STOMATOLOGIYA
3.
Орехов
Д.Ю.
Клинико-биохимическое
обоснование оказания стоматологической помощи
пациентам,
получающим
гемодиализ:
Автореф.
дис. ... канд мед. наук. - М., 2009. - 28 с.
4. Усманова Ш.Р., Давлатова Д.Д. Дисфункция
эндотелиоцитов
у
больных
хроническим
генерализованным пародонтитом // Интернаука. -
2020.-№44.-С. 62-65.
5.
Усманова Ш.Р., Хаджиметов А.А., Комилов
Х.П. Оценка местного и гуморального иммунитета
у
больных
с
хроническим
пиелонефритом
//
Стоматология:
наука
и
практика,
перспективы
развития. Волгоград, 2021. - С. 221-222.
Цель:
определение
биомаркеров
ренального
поражения
почек
у
больных
хроническим
генерализованным пародонтитом.
Материал и методы:
под наблюдением были
58 пациентов с хронической болезнью почек, а
именно
с
тубулоинтерстициальным
поражением
почек,
госпитализированных
в
нефрологическое
отделение
клиники
ТГСИ
в
2018-2019
гг.
Контрольную группу составили 18 человек со
здоровой полостью рта, не имеющих патологии
почек.
Результаты:
чувствительным маркером
тубулоинтерстициального
поражения
почек
является уровень в слюне, крови и моче активности
лизоцима и липокалина-2.
Выводы:
маркеры проксимальных канальцев
почек
у
больных
позволили
предложить
лечебно-профилактические
мероприятия
при
тубулоинтерстициальном
поражении
почек,
направленные на улучшение качества жизни.
Ключевые слова:
хронический
генерализованный
пародонтит,
тубулоинтерстициальное
поражение
почек,
лизоцим, гипероксалурия, уратурия.
Maqsad:
surunkali generalize periodontit bilan
og’rigan bemorlarda buyrak buyrak shikastlanishining
Хирургическая
стоматология
biomarkerlarini aniqlash.
Material va usullar:
2018-2019 yillarda TSSI
klinikasining
nefrologiya
bo’limiga
yotqizilgan
surunkali
buyrak
kasalligi,
ya’ni
tubulointerstitial
buyrak shikastlanishi bilan kasallangan 58 nafar
bemor
kuzatuvda
olindi.
Nazorat
guruhi
og’iz
bo’shlig’i sog’lom va buyrak patologiyasi bo’lmagan
18 kishidan iborat edi.
Natijalar:
tubulointerstitial buyrak
shikastlanishining
sezgir
belgisi
tupurik,
qon
va
siydikdagi lizozim va lipokalin-2 faolligi darajasidir.
Xulosa:
bemorlarda buyrak proksimal
kanalchalarining markerlari hayot sifatini yaxshilashga
qaratilgan
tubulointerstitial
buyrak
shikastlanishi
uchun terapevtik va profilaktika choralarini taklif
qilish imkonini berdi.
Kalit so’zlar:
surunkali generalize periodontit,
tubulointerstitial
buyrak
kasalligi,
lizozim,
giperoksaluriya, uraturiya.
Objective:
To determine the biomarkers of renal
kidney damage in patients with chronic generalized
periodontitis.
Material and methods:
58 patients with chronic
kidney disease, namely, with tubulointerstitial kidney
damage, hospitalized in the nephrology department of
the TSSI clinic in 2018-2019, were under observation.
The control group consisted of 18 people with a
healthy oral cavity and no kidney pathology.
Results:
A sensitive marker of tubulointerstitial
kidney damage is the level of lysozyme and lipocalin-2
activity in saliva, blood and urine.
Conclusions:
Markers of the proximal tubules
of the kidneys in patients made it possible to
propose therapeutic and preventive measures for
tubulointerstitial kidney damage aimed at improving
the quality of life.
Key
words:
chronic
generalized
periodontitis,
tubulointerstitial
kidney
disease,
lysozyme,
hyperoxaluria, uraturia.
UDC: 616.716+616-001,5:616.31:616-036.82
IMMUNOCORRECTION OF POST-TRAUMATIC INFLAMMATORY COMPLICATIONS IN
PATIENTS WITH FRACTURES OF THE LOWER JAW
V7
Rakhimov Z.K., Razzakov Q.R.
