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UDC-618
BRONCHOECTASIS DISEASE IS ASSOCIATED WITH NEUTROPHIL
GELATINASE AND LIPOCALIN-2
Go‘zala Ropiyeva
Student of Jizzakh State Pedagogical University
Employee of the "Republican Emergency Medical Aid"
Jizzakh Regional Branch
Abstract:
This article provides information about the negative effects that bronchoectasis
disease and its causes can have on human health. Based on practical experiences, various
processes are presented in tabular form, and the information collected by the author serves
as a practical guide for specialists in the field and individuals with a high interest in the
subject.
Keywords:
bronchoectasis disease, neutrophils, symptoms, lipocalin-2, gelatinase,
argument.
Introduction
Today, significant changes are being implemented in the field of medicine, just as in all
other areas of our country. Decisions and decrees are being adopted by our state leader to
prevent human health issues and various infectious and chronic diseases. The decree of the
President of the Republic of Uzbekistan dated July 28, 2021, PQ-5199, "Measures to further
improve the system of specialized medical care in the healthcare sector," indicates the
responsibility each individual has for their health. This, in turn, motivates us to acquire new
knowledge in the field of medicine. Currently, one of the diseases that can quickly debilitate
not only young children but also adults is bronchoectasis. Bronchoectasis is a disease
associated with the dilation and inflammation of the airways, which often occurs
spontaneously or as a result of other respiratory diseases. Identifying systemic inflammation
markers in this disease is crucial, as these inflammatory processes determine the severity of
bronchoectasis and its treatment.
1. Inflammation Markers: Identified through blood tests, such as C-reactive protein (CRP)
and other inflammation markers.
2. Neutrophils: These are one of the main cells of the immune system and play an active role
in the inflammatory process. Their levels may be elevated in bronchoectasis.
3. Symptoms: Clinical signs such as bleeding, fever, cough, and difficulty breathing.
Neutrophil Gelatinase and Lipocalin-2 are enzymes produced by neutrophils that play a
crucial role in the inflammatory process. They participate in the breakdown of tissues
between cells and in the inflammatory process. Lipocalin-2 is another protein produced by
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neutrophils that is significant in the inflammatory process. It regulates interactions between
cells and tissues during inflammation. In bronchoectasis, as a result of systemic
inflammatory processes, neutrophils increase, and the production of gelatinase and lipocalin-
2 rises. These processes lead to an intensification of inflammation, as the substances
produced by neutrophils enhance the inflammatory process. The systemic effect is reflected
in the levels of neutrophil gelatinase and lipocalin-2, indicating systemic inflammation
markers and determining the severity of the disease.
Materials and Methods
Bronchoectasis arises from recurrent or chronic infections. Chronic, persistent dilation of the
airways leads to an inflammatory disease that triggers neutrophilic inflammation in the
infectious or inflammatory airways, resulting in the release of proteolytic enzymes from
neutrophils, which in turn causes damage to the airway matrix. Damage to the epithelial
mucosa and decreased efficiency of mucosal clearance lead to reduced air quality and
bacterial colonization. Further intensification of inflammation and damage to the airways
contribute to the exacerbation of the disease. The most common causes include pneumonia
or lung infections, tuberculosis, primary and secondary immunodeficiency, abnormal ciliary
function, allergic bronchopulmonary aspergillosis (ABPA), and connective tissue diseases.
Today, in developed countries, effective use of antibiotics and immunization has led to a
decrease in the incidence of bronchoectasis. However, in developing countries, the high
prevalence of pulmonary tuberculosis, inability to carry out effective vaccinations, and
recurrent and inadequately treated lower respiratory tract infections still make it a
widespread disease. Neutrophilic bronchial inflammation is a primary cause of
bronchoectasis. There is an increase in neutrophilia in the blood and certain cytokines
associated with neutrophils. Neutrophil gelatinase-associated lipocalin (NGAL) is a small,
stable protein synthesized by neutrophils and various epithelial cells, including renal
proximal tubules, whose physiological functions are not yet fully understood.
According to the materials and methods, patients who sought medical attention and were
diagnosed with acute infections were included in the study. Fifty stable patients with
bronchoectasis who exhibited no symptoms or signs were included. A control group
consisting of 30 healthy individuals of the same age and gender was created. The age,
gender, HRCT results, spirometric data recorded at the time of admission, and serum NGAL
levels of all patients were noted.
