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FEATURES OF THE INFLAMMATORY RESPONSE IN PATIENTS WITH
ACUTE AND LONG-LASTING NON-HEALING BURN WOUNDS
Baxodirov Behzod Baxodirovich
1
, Xolmurodova Dilorom Bekpo‘latovna
2
,
Xolmurotov Baxodir Toshpo‘latovich
2
1
Tashkent medical academy
2
Bukhara Branch of the RSPCFME
Annotation:
The problem of treating chronic wounds remains relevant, but
the topic of research on the inflammatory process in patients with long-term non-
healing burn wounds has not been sufficiently covered in the literature. The article is
devoted to the study of the peculiarities of changes in the content of inflammatory
markers in patients during the acute period of burn disease and with a duration of the
wound process of more than 35 days. The conducted studies indicate the severity of
inflammation, which persists despite the age of the process and undoubtedly has an
effect on wound healing. Everyone has patients showed a significant increase in the
level of C-reactive protein, and a1 - antitrypsin. When assessing the content of α
2
-
macroglobulin (α
2
-MG) and haptoglobin (GG), individual variability of these
indicators was established. In patients with long-term non-healing wounds, a greater
frequency of a decrease in the concentration of α
2
-MG and an increase in GH was
found compared with similar indicators in patients during the acute period of burn
disease. The level of ceruloplasmin turned out to be a more stable indicator than other
acute-phase proteins and exceeded the limits of Normal values are found in only one
patient during the acute period of burn disease, as well as in one patient with long-
term non-healing wounds. There was no correlation between changes in the
concentrations of the studied acute-phase proteins, except for the found relationship
between the level of GH and α
2
-MG, which indicates compensatory rearrangements
leading to increased synthesis of GH neutralizing lysosomal enzymes against the
background of reduced α
2
-MG activity. Analysis of changes in the content of acute-
phase blood proteins (a
1
-antitrypsin, α
2
-MG, GG) can it can be important in assessing
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the severity of the course and prognosis of the disease, which will make it possible to
outline tactics for regulating the inflammatory process and thereby increase the
effectiveness of treatment of chronic wounds in burned patients.
Keywords:
burn
wounds;
C-reactive
protein;
α
1
-antitrypsin;
α2
-
macroglobulin; haptoglobin; ceruloplasmin
Introduction.
In response to severe thermal injury, infection, which can join
and complicate the course of the underlying disease, physiological reactions develop
in the div of the burned patient aimed at localizing the lesion and restoring impaired
functions. The resulting inflammatory reaction is accompanied by changes in the
immune system, intensification of catabolic reactions, increased energy consumption,
and impaired microcirculation and blood coagulation [1-4]. The classic acute phase
lasts for several days, but this The process can be prolonged if the damaging factors
continue to act or if the control and regulation mechanisms are disrupted, as a result
of which the acute phase response can be converted into a chronic phase of
inflammation [5-8]. During the development of the inflammatory reaction, an
increase in the content of acute phase proteins (OFBS), which occupy an important
place in the system of immunoregulation and nonspecific resistance, is noted in the
blood serum and damaged tissues. The dependence of the course of the wound process
is known It depends on the level of acute-phase proteins with antiproteolytic activity
[9-12]. On the one hand, a decrease in the activity of proteolytic enzymes of wound
secretions slows down the cleansing of wounds from necrotic tissues, but on the other
hand, a significant increase in proteolytic activity can contribute to deep tissue
alteration with increased invasion of microorganisms. Such changes, depending on
the course of the wound process, must be taken into account in the treatment of
wounds using bandages containing immobilized enzyme preparations [13-14].
Among the victims of thermal trauma, there are patients with long-term
wounds, the treatment of which is quite lengthy. The healing time of chronic burn
wounds is influenced by many factors, including infection, inflammation, and
microcirculation disorders [15-16]. The topic of studying the features of the
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inflammatory process in this category of patients has not been sufficiently covered in
the literature and needs further study.
The purpose of this work
is to study changes in inflammatory process
reactants in patients with acute period of burn disease and with long-term non-healing
burn wounds.
Material and methods
. 17 patients with a burn area of more than 20% of the
div surface and a duration of the wound process of more than 35 days were
examined (group 2). The comparison group (group 1) included 16 patients with a
similar lesion area who were examined during the first 12 days after injury. The
control group consisted of 20 practically healthy people. The groups were comparable
in gender and age. The severity of the systemic inflammatory response was assessed
by the content of acute phase proteins in the blood. Levels of haptoglobin (Hp),
ceruloplasmin (CP), α
1
-antitrypsin (α
1
-AT), α
2
-macroglobulin (α
2
-MG) was studied
using ptec kits Belgium) on a semi-automatic biochemical analyzer "lima-15"
(Spain). C-reactive protein levels (CRP) was determined using the diagnostic system
"ycoard®" (xis-hield, Norway). The concentration of total protein and albumin was
studied using an ab-650 biochemical analyzer (Italy, USA, Japan).
