IMMUNE RESPONSE IN HEPATIC ECHINOCOCCOSIS

A.Z. VAFIN, Y.V. MASHUROVA, I.A. ZAGUMENNOV

Stavropol State Medical Academy, Stavropol, RUSSIA

At present, special interest of researchers is drawn by the study of regulatory actions and intersystematic factors, mediators of the immune response to the functioning of immune system. Immune status of patients with echinococcosis is characterized by expressed changes in the immune system. Determination of the level and trends of the immune response of patients with hepatic echinococcosis to invasion, its influence on the nature and course of pathological process should improve the quality of treatment during hepatic echinococcosis.

The aim of the work was to study the levels of IL-6, IL-4 and TNF-α in combination with the main indicators of immune status in patients with hepatic echinococcosis.

Materials and methods. 53 patients with hepatic echinococcosis at the age of 18-75 years were examined. 24 of the were men, 29 - women. The control group consisted of 30 healthy individuals aged between 18-25 years.

Results and discussions. After echinococcectomy of patients with hepatic echinococcosis there was observed a significant increase in the number and functional MNCs activity of peripheral blood, demonstrated by the increase of TNF-α production (p <0.05), as well as increase in the number of NK (natural killers) and T-lymphocytes due to CD4, CD8 and CD25 cells (p <0.05), with significant increase of the activity of type 1 T-helpers with special antitumor cytotoxicity, demonstrated reduced production of IL-4. As to the humoral immunity, there was found increased production of IgA and IgM (p <0.05), which together with increased production of IL-6 may show the activation of the humoral immune response. During a regular medical check-up 3 months after echinococcectomy, all indicators of the activity of immune system of patients with hepatic echinococcosis return to the physiological level.

Conclusions. Increased production of IL-6 in patients with hepatic echinococcosis, may not indicate the activation of humoral immunity, and is a compensatory response to increased production of TNF-α with IL-6 antagonist. Normalization of the studied indicators of immune status of patients previously operated for hepatic echinococcosis, confirmed by a regular medical check-up, showed no recurrence of echinococcosis.

PRINCIPLE OF APARASITORY AND ANTIAPARASITORY OF THE SURGERY OF ECHINOCOCCOSIS, RESULTS OF MULTIYEAR UTILIZATION IN THE HYDATID DISEASE OF LIVER

А.Z. VAFIN, А.N. AYDEMIROV, V.Z. KARDANOV, A.D. ABDOKOV, M.A. UZDENOV

State Medical Academy, Stavropol, RUSSIA

Echinococcosis at men continues being a severe disease the result of which is very difficult to consider satisfactory. We developed a principle of improvement of aparasitory and antiaparasitory of the surgery of echinococcosis for the purpose of improvement of surgical treatment of echinococcosis in 1980 years (“Surgery” – 1993 - №4, - P 70 – 74).

Aim: Clinic assessment of the results of long-term utilization of the principle of improvement of aparasitory and antiaparasitory of the surgery of the hydatid disease of liver.

Material and methods: The principle of aparasitory is the complex of measures taken before and during the operation for the purpose of prophylaxis of dissemination and implantation of germinal elements of echinococcus on the area of the operative intervention.

The principle of antiaparasitory is the complex of measures taken before and during the operation for the purpose of neutralization of germinal elements of vermins in the organism of the patient, at the affected organ, cysts infecting the surface of the affected or adjacent organs, wound, surgical garbs.

Results: The analyzed results of the surgical treatment of 558 patients suffering from the hydatid disease of liver: at 100 patients operated in 1982-1990 years after the practical application of the basis of the principle of aparasitory and aparasitory (monitoring group) and at 458 patients operated in 1991-2010 after the stable clinical practical application of all conditions of the principle (the principal group). 741 patients had been operated under traditional methods till 1980 and the frequency of recurrences was 19.8%. 343 patients have been operated after the practical application of the work of the principal components of the principle in 1982-1990 years and recurrence of echinococcosis manifested at 34 (9.9%) out of them 5 years later. 458 patients have been operated within 1991-2010 years after the practical application of all components of the principle by a specialized surgical team in a patient care institution. Recurrence of the disease at the patients operated for the first time in our clinic was diagnosed at 5 patients (1.1%) over the period of 5 years observation. Frequency of postoperative complication decreased from 36% to 12.1%, lethality from 7% to 0.4%, duration of stationary treatment from 41.3 to 15 beds in a day over the last 20 years.

Summary: Strict observance to the principle of aparasitory and antiaparasitory in the surgery of the hydatid disease of liver allows to improve the results of the treatment.

Date: 2014-12-28; view: 734