1. A confirmed diagnosis of bronchoectasis was made using high-resolution computed
tomography (HRCT).
2. Stable disease (without exacerbation and antibiotic use for 4 weeks prior) was assessed as
stable disease. Acute exacerbation was defined by the absence of increased dyspnea, sputum
volume, and purulence criteria.
3. Participants must adhere to criteria of not smoking for at least 1 year and limiting
smoking
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Figure 1
The diagnosis of bronchiectasis was carried out in all patients using HRCT. Typically, any
lesions in the lung parenchyma visible within the airways and bronchi should not be closer
than 1 cm from the costal pleura. In adults, a bronchus/artery diameter ratio greater than 1 is
considered abnormal. The accepted and peripheral airways are located 1 cm below the costal
pleura. If visible in bronchiectasis, it is assessed in favor. The presence and degree of
bronchiectasis were determined by HRCT in patients. Findings were reviewed by a
radiologist, and each process was evaluated separately according to a scoring system.
According to this classification, the degree of bronchiectasis is rated as 0 = absent, 1 = less
than 25% of lobar volume, 2 = 25% to 50% of lobar volume, and 3 = more than 50% of
lobar volume. The overall score for each patient is calculated as a bronchiectatic severity
index. Additionally, based on HRCT results, wall thickness was assessed as 0 = no
thickening, 1 = wall thickness less than 25-50%, 2 = wall thickness greater than 50%, and 3
= completely obliterated. Furthermore, findings such as peribronchial thickening, loss of
mosaic perfusion volume in adjacent lung tissue, and fibrosis were evaluated and recorded
alongside HRCT.
Table 1. Demographic Characteristics of Bronchiectasis and Healthy Control Groups
and Serum NGAL Levels
№
Age
Gender
NGAL (ng/ml)
1
57,68±13,04
Ayol, n, %) 43, 54% 16, 53,3%
1,00
74,18±24,54
53,33±14,87 <0,001
Argument
In our study, the average age was 57.68±13.04, and the average NGAL value in the
bronchiectasis group was 74.18±24.54 ng/ml, while in the control group it was 53.33±14.87
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ng/ml. It was found that NGAL was significantly higher in patients with bronchiectasis. This
indicates that inflammation remains active even during stable periods in these patients,
revealing markers of systemic inflammation. No significant correlation was found between
NGAL and other variables. A statistically significant relationship was identified between
total small airway disease, bronchiectatic score, total wall disease thickness, and overall
mosaic perfusion. The studies showed that exacerbations occur in patients suffering from
bronchiectasis. Furthermore, even during the stable phase of the disease, signs of systemic
inflammation were also examined, as our research indicated that concentrations in serum
increased during stable periods in patients with bronchiectasis. Previous studies have shown
that NGAL expression increases in various malignancies such as breast, lung, prostate, and
colorectal cancers, and this is considered a prognostic factor for cancer treatment.
Conclusion
In conclusion, it can be stated that the level of inflammation in the blood of patients with
bronchiectasis indicates that mediators are systematically increasing. Inflammation plays a
significant role in the pathogenesis. This is concerning. The aim of our study is to
investigate the relationship between neutrophil gelatinase, NGAL as an inflammatory
marker, and inflammation in patients with bronchiectasis.
Materials and Methods: The study included 50 patients diagnosed with bronchiectasis who
did not have a history of bronchiectatic disease and exhibited symptoms of acute infection.
A healthy control group matched for age and gender was created with 30 participants.
Peripheral venous blood samples were taken from both the bronchiectasis patients and the
control group, and NGAL levels were measured.
References
1. "Measures to further improve the system of specialized medical care in the field of health
care" PQ July 28, 2021.2-Jasper AE, McIver WJ, Sapey E, Walton GM. Understanding the
role of neutrophils in chronic inflammatory airway disease. F1000Research. 2019;8
3-Weycker D, Hansen GL, Seifer FD. Prevalence and incidence of noncystic fibrosis
bronchiectasis among US adults in 2013. Chronic respiratory disease. 2017;14(4):377- 84
4-Ozyurt S, Karatas M, Arpa M, Kara BY, Duman H, Memoglu M, et al. Neutrophil
gelatinase-associated lipocalin as a potential biomarker for pulmonary thromboembolism.
Turk J Biochem 2020;45(1):51–56.