Bukhara State Medical Institute
36
ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ
Preparations containing bacterial lysates attract
the interest of many specialists in various fields
of medicine. A long study of the properties and
mechanism of action confirms their immunotropic
effect and indicates the absence of the formation
of
persistent
protective
immunity,
which allows
them to be attributed to immunostimulating drugs
[2,3,9,15.17].
Lysates are fragments of destroyed bacterial cells
that have lost their viability (and therefore cannot
cause infectious diseases), but retained the ability to
activate immunity [16].
Lysates stimulate both innate immunity (through an
increase in the activity of dendritic cells, macrophages,
natural killers, the synthesis of interferons, etc.) and
acquired immunity
(by increasing the activation
of antidiv production, increasing the activity of
lymphocytes) [10,14].
In the 1970s, the first works were published proving
the effectiveness of the use ofbacterial lysates to reduce
the frequency and severity of respiratory infections.
In the same years, lysates of nonspecific action were
developed, however, the first representatives of this
group (pyrogenal and prodigiosan) had pronounced
side effects [6,13]. Second-generation drugs have
been more successful in terms of efficacy and safety.
Among them are Broncho-Munal, Ismigen, Imudon.
The use of the drug Imudon causes a number of
cascading immune actions in the div [4,18].
In Peyer’s intestinal plaques, dendritic cells are
activated, which begin to capture and destroy any
pathogens. In this case, dendritic cells represent
antigens of pathogenic microorganisms to lymphocytes
[11,12]. The production of interferons (IFN) a and
p with virostatic activity occurs. The synthesis of
antibodies involved in antibacterial protection is
increasing.
Especially often, fractures of the lower jaw lead
to (PTOLJ) in patients with improper reposition of
fragments of the jaw, in the presence of bruxism, as
well as in patients with various concomitant diseases
- diabetes, tuberculosis, alcoholism, etc. All these
diseases are accompanied by immunodeficiency, and
this is very likely to become a trigger in development
(PTOLJ) [1].
The purpose of the study.
Study of the
effect
of local immunocorrective therapy on pathogenic
microflora in patients withpost-traumatic osteomyelitis
(PTOLJ).
Materials and Research Methods
One of the main problems facing specialists in
surgical dentistry in the field of treatment of fractures
of the lower jaw (FLJ) is a comparative assessment
of the microbial landscape of acute and chronic
osteomyelitis in the formation of (PTOLJ).
Studies conducted by Ergashev V.A. with 380
adults and 68 children diagnosed with acute and
chronic osteomyelitis showed the following.
Adult
patients
375
(98.7±0.6%)
received
conservative treatment, and 179 of them (47.2±2.6%)
received both conservative and surgical treatment.
A group of children (100.0%, n = 68) received
conservative treatment after hospitalization, and 23
of them (33.8±5.7%) underwent surgical treatment in
addition to conservative treatment.
In this case, radiological signs were revealed that
are characteristic of the pathogenesis of the formation
and development of the disease in acute and chronic
osteomyelitis. Age-related differences of these signs
in patients have not been determined in practice.
In the acute form of the disease, the spectrum of
pathogenic microorganisms (strains of 4 species) was
significantly lower than in the chronic form (strains
of 10 species), all positive bacteriological results
isolated pathogens in the form of monoculture. The
monoculture leader was
Staph, aureus,
followed by
Ps. aeruginosa
[8].
In
various
experimental
studies,
a
causal
relationship between the microbiological aspects of
the formation of acute and chronic post-traumatic
lower jaw osteomyelitis was determined. The leading
causative agents of osteomyelitis were identified, and
despite the presence of age-related differences, the
microbial landscape was essentially an association
of gram-positive cocci
(Staph, aureus
and
Staph,
epidermidis}
in leading positions, which coincides
with the literature on osteomyelitis and is consistent
with the general the trend in the occurrence of
pathogens of osteomyelitis.
It was noted that the part of patients of different
age groups taking immunocorrective drugs had a
small number of various complications, including
the transition of the phase of acute osteomyelitis to a
chronic form.