Mathematical data processing was performed using descriptive statistics,
sample comparison (Mann-Whitney U–test), and correlation analysis based on the
calculation of Spearman's nonparametric correlation coefficient. The critical value of
the significance level was assumed to be 0.05. The data was provided in the form of
Me (P25; P75), where Me is the median, P25 and P75 are the first and third quartiles.
Statistical data processing was performed using the statistical 6.0 program.
Results and discussion.
In both groups of patients examined, pronounced
changes in inflammatory markers were found. In all patients of the examined groups,
a high level of the "golden marker" of inflammation, CRP, was detected, the average
content of which changed slightly with the duration of the disease. This acute-phase
reactant has proinflammatory and procoagulant properties by inducing the release of
roinflammatory cytokines, activating monocyte differentiation into macrophages, and
stimulating thrombosis by suppressing tissue plasminogen activator [9].
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Investigation of the content of the main antiprotease of blood plasma-a
1
-AT-
revealed her increased. The level is high both in the acute period of burn disease and
in patients with long-term non-healing wounds. The increase in the content of this
enzyme has a protective mechanism and is due to the activation of its synthesis, aimed
at interacting in damaged tissues with proteases, primarily with neutrophil elastase
and collagenase [10]. When assessing the content of the universal protease inhibitor
α
2
-MG, the individual variability of this indicator was established. In the first group
of patients, the frequency of decrease in α
2
content-MG was 18%, in 9% of cases it
exceeded the values of healthy people and in 63% of cases it did not exceed the normal
values. A different pattern was observed in patients with long-term non-healing
wounds: the frequency of occurrence of normal α
2
-MG values was 53%, a decrease
was detected in 47% of cases. When comparing the values of this protease, a
statistically significant difference was found between the patient groups (p=0.005).
Apparently, the overall decrease in the level of α
2
-MG is associated with its
expenditure on inhibition of endopeptidases and removal from the vascular bed. It can
be assumed that another reason for the decrease in the level of α
2
-MG is a violation
of the protein–synthesizing function of the liver in patients at all follow-up periods,
manifestedby a decrease in the concentration of total protein, as well as albumin – a
negative reactant of the acute phase of inflammation. A decrease in macroglobulin
production contributes to the predominance of blood coagulation processes over
fibrinolysis, which allows for the creation of a pathological a barrier to the spread of
tissue destruction [11]. At the same time, there is an excess of proteinases, metabolic
disorders in the focus of inflammation and, as a result, the accumulation of under-
oxidized metabolic products and a decrease in the pH of the medium cause damage
to α
2
-MG. The resulting complex of damaged α
2
-MG with enzymes such as plasmin
preserves the catalytic properties of the latter, but protects hydrolases from inhibition
by serpins, which allows it to freely destroy specific substrates and contribute to the
further development of necrosis. It is possible that the inhibition of α
2
-MG synthesis
by in the later stages of inflammation, it minimizes the formation of such
autoaggressive complexes [12].
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In patients of the second group, the incidence of values exceeding those of
healthy people was 88.2%,while in other patients the indicator was within the normal
range. The pathogenetic significance of increasing the level of this acute-phase
protein lies in the fact that, in addition to binding free hemoglobin , it inhibits
lysosomal hydrolases, modulates the activity and proliferation of leukocytes in the
inflammatory site, and, being a peroxidase, provides protection against reactive
oxygen species [13]. The CP level turned out to be a more stable indicator than the
rest of the AFB, and exceeded the normal values in only one patient during the acute
period of burn disease (66.4 mg/dl at a norm of 20-61mg/dl) and in one patient with
long-term non-healing wounds (79.8 mg/dl). It should be noted that there was no
correlation between the changes in the concentrations of the studied OFBS, with the
exception of the detected relationship between the level of GH and α
2
-MG (r = -0.62,
p = 0.007), which may indicate compensatory changes leading to reduced α
2
activity.
Conclusion.
The conducted studies in patients both in the acute period of burn
disease and in patients with long-term non-healing burn wounds indicate the severity
of inflammation, which persists despite the prescription of the process and
undoubtedly affects wound healing. Analysis of changes in blood OFB content,
namely α
1
-antitrypsin, Hp and α
2
-MG, may be important in assessing the severity of
the course and prognosis of the disease, which will allow us to outline the tactics of
regulation the inflammatory process and thereby increase the effectiveness of
treatment of chronic wounds in burned patients.
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