INDICATORS OF NONSPECIFIC IMMUNITY AND DYSFUNCTION OF ENDOTHELIUM IN CHRONIC HEPATITIS AND CIRRHOSIS

A.P.SHCHEKOTOVA

SBEI of HPE, Perm State Medical Academy named after academician E.A. Vagner,

Perm, RUSSIA

Introduction. Disorders of non-specific mechanisms of immunity of a special significance in the pathogenesis of inflammatory injuries of liver, endothelium of liver sinusoids is naturally affected, which shows development of fibrosis and progression of the pathological process.

Materials and methods. We examined 40 patients with chronic hepatitis C (CH), the second group consisted of 15 patients with liver cirrhosis (LC) of viral etiology. The control group consisted of 13 healthy individuals. Concentration of MCP-1 in serum, indicators of phagocytosis: the phagocytal activity of leukocytes (FAL), phagocytic index, absolute phagocytosis, the level of total nitric oxide, endothelin-1, vasculoendothelial growth factor, activity Villebrand factor was studied, the number of desquamated endothelial cells in blood plasma by the Hladovec method, 1978 was calculated.

Results. In patients with CH, increased content of MCP-1 in blood was revealed as compared with a group of healthy individuals (154,5 ± 77,5 and 336,7 ± 199,8 pg / ml respectively, P = 0.01). This shows stimulation of macrophagal inflammatory response to viral infection. In LC content of MCP-1 did not differ from the control group. The diagnostic sensitivity MCP test at the point of separation 175 pg / ml for CH constituted 59%, diagnostic specificity of the test for the exclusion of LC - 60%. FAL in both groups was equally reduced as compared to the norm: 37,8 ± 15,3 and 37,8 ± 16,5%, respectively (p = 0.004 and p = 0.01). Diagnostic sensitivity of FAL at point of separation 45% for patients with CG and LC constituted 62%, diagnostic specificity of the test - 83%. In patients with liver pathologies, the index of phagocytosis was similar with those of healthy persons. Absolute phagocytosis by CH and LC was significantly lower as compared with the control group: 79,8 ± 33,5 and 82,8 ± 33,9 per 100 phagocytes, respectively (p = 0.003 and p = 0.01). The diagnostic sensitivity of the absolute phagocytosis at the point of separation 100 phagocytized erythrocyte per 100 leukocyte for CH and LC was 75%, diagnostic specificity - 90%. In patients with a hepatic pathology there were significant changes in DE indicators, more expressed in patients with LC. In CH there were revealed significant correlations between MCP-1, rates of phagocytosis, inverse relationships of MCP-1 and nitric oxide, and vasculoendothelial growth factor, direct with endothelin-1. Similar relationships, except for MCP-1 correlations with the indicators of phagocytosis were reported for LC.

Conclusion. Disorders of nonspecific immune mechanisms in the form of increased MCP-1, reduced FAL and absolute phagocytosis were revealed during CH and LC, reflecting the activity of the inflammatory process and is correlated with the severity of DE.

STUDY OF THE “THE QUALITY OF LIFE” AFTER CHOLECYSTECTOMY OPERATIONS BY VARIOUS METHODS

Z.T.SHIRINOV, F.S.IDRISOV

Scientific Centre of Surgery named after M.A. Topchubashev, Baku, AZERBAIJAN

Cholelithiasis is a very widely spread disease, occurence of the disease in person of middle age ranges between 2-50% percent, and constitutes average of 10%. According to the National Institutes of Health average of 10-15% of old population suffer from cholelithiasis. Cholelithiasis is observed in every forth mane at the age over 60 years, and every third man at the age over 70 years.

Every 10 years cholelithiasis increases two times. According to mass epidemiological examinations carried out in Western Europe and Northern America, almost 30% of white-skinned population suffer from cholelithiasis.

\Despite the availability of modern conservative methods – lithotripsy with extra and intracorporal radiation and various litholytic methods of treatment, surgical cholecystectomy is one of the main methods of treatment. Cholecystectomy consists of open and tradidional laparascopic methods applied since 80s of the past century. At present laparascopic cholecystectomy is used throughout the world as “gold standard”. However, this method also has contraindications and traditional – open cholecystectomy is unavoidable. Remote results of operations carried out by the both methods are assessed by Visick scale based on clinical and instrumental examinations. At present “quality of lafe scale” is used in the Erupean countries for the assessment of post-operative results. We also have used “quality of life” scale in our clinical investigations.

Results of 500 patients exposed to cholecystectomy at the hepatic, biliary and MAV surgery at the SSC named after M.A.Topchubashov within 2006-2011 were studied. The patients were divided into 3 random groups. The 1^st group were performed open – traditional cholecystectomy – 200 (40%) patients, 2^nd group – laparascopic cholecystectomy – 200 (40%) patients and 3^rd group - “mini” resection open cholecystectomy operation - 100 (20%) patients.

In all the patients “quality of life” was studied and comparatively assessed before and after the operation. Thus, in the patients of the II group “quality of lige” indicator was better, the III group took the 2^nd place and I group – third place.

Date: 2014-12-28; view: 823