Immunostimulants contribute to the neutrophilic
and lymphocytic response of the div to antigens
contained in the preparations. In acute inflammations
and
infections,
a
neutrophilic
response
always
precedes a more specific lymphocytic one. In chronic
inflammation and infections, the role of neutrophils
is
insignificant
and
the
lymphocytic
response
predominates (infiltration of the focus of inflammation
by lymphocytes).
Non-specific
resistance
indices
(complement
components C3 and ceruloplasmin) were evaluated by
the immunochemical method, the level of circulating
37
STOMATOLOGIYA
immune complexes (CIC), average molecular peptides
(AMP) in the blood, complement C3, phagocytic
neutrophil activity, and ceruloplasmin concentration.
The Results of the Study
Complex treatment with the use of the local
immunocorrecting drug Imudon allowed to reduce
the concentration of average molecular peptides AMP
(from 0.58±0.06 conventional units to 0.28±0.02
conventional units, p<0.05), the level of circulating
immune complexes CIC (with 78.1±5.12 conventional
units
to
34.8±3.12
conventional
units,
p<0.05),
ceruloplasmin concentration (from 39.6 ± 0.52 mg/
dl to 25.2±0.22 mg/dl). The level of complement C3
after treatment significantly increased compared to the
initial one (from 68.8±2.15 mg/dl - 101.6±5.62 mg/dl,
p<0.05).
For 5 years, 93 patients with (FLJ) aged 17 to 62
years old, 67 men and 26 women, were hospitalized.
Persons of a young age prevailed, only 8 men were
over the age of 50. 57 patients had unilateral (FLJ), 36
had bilateral.
The control group consisted of 31 practically
healthy people.
Among the observed patients, 68.3% of patients
were admitted to the hospital on the first day of the
disease, up to three days - 24.5%, the rest - later
than 3 days. Due to the late immobilization of
fragments of the lower jaw, a purulent-inflammatory
process developed in the fracture gap. The source of
purulent infection was a tooth with necrotic pulp or
a pathological process in the periapical tissues. In
cases of rapid elimination of the focus of infection,
adequate antimicrobial therapy and reliable fixation
of fragments, the inflammatory process was stopped.
With a delay in tooth extraction and the absence
of reliable immobilization of bone fragments, the
transition of acute traumatic osteomyelitis into a
purulent-destructive process was noted.
Traditionally,
orthopedic
immobilization
was
carried out using various modifications, individually
curved wire or standard tape tires with hook loops.
Drug therapy included antibacterial (ceftriaxone, sulfa
drugs), desensitizing, painkillers.
All patients were divided into 2 groups: group
1-42 patients who underwent traditional therapy,
group 2-51 patients who were additionally given the
immunocorrecting drug Imudon (before surgery).
Non-specific
resistance
indices
(complement
components C3 and ceruloplasmin) were evaluated by
the immunochemical method, the level of circulating
immune complexes (CIC), and average molecular
peptides (AMP) in the blood according to the method
of A. Gabrielyan (1981), phagocytic activity of
neutrophils (FAN).
The results are presented in table.
Dynamics of non-specific resistance indices in patients with (FLJ)
Table
Index
Control
1 group
2 group
Initially
14 days
Initially
14 days
AMP (con. unit)
0.28 ±0.06
0.58 ±0.06*
0.58 ±0.06*
0.58 ± 0.06 *
0.28 ± 0.02 **
CIC (con. unit)
39.2 ±2.4
78.1 ±5.11 *
8.1 ±5.12*
78.1 ±5.12*
34.8 ±3.12 **
Complement C3,
mg/dl
124.7 ±8.9
68.9 ±2.13 *
8.8 ±2.15*
68.8 ±2.15*
101.9 ±5.64*
Ceruloplasmin,
mg/dl
24.6 ±0.41
39.6 ±0.51 *
39.6 ±0.52*
39.6 ± 0.52 *
25.2 ± 0.22
FAN, %
27.7 ± 0.61
38.4 ±1.38*
38.6 ±1.37*
38.6 ±1.37*
28.8 ± 0.5
* — significance of differences compared with control, p <0.05; ** — significance of differences
compared with the initial value in the same group, p <0.05.
