Биология ва тиббиёт муаммолари, 2015, №1 (82) 127
УДК: 615.37-616-001-611.389
IMMUNOLOGICAL PREREQUISITES COMPLICATED COURSE OF ABDOMINAL TRAUMA
V.P. POLIOVYI, F.G. KULACHEK, Y.V. KULACHEK
Bukovinian State Medical University, Ukraine, Chernovtsy
АБДОМИНАЛ ТРАВМАНИНГ АСОРАТЛИ КЕЧИШИДА ИММУНОЛОГИК ДАСТЛАБКИ
ШАРТЛАР
В.П. ПОЛЕВОЙ, Ф.Г. КУЛАЧЕК, И.В. КУЛАЧЕК
Буковина Давлат тиббиёт университети, Украина, Черновци
ИММУНОЛОГИЧЕСКИЕ ПРЕДПОСЫЛКИ ОСЛОЖНЕННОГО ТЕЧЕНИЯ
АБДОМИНАЛЬНОЙ ТРАВМЫ
В.П. ПОЛЕВОЙ, Ф.Г. КУЛАЧЕК, И.В. КУЛАЧЕК
Буковинский Государственный медицинский университет, Украина, г. Черновцы
Мақолада қорин бўшлиғи травмаларининг асоратли кечиши сабабларини организмда иммуноло-
гик ўзгаришлар билан мос равишда булиши мумкинлигини кўрсатилган.
Калит сўзлар:
абдоминал травма, асоратлар, иммунологик ўзгаришлар.
Статья представляет собой анализ причин травмы живота с осложненным течением в соответ-
ствии с иммунологических изменений, которые могут быть причиной.
Kлючевые слова
:
абдоминальная травма, осложнения, иммунологические изменения
.
System immunological surveillance allocated as
a leading position in the processes of pathological
conditions. In patients with abdominal trauma with
low phagocytosis level, reduced synthesis of anti-
bodies, increased production of T-suppressor, cyto-
kine dysregulation is one manifestation of complica-
tions in post trauma period. Average level of pro
inflammatory cytokines in plasma increased in pa-
tients with uncomplicated post-traumatic period,
although in the case of systemic inflammatory re-
sponse syndrome and endogenous intoxication this
level increases 10 times or more. Compensatory re-
actions can lead to the development of countervail-
ing changes - from episodic syndromes to dangerous
critical states. Therefore, in patients with abdominal
trauma is important to determine violations of im-
munological reactivity, especially in the case of
complications. Immunological studies conducted in
90 patients with varying severity of abdominal
trauma and its complications. Immunological pa-
rameters are defined for identify patterns of post-
traumatic complications in the postoperative period
and confirmed the effectiveness of the proposed al-
gorithm. To determine the initial level of perfor-
mance indicators the benchmarks there was used the
control group: phagocytic index 65,14 ± 3,48%, the
number of phagocytic 3,26 ± 0,12, completeness
phagocytosis index 1,17 ± 0,06, circulating immune
complexes 74,98 ± 2,59 units. Among the factors of
humoral immunity we determined the concentration
of immunoglobulins IgA, Ig M, IgG. These indica-
tors reflect the level of intensity of humoral immuni-
ty and are not specific, while their complex and dy-
namic assessment makes it possible to predict the
development of post-traumatic postoperative com-
plications. Should be noted that analyzing of im-
munoglobulin performance fluctuations in serum
IgА had not prognostic significance in damaged of
hollow organs in the range 1,51 ± 0,07 g/l (varia-
tion1,34% of the benchmark group). At the same
time fluctuations IgА had significant level of 1,06 ±
0,04 g / l in trauma parenchymal organs (varia-
tion28.85% of the benchmark group). Dynamics of
IgА changes was explained in patients with dam-
aged parenchymal organs by the volume of blood
loss, efficiency of medical actions and compensato-
ry capacity of the organism in posttraumatic period.
A special place in determining and monitoring the
progress of post-traumatic process there is the level
of middle mass molecules (IMS) that characterize
the level of endogenous intoxication (tabl. 1.1).
To identify the relationship between the devel-
opment of multiorgan dysfunction syndrome and the
occurrence of complications in post-traumatic peri-
od there were analyzed indicators of immune regula-
tion. We were observed changes LII, IMS and activ-
ity of the complement system in cases of post trau-
matic complications on a background of multiple
organ failure (tabl. 1.2).
Complications of abdominal trauma that devel-
oped against a background of multiple organ dys-
function had a long high level (more than 3 days)
middle mass molecules. Increase level of IMS more
than 200 standard units over a period 72 hours is an
unfavorable factor for complications, because the
percentage of occurrence of posttraumatic complica-
tions against the background multiple organ failure
and high rates of MSM was 63.1%.
