infrared polarized light on the cervix in combination with Imiquimod 5% cream for external use in patients with chronic cervicitis associated with papillomavirus infection, which is confirmed by an improvement in the cytokine profile.
Taking into account the literature data on the significance of the mucous membranes in providing an immune filter, and cervical mucus in providing an immune response due to the high content of the main mediators of the development of a local inflammatory response, i.e. anti-inflammatory cytokines, which play a major role in the regulation of the immune response and the formation of local antiviral and antitumor immunity, we studied the cytokine profile in patients with HPV-associated cervicitis and the effect of the combined use of polarized light and an immunomodulator on their content, depending on the viral load. The purpose of the work is to study the effect of the combined exposure to blue monochromatic polarized incoherent light and polychromatic visible and infrared polarized light in combination with Imiquimod 5% cream for external use on the state of the cytokine profile in the cervical mucus in patients with HPV-associated cervicitis. Material and methods. The study included 60 patients with an HPV-associated cervicitis with the history of at least 1 year, aged 20 to 35 years, who were randomly divided into three groups: the main group of 20 patients who underwent course exposure to blue monochromatic polarized incoherent light on the projection of the carotid arteries and polychromatic visible and infrared polarized light on the cervix in combination with Imiquimod 5% cream for external use (complex 1); a comparison group of 20 patients who underwent the exposure to polychromatic visible and infrared polarized light on the cervix in combination with the topical cream, Imiquimod 5% (complex 2); a control group of 20 patients who underwent a course of local effects on the cervix with the cream Imiquimod 5% and 20 healthy women of similar age, whose the survey data were taken as a norm. To assess the cytokine state in patients with HPV-associated cervicitis, the levels of IL-1β, IL-2, IL-10, IFNa, IFNy, and TNFa in the cervical mucus were studied before and after the course of treatment by the enzyme immunoassay method. The results of the research and the discussion. Prior to the treatment, certain differences were found depending on the viral load. In patients with a low viral load, interferon levels of IFNα and IFNγ were increased by 55% (p < 0.05) and 93%, respectively (p < 0.01), compared with those of healthy women, with a significant decrease in the content of IL-10 — by 85% (p < 0.01), IL-2 — by 53% (p < 0.05) and TNFα — by 56% (p < 0.05), the content of IL-1β was increased only by 8% (p > 0.05). When analyzing cytokine levels in patients with an increased viral load, IFNα was increased by 48% (p < 0.05) and IFNγ — by 62% (p < 0.05), as well as IL-1β — by 59% (p < 0.05), and TNFα — by 37% (p < 0.05), compared to healthy women, with a significant decrease in IL-10 and IL-2 — by 53% and 56%, respectively (p < 0.05). The increase in the concentration of TNFα and IFNγ with an increased viral load was slightly lower. In patients with a significant viral load, interferons IFNα and IFNγ were increased by 35% and 40%, accordingly (p < 0.05), IL-1β — by 17.9% (p < 0.05) and IL-10 — by 14.1% against the background of a slight decrease in the content of TNFα — by 14.5% (p >0.05) and a highly significant 2.26-fold decrease in IL-2 — (p < 0.05), which play an important role in the regulation of the Th1 immune response. After the treatment, in patients of the main group (complex 1) and a comparison group (complex 2) with no significant differences, the positive dynamics was observed, manifested in lowering the initially increased concentrations of TNFα and IFNγ, IL-1β and IL-10 approaching the level of healthy individuals; in the control group, the decrease of the initially increased IL-2 and TNFα was noted, and, although there was a positive dynamics of all the studied indicators, it was less pronounced. Conclusion. The obtained data indicate a pronounced immunocorrective effect of the combined use of blue monochromatic polarized incoherent light on the projection of the carotid arteries and polychromatic visible and infrared polarized light on the cervix in combination with Imiquimod 5% cream for external use in patients with chronic cervicitis associated with papillomavirus infection, which is confirmed by an improvement in the cytokine profile.
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