Initially, all the studied parameters in both groups
significantly differed from the control. High values of
the level of (AMP) in patients with (FLJ) indicated
an unfavorable clinical course of the inflammatory
process, since they have toxicity and thereby reduce
local resistance. The phagocytic activity of neutrophils
(FAN) in the observed patients was statistically
significantly (1.4 times) higher than in healthy
individuals and practically did not change in dynamics
in the 1st group. The level of (CIC) was initially more
than 2 times higher; under their influence, lysosomal
enzymes are released from neutrophils, this leads to
the activation of mediator carrier cells, which in turn
induces an acute inflammatory process.
There was a decrease in the level of complement
C3 in patients with (FLJ) by almost 2 times compared
with the control, which, apparently, was due to
“increased consumption” of the (CIC) against a
purulent-inflammatory
process.
Low
values
of
complement C3, which is responsible for immune
adhesion of the (CIC) and chemotaxis, contribute to
exocytosis of neutrophil granules and secretion of
38
ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ
lysosomal hydrolases. Alteration of tissues with cell
breakdown during inflammation leads to an increase
in ceruloplasmin, which enhances the activation of the
lysosomal neutrophil complex.
After a course of therapy for 14 days, the level
of all the studied parameters in the 1st group did not
change compared to the initial one and significantly
exceeded the similar indicators in the control group.
In group 2, complex treatment with the use of the
immunocorrecting
drug
Imudon
significantly
and
significantly reduced the concentration of AMP (2
times), the level of the CIC - 2.3 times.
After the therapy, these indicators approached the
values in the control group. The level of complement
C3 increased after treatment, however, it remained
below the control values (101.6±5.62 mg/dl, in the
control 124.7±8.9 mg/dl (p <0.05).
The concentration of ceruloplasmin after treatment
decreased by 64%. Both indicators - ceruloplasmin
and FAN - after treatment in the 2nd group did not
differ from the control.
We
associated
all
the
results
with
the
immunostimulating effect of the drug Imudon, which
contains a mixture of bacterial lysates. The multivalent
antigenic complex of the drug Imudon corresponds
to pathogens that most often cause inflammatory
processes in the oral cavity.
Bacterial lysates have a number of specific
properties at all stages of the immune response, due
to which the effectiveness of their use is much higher.
The mechanism of action consists in stimulating the
processes of phagocytosis and antigen presentation,
enhancing
the
production
of
anti-inflammatory
cytokines (interleukin-4, interleukin-10, TGF), and
the development of an adjuvant effect. Moreover, this
mechanism is the most physiological, since bacterial
lysates stimulate the div’s own reactions to antigen
exposure and do not cause unnecessary additional
effects. Along with the production of specific antibodies
to the pathogens included in the preparations, they
also stimulate nonspecific immunity - the production
of
secretory IgA, interleukin-1
and a-interferon,
cytokines, NK cells, macrophage-phagocytic system
cells, etc. increase [5,7]
Conclusions
1.
Taking the drug Imudon activates antibacterial
immunity, helps to reduce the risk of bacterial
complications,
thereby
reducing
the
need
for
antibiotics.
2.
Imudon activates phagocytosis, increases the
number of immunocompetent cells, increases the
production of lysozyme and interferon, and IgA in
saliva. All this favors a sharp decrease in the incidence
rate (PTOLJ) in patients with fractures of the lower jaw,
or softens the course of post-traumatic osteomyelitis
in patients with severe immunodeficiency.
3.
However, despite the successes achieved with
treatment (PTOLJ) and other bone injuries,
it is
often not possible to minimize the possibility of
complications.
4.
Currently, scientific studies have proved that most
pathologies occur due to immunological disorders that
contribute to the appearance of complications or the
transition of the process to a chronic course.
References
1.
Пулатова
Ш.К.,
Рахимов
3.K.,
Камбарова
Ш.А.,
Хамитова
Ф.А.
Комплексное
патогенетическое лечение больных с разлитыми
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острых
одонтогенных
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Ш.К.
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одонтогенных
воспалительных
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комплексного
лечения
больных
с
травматическим
остеомиелитом
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Рахимов З.К., Пулатова Ш.К., Замонова
Г.Ш. Совершенствование схемы патогенетической
терапии переломов нижней челюсти с осложненным
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Рахимов З.К., Пулатова Ш.К., Камбарова
Ш.А.
Особенности
эффективности
лечения
воспалительных
осложнений
переломов
нижней
челюсти и принципы терапии // Новый день в
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Рахимов З.К., Пулатова Ш.К., Сафарова
М.С.
