THE IMMUNE SYSTEM IN CHILDREN WITH ASTHMA WITH COMBINED AND COMBINED FORMS AND ALLERGIC RHINOSINUSITIS

Allergic diseases are increasing all the socio - economic problem worldwide [4,5,6,7] Rising allergies and asthma coincided with changes in both the environment and the lifestyle of people . According to the results of epidemiological studies , the incidence of allergies and asthma in different nations varies widely . This is due to climatic characteristics , environmental variability , social inequality between wealthy and low-income segments of the population [ 4,5,6,7 ] . It is currently believed that rhinitis and asthma are manifestations of a single disease , the combined group in the airways ("one wag, one discase", allergic rhinobronchitis ")[8,9,10]. In this regard, the aim of our research is the study of cell- humoral immunity in patients with asthmatic children combined and incongruous form of allergic rhinosinusitis APC. Resume Accovding to our research there are 49 patients who hurt with bronchial asthma and first group i.e. (id est) 26 of them hurt with bronchial asthma (BA),second group i.e. 23 of them hurt with bronchial asthma which combined with allergic rinosinusith. The results of research show that cellule humoral immunity spoiled in patients of both group. There are a lot of patients who hurt with bronchial asthma which combined with allergic rinosinusiths. Research on acturity of fagositos show that fagositive activity of neutrofeels exceed in B.A. but decredse in BATARS. Materials and Methods We have carried out a study on the state of the immune system in 49 children with asthma . Of these 27 boys , 22 girls . The control group consisted of 20 healthy children of similar age. Patients were divided into two groups , one group of 26 children with bronchial asthma (BA ) . 2-group of 23 children with asthma sochetannym allergic rhinosinusitis . (APC ) . Immunological studies were carried out to study the quantitative determination of lymphocyte fenotinom CD3 , CD4 , CD8 , SD16 , SD20 of peripheral blood in a series of monoclonal antibodies LT ( Institute of Immunology , TOO " sorbent " , Moscow, Russia ) . Of serum immunoglobulins A.M.G. determined by the method Manshini (1963), the phagocytic activity of neutrophils was determined by the method G.E.Platonova (1966), the content of anti-inflammatory cytokines : determined by ELISA method . Results and discussion . Analysis of the studies showed that the content of T-lymphocytes in asthma was significantly reduced compared with the control group . And it was observed in both children with asthma and in associated with allergic rhinosinusitis . The relative number of lymphocytes in the CD - averaged 45.2 + _ 1.6 % in bronchial asthma and 42.2 _ 1.5 % when combined with a form of allergic rhinosinusitis , below the control values by 1.3 and 1.4 times , respectively, (p < 0.001 ) . The absolute number of T lymphocytes in combined form was 1.1 times lower than the reference values -968 , 29.0 in 1mkl 0_ (p <0.05 ), while BA- 1, 3 -fold lower than the control group , 820.0 _ + 75.0 to 1 l ( p < 0.001).

                                                                                                                                  Table 1

 Parameters of cellular immunity in children with atopic asthma with combined and combined forms of ADR (M ± m)

Note: * - Value are valid with respect to the control group (P <0,05 - 0,01); 

        ** - Significance of differences between the groups being compared indicators of sick               children (P <0,05 - 0,01)