Immunological prerequisites complicated course of abdominal trauma
128 Проблемы биологии и медицины, 2015, №1 (82)
Table. 1.1
Dynamics of average IMS in patients with abdominal trauma research groups at the stages of treatment
Table. 1.2
Immunological predictors of multiorgan dysfunction syndrome in patients with dominant abdominal trauma
Studied parameters
controlgroup
n=35
main group
n=55
Leukocyteindex of intoxication
4,01±0,77
2,87±0,47
Middle mass molecules ,standard units
0,241±0,015
р<0,05
0,294±0,014
р<0,05
Activity of the complement system, standard units
1,20±0,03
р<0,05
1,29±0,06
р<0,05
In addition, the prolonged duration of multiple
organ failure syndrome (over 2 days) cause signifi-
cant changes in the indicators of phagocytosis,
namely, the decreased rate of phagocytic index
(18.2%) and was in the control group (52,27 ± 2,51),
study group (49,74 ± 3,74).
For the diagnosis of multiple organ failure, oth-
er than direct clinical indicators used scale MODS.
Characteristic changes in the ballroom range was
observed in the indicators of phagocytosis and level
of circulating immune complexes. In conducting the
analysis and identification of key current values
post traumatic period remains unclear primacy of
fact relevant changes: violation of phagocytosis
cause the development of multiple organ failure or
multiple organ failure causes corresponding changes
in the immune regulatory systems. Although gener-
alized not only performance MODS scale but also
clinical data and traumatic process we discovered
interdependent evidence that these processes not
only lead to the emergence of each other, but also
can provoke the development of infectious compli-
cations due to a significant fall in resistance of the
organism as a whole (tab. 1.3).
The development of multiple organ failure oc-
curs as a fragment of endogenous intoxication in
which the immune system plays a role as the leading
element of detoxification and elimination of anti-
genic fragments. To display this immunity using
leukocyte index of intoxication allows a prediction
criterion. Leukocyte index of intoxication and rate
duration determined and was compared with indica-
tors of phagocytosis, complement system activity,
IMS (tab. 1.4).
Conclusion
. Determination of immunological
parameters has a leading role in predicting postoper-
ative course in patients with abdominal trauma and
reveals the development of infectious complications
in the preclinical stage of their formation.
Tab. 1.3
Indicators of changes in nonspecific immunity in accordance with the development of multiple organ dys-
function syndrome
Indicators
MODS (points)
1-6
7-12
13-24
>24
Phagocytic index, %
61,29±3,09
p>0,7
66,14±3,47
p>0,9
41,93±1,52
p<0,001
25,15±1,21
p<0,001
Phagocytic number
2,84±0,21
p>0,2
2,96±0,19
p>0,07
2,51±0,20
p<0,001
1,92±0,11
p<0,001
Index completion of phagocytosis
1,43±0,21
p>0,1
1,48±0,19
p>0,1
1,15±0,18
p>0,4
0,71±0,19
p<0,01
Circulating immune complexes,
units
91,89±6,58
p<0,01
73,27±6,91
p>0,8
235,32±9,28
p<0,001
181,58±7,19
p<0,001
Study group
Middle mass molecules, standard units
24 hours
72 hours
7-th day
10-TH DAY
І
N=35
0,183 ±0,024
р<0,001
0,402 ±0,011
р<0,001
0,324 ±0,037
р<0,001
0,247 ±0,012
Р<0,001
ІI
N=55
0,269 ±0,014
Р<0,001
0,341 ±0,008
Р<0,001
0,384 ±0,019
Р<0,001
0,278 ±0,011
Р<0,001
V.P. Poliovyi, F.G. Kulachek, Y.V. Kulachek
Биология ва тиббиёт муаммолари, 2015, №1 (82) 129
Tab. 1.4
Dynamics of changes nonspecific immunity in accordance with the criteria for prognosis of post-traumatic
period
Indicators
Leukocyte index of intoxication
1-st level
2,7-3,7
2-nd level
3,8-5,8
3-rd level
5,8-8,5
4-th level
8,6 та >
Middle mass molecules, standard units
0,206
±0,015
р˂0,001
0,359
±0,013
р˂0,001
0,311
±0,017
р˂0,001
0,227
±0,021
р˂0,001
Phagocytic index, %
54,50±4,22
p>0,05
63,65±3,17
p>0,7
64,88±2,86
p>0,9
42,00±2,13
p<0,001
Phagocytic number
3,00±0,26
p>0,3
2,95±0,23
p>0,2
2,84±0,21
p>0,07
2,42±0,20
p<0,001
Index completion of phagocytosis
1,59±0,20
p<0,05
1,44±0,20
p>0,1
1,46±0,19
p>0,1
1,29±0,17
p>0,4
Circulating immune complexes,
units
53,60±4,76
p<0,001
93,76±5,57
p<0,01
76,04±6,95
p>0,8
221,60±8,26
p<0,001
Activity of the complement system,
standard units
1,11±0,04
р˂0,05
1,16±0,02
р˂0,05
1,21±0,03
р˂0,05
1,28±0,01
р˂0,05
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IMMUNOLOGICAL PREREQUISITES
COMPLICATED COURSE OF ABDOMINAL
TRAUMA
V.P. POLIOVYI, F.G. KULACHEK,
Y.V. KULACHEK
Bukovinian State Medical University,
Ukraine, Chernovtsy
The article presents an analysis of the causes of
abdominal trauma with complicated course accord-
ing to immunological changes that may cause.
Key words
:
abdominal trauma, complications,
immunological changes.