Отдалённые
результаты
применения
Вобэнзима
в
комплексном
лечении
гнойно
воспалительных
осложнений
при
переломах
нижней
челюсти
//
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стоматологии:
Сб.
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Цель:
изучение влияния местной
иммунокорригирующей
терапии
на
патогенную
микрофлору
у
больных
посттравматическим
остеомиелитом.
Материал иметоды:
за5лет госпитализированы
93 пациента с
ФЛЖ
в возрасте от 17 до 62 лет, из
них 67 мужчин и 26 женщин. Преобладали лица
молодого возраста, только 8 мужчин были старше
50 лет. У 57 больных был односторонний
(ФЛС),
у
36 - двусторонний.
Результаты:
имудон
активирует
фагоцитоз,
увеличивает
количество
иммунокомпетентных
клеток,
увеличивает
продукцию
лизоцима
и
интерферона, а также IgA в слюне. Все это
способствует резкому снижению заболеваемости
у
больных
с
переломами
нижней
челюсти
или
смягчает
течение
посттравматического
остеомиелита
у
больных
с
выраженным
иммунодефицитом.
Выводы:
в настоящее время доказано,
что
большинство
патологий
является
следствием
иммунологических
нарушений,
способствующих
возникновению
осложнений
или
переходу
процесса в хроническое течение.
Ключевые
слова:
постгравматический
остеомиелит
нижней
челюсти,
одонтогенный
очаг,
патогенная
микрофлора,
Staph,
aureus,
иммуностимуляторы,
неспецифическая
резистентность
организма,
бактериальные
лизаты, фагоцитоз, иммунокомпетентные клетки,
репаративный остеогенез.
Objective:
То
study
the
effect
of
local
immunocorrective therapy on pathogenic microflora
in patients with post-traumatic osteomyelitis.
Material and methods:
93 patients with LVH
aged 17 to 62 years were hospitalized over 5 years,
including 67 men and 26 women. Young people
predominated, only 8 men were over 50 years old.
In 57 patients it was unilateral (FLS), in 36 it was
bilateral.
Results:
Imudon activates phagocytosis, increases
the number of immunocompetent cells, increases the
production of lysozyme and interferon, as well as IgA
in saliva. All this contributes to a sharp decrease in
morbidity in patients with fractures of the lower jaw
or softens the course of post-traumatic osteomyelitis
in patients with severe immunodeficiency.
Conclusions:
At present, it has been proven that
most pathologies are the result of immunological
disorders
that
contribute
to
the
occurrence
of
complications or the transition of the process to a
chronic course.
Key words:
post-traumatic osteomyelitis of the
mandible, odontogenic focus, pathogenic microflora,
Staph,
aureus,
immunostimulants,
nonspecific
resistance
of
the
organism,
bacterial
lysates,
phagocytosis,
immunocompetent
cells,
reparative
osteogenesis.
40
ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ
Maqsad:
travmadan
keyingi
osteomielitli
bemorlarda
mahalliy
immunokorrektiv
terapiyaning
patogen mikrofloraga ta’sirini o’rganish.
Material va usullar:
17 yoshdan 62 yoshgacha
bo’lgan LVH bilan kasallangan 93 nafar bemor 5 yil
davomida kasalxonaga yotqizilgan, shu jumladan 67
erkak va 26 ayol. Yoshlar ustunlik qildi, atigi 8 nafari
50 yoshdan oshgan erkaklar edi. 57 bemorda bir
tomonlama, 36 bemorda ikki tomonlama edi.
Natijalar:
imudon
fagotsitozni
faollashtiradi,
immunokompetent
hujayralar
sonini
oshiradi,
lizozim va interferon, shuningdek, tupurikda IgA
ishlab chiqarishni oshiradi. Bulaming barchasi pastki
jag’ning sinishi bo’lgan bemorlarda kasallanishning
keskin
kamayishiga
yordam
beradi
yoki
og’ir
immunitet tanqisligi bo’lgan bemorlarda travmadan
keyingi osteomielit kursini yumshatadi.
Xulosa:
hozirgi vaqtda ko’pchilik patologiyalar
asoratlaming pay do bo’lishiga yoki jarayonning
surunkali
kursga
o’tishiga
yordam
beradigan
immunologik kasalliklar natijasi ekanligi isbotlangan.