 Analysis of the results of the study subpopulations of T lymphocytes showed that in AD observed significantly reduced content as T-helperov/induktorov 24,2-1,3 439.0 % and 21.0 _ in l (p < 0.01) and cytotoxic T- suppressor lymphocytes -18 1.007 % 4_ _ 333.0 and 26.0 in 1 l ( p < 0.01). In children with asthma combined form of APC relative number of LEDs 4 -lymphocytes was reduced by 1.4 times to 26.4 _ 1.05 % and the absolute in the same 605.0 _ 29.0 in 1 l ( p <0.01) . Whereas the relative and the absolute value DM - 8 cells in the second group of children had significantly elevated _ 26.1 1.7 % (p < 0.01) and in 598,0-27,0 l (p < 0.01) respectively. Sick children asthma was observed significantly reduced content of CD 16 + lymphocytes ( 8,3-0,41 %) , which is 1.7 times lower than the control group ( p <0.01) . Different pattern was observed in 2 patients which children were children with asthma in conjunction with APC , the relative and the absolute value of DM 16 cells was increased compared with the control group 19.2 _ 1.2 (p <0.01) and 440.0 _ 26.0 in 1 mm (p < 0.05).
In the study of humoral immunity in patients with asthmatic children had an average of : IgG 1-1276,0 _ +56,0 mg
% (p < 0.05). IgA -220,0 _ + -11,0 mg % (p < 0.01). IgM level slightly below control values 99, 11.0 mg % 0_ %. In the group of children with asthma combined ARS IgG1 level was significantly higher than the control values -1417 , 0_ 72.0 % vs 1173.0 mg _ 54.0 mg % , IgA levels were significantly elevated -267 , 20.0 mg % 0_ against 142.0 _ 7.9 mg % (p < 0.001). IgM concentration was significantly lower in the control values of 74.0 _ 7.9 mg % vs. 125.0 _ 11.0 mg % (p < 0.05). Phagocytic activity of neutrophils in atopic asthma in children was significantly increased compared with the control group - 70.1 + _3 , 8 % versus 54.3 _ + 1.2% ( p <0.001) . However , in a group of children with asthma in combination with phagocytosis by APCs was reduced by 1.9 % -42.4 _ (p < 0.01)




Pic.1. Levels of immunoglobulins A, M, G in the serum of children with asthma and BAsARS
It is known that T-lymphocytes helper type 1 (Th1) responsibility for the development of cellular immunity and T - lymphocyte helper type 2 (Th2)- humoral . Osnavnaya role in regulating the immune response between klonamiTh1 -Th2 cells play cytokines tumor necrosis factor ( TNF ), γ- interferon (IFN γ), interleukin -1β. Therefore determine the level of serum TNF , IFN γ and IL -1β in patients with both groups of children .
Our data demonstrate increasing levels of proinflammatory cytokine levels in patients , both children groups . Particularly pronounced increase in TNF , IL -1β was observed in children with asthma form the perfect balance with allergic rhinosinusitis .

Pic.2.Interleukin pediatric patients combined and combined forms of bronchial asthma with ARS

In bronchial asthma with combined ARS TNFa level h greatly privyshe (243,5 ± 68,0 pg / ml compared with a group of patients with bronchial astmoy113 , 7 ± 32,0 pg / ml, p <0.001) . Contents of IL 1β in the blood serum of children patients with co Bass ARS form pokazivaet tenfold increase compared with the control group (346,7 ± 73,0 pg ml versus 35,8,6 pg / ml ± 12 , p <0.001 ) .
In children with bronchial asthma levels of IL -1β more than 3 -fold compared with the control group 110,4 ± 21,0 pg ml , p < 0.00. The results of determination of serum IFNγ in both groups of patients showed a decrease in concentration as IFNΥ combined and when not combined with a form of asthma APC 74,3 ± 12,5 pg / ml and 78,5 ± 14,1 pg / ml. against a control group 131,7 ± 18,1 pg / ml. Thus, when analyzing the level of a number of anti-inflammatory cytokines in the serum of children and co- co- BA form with a marked ARS significant increase FNO2 and IL1β in combined form with BA ARS and a moderate increase in bronchial asthma. Serum levels of IFN γ in patients okozalos both groups was significantly lower than the control group.
On the basis of research results , the following conclusions :
1. As for combined and combined forms of BA ARS marked with violations cell humoral immunity , T-and B - lymphocytes and their subsets , as well as increasing the concentration of IgA, IgG and reduction in blood IgM. These changes are more pronounced in AD combined with APC. The study shows a significant increase in phagocytosis of phagocytic activity of neutrophils in asthma and vice versa , reducing it in AD with concomitant AR
2. Analysis of anti-inflammatory cytokines in the serum of children with combined and co- form with BA ARS recognizes the significant significant increase of TNF and IL -1β in combined form with asthma and ARS moderate increase in bronchial asthma. Serum IFNγ levels in patients , both groups were significantly lower than control group (p < 0.001).

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