Kalit so’zlar:
pastki jag’ning travmadan keyingi
osteomiyelitlari, odontogen fokus, patogen mikroflora,
Staph,
aureus,
immunostimulyatorlar,
organizmning
nospesifik
qarshiligi,
bakterial
lizatlar,
fagotsitoz,
immunokompetent hujayralar, reparativ osteogenez.
UDK: 616.314.17-008.1-089 (075.8)
«KOLLAPAN» MATERIALLARIDAN FOYDALANGAN HOLDA SURUNKALI
PERIODONTITLARNIJARROHLIK USULI BILAN DAVOLASH
Rahimov Z.Q., Abdullayev D.R.
Buxoro davlat tibbiyo tinstituti
Tishlami saqlashuchunqo ’ llaniladiganoperatsiyalar
- uzoq davom etuvchi surunkali periodontitda ildiz
uchi zararlangan qismini olib tashlash va periodontal
soxadan ildiz kanaliga reinfeksiyalanish jarayonini
oldini olish imkonini beradi. Surunkali periodontitni
jarroxlik usuli bilan davolashning asosiy vazifasi
tish funksiyasini saqlab qolish va suyak to’qimasini
tiklashdir. Ildiz uchi rezeksiyasidan keng foydalanish
va shilliq qavatdan kesma o’tkazishning zamonaviy
usulidan
foydalanish
granulyomektomiyadan
so’ng
suyak
nuqsonini
to’ldirish
uchun
osteoplastik
materiallardan foydalanish imkonini berdi. Tish ildiz
uchi rezeksiyasidan so’ng har doim ham bo’shliq
qon orqali yangi suyak to’qimasi bilan to’lmagan.
Ko’pincha
tiklanish
jarayoni
chandiq
shakllanishi
bilan davom etmaydi va yillar davomida kechadi.
5%
hollarda
suyak
nuqsoni
umuman
to’lmaydi.
Osteogenezni
rag’batlantirish
uchun
suyak
nuqsonida osteoplastik materiallardan depo yaratish
katta
ahamiyatga
ega.
Alloplastik
(biocompositic)
g’ovak
modda
“Kollapan“
kukun
ko’rinishidagi
gidroksiapatitdan iborat bir xil II tip kollagenli va
antibiotik (linkomitsin gidroxlorid, gentamitsin sulfat,
klofaran,
rifampitsin,
metronidazole)
tuzilishida
plastin,
granula
va
gelsimon
“intermedapatit“
shaklida
ishlab
chiqariladi.
Submikron
zarracha
kattaligi va yuqori o’ziga xos yuzali “Kollapan“
gidroksiapatit suyakning gidroksiapatitiga mos keladi.
Antibiotiklar
asta-sekin
15 kundan 20 kungacha
granulalardan
atrofdagi
to’qimalarga
chiqariladi.
“Kollapan” materiallari reparativ osteogenezga ijobiy
tasir ko’rsatadi, appozitsion suyak o’sishi uchun
yo’naltiruvchi
matritsa
ro’lini
o’ynaydi
va
uzoq
muddatli antimikrob tasir ko’rsatadi.
Tadqiqot maqsadi
Surunkali
periodontit
kasalliklariga
chalingan
bemorlami tashxislash va ulami xirurgik davolash
usullarinitakomillashtirish.“Kollapan”materiallaridan
foydalangan holda surunkali periodontitni jarrohlik
davolash natijalarini o’rganish.
Material va usullar
18 yoshdan 55 yoshgacha bo’lgan (o’rtacha yosh
- 34,1 yosh) 28 bemorda (10 erkak, 18 ayol) 33 tishni
jarrohlik
usuli
bilan
davolash
amalga
oshiriladi.
Bemorlaming yuqori jag’ida 29 (87,8%) va pastki
jag’ida 4 (12,2%) ildiz cho’qqisi rezeksiyasi amalga
oshirildi. Eng ko’p kesuvchi (66,6%) operatsiya
qilindi. So’rovda yuz va og’iz bo’shlig’ini tekshirish,
“sabachi” tishni o’rganish (tikiash sifati suniy toj,
yiring
yo’li,
cho’ntaklar,
harakatlami
baholash,
41
