Zheliba, Khimich, Chornopyshchuk, Oshovskyy, and Shevnya: State of Nonspecific Host Defense in Patients with Pyoinflammatory Diseases of Soft Tissues and Its Correction by Photomodification



Problem statement and analysis of the recent research

Severe acute surgical infection is known to be accompanied by a significant endogenous intoxication caused by input of a large number of bacterial toxins and decomposition products of damaged tissues from suppurative foci into the blood stream, which are strong biologically active substances. As a result of their direct effect on the vascular endothelium, immune system cells and blood corpuscles, a huge number of substances releases, under the influence of which extremely complex mechanism of changes is triggered in the microcirculatory bloodstream, coagulation system of the blood and heart activity eventually leading to profound disorders of hemodynamic, metabolic processes, increase in tissue hypoxia and decompensation of vital organs and systems functions, including immune system.

Thus, pyoinflammatory process is a complex infectious-immune reaction that develops in response to tissues changed by antigens in the course of disease and bacteria that penetrate into them. An important role in its implementation belongs to the system of nonspecific host defense. Action of nonspecific resistance factors is constant and immediate. These factors are genetically determined; they exist in the body not requiring a prior contact (sensibilization) with a foreign material and represent the first line of body defense inducing acute inflammation as nonspecific a reaction of destruction and elimination of all foreign. If the effect of the first line of body defense is insufficient to localize the inflammation process, it will lead to a generalization of infection and progression of endogenous intoxication. The more serious endogenous intoxication is, the stronger suppression of nonspecific resistance factors is: phagocytosis, lysozyme, complement [5].

Unfortunately, in the scientific literature we can find just few results of advanced study of body’s non-specific resistance in case of acute surgical infection and its correction using photo-hemotherapy [2, 3, 4, 6].

The objective of the research was to study the state of nonspecific host defense in patients with acute purulent pathology of soft tissues depending on the severity and its change in the course of complex treatment with the use of blood photomodification.

Materials and methods

The study involved 116 patients with acute purulent inflammation of soft tissues and 30 healthy people (donors). According to the severity level of purulent infectious process and depending on the treatment, the patients were divided into 5 groups. The first group included 30 patients with mild severity, and limited (5.3 cm2) purulent process located superficially. Body temperature remained normal or was subfebrile. Indicators of leukocytosis remained within normal limits. Local treatment was applied: lancing of abscess, bandages with 0.02% solution of decamethoxin or using ointments on a water-soluble base. The second group included 30 patients with moderate severity with pyoinflammatory process of average size (up to 10 cm2), accompanied by fever up to 38°C and other manifestations of endogenous intoxication. Indicators of leukocytosis were increased to 10 × 109/l with a slight formula deviation to the left.

The third (n - 10), fourth (n - 16) and fifth (n - 30) groups consisted of patients with a severe course of pyoinflammatory process, which occupied the area of 15 cm2 or had a deep localization, accompanied by a significant violation of general state and presence of 3-4 signs of systemic inflammatory response syndrome. The disease was complicated by the development of an infectious-toxic shock in 6 patients.

Complex of remedial measures consisted of:

A) primary therapy, if possible radical, surgical treatment of purulent focus, adequate drainage, sanitation of wounds in purulent necrotic phase by antiseptic solutions, bandages with ointments on a water-soluble base, necrolytic and sorption agents, immobilization of extremities;

B) drug therapy of general action aimed at combating pathogens of surgical infections, endogenous intoxication, fluid and electrolyte disorders, carbohydrate and protein metabolism, functions of vital organs and systems, nutritional support;

The complex of remedial measures was supplemented by an extracorporeal laser irradiation of the blood in patients of the fourth group, and by extracorporeal ultraviolet irradiation of the blood in the fifth group.

In order to assess the state of nonspecific host defense we studied body immune reactivity (BIR) according to the method developed by us [1]. Determination of complement titer, phagocytic activity of micro- and macrophages (PAL) and the phagocytic number (PN) of bacterial cells were performed by standard methods. As a control we used the same indicators of donors. Studies were performed before and after treatment.

Results and Discussion

Results of the study of nonspecific defense factors of the body are presented in Table 1 and Table 2.

Table 1

Dynamics of changes of the indicators of body nonspecific reactivity in patients with pyoinflammatory diseases in the process of treatment (M±m; p)

Group of examined persons Number of persons Body immunological reactivity (BIR)
a b p
Control 30 81.1±4.6 - -
1 group 30 80.9±1.9 82.9±1.2 >0.05
2 group 30 76.0±9.25 79.6±1.8 >0.05
3 group 10 64.7±2.1 68.7±2.4 <0.05
4 group 16 65.3±4.6 78.0±3.9 <0.05
5 group 30 64.1±6.1 74.9±2.1 <0.01

Note.

а - indicators before treatment;

b - indicators after treatment.

Table 2

Indicators of nonspecific host defense factors in patients with pyoinflammatory diseases in the process of treatment (M±m; p)

Group of examined persons Number of persons FAL (%) SF (%) Complement
a b p a b p a b p
Control 30 74.1±1.6 - - 3.0±0.2 - - 0.11±0.001 - -
1 group 30 75.4±1.6 76.8±1.2 >0.05 3.1±0.16 2.8±0.14 >0.05 0.12±0.01 0.17±0.03 >0.05
2 group 30 70.6±1.8 73.3±7.4 >0.05 2.56±0.16 2.86±0.11 >0.05 0.13±0.02 0.13±0.01 >0.05
3 group 10 52.2±1.3 61.8±2.8 <0.05 1.4±0.5 1.8±0.8 <0.01 0.17±0.01 0.15±0.01 >0.05
4 group 16 51.6±3.15 69.3±3.35 <0.05 1.46±0.49 2.25±0.71 <0.01 0.21±0.015 0.09±0.018 <0.05
5 group 30 52.8±1.84 64.9±1.95 <0.01 1.6±0.1 2.7±0.9 <0.01 0.21±0.02 0.05±0.01 <0.05

Note.

а - indicators before treatment;

b - indicators after treatment.

Analysis of the obtained results of the study of nonspecific host defense before the treatment showed that patients with mild and moderate severity of pyoinflammatory process indicators BIR, PAL, PN and complement had lower values ​​in relation to these indicators in the group of apparently healthy people, but this difference was statistically unreliable (p>0.05). In the third, fourth and fifth groups of patients with severe disease the difference was significant and indicated the failure of these levels of nonspecific defense factors (p<0.05) and the need for their correction.

Positive dynamics of activation of nonspecific host defense indicators was observed practically in all five groups of patients in the process of treatment.

An activation of nonspecific defense factors of the body was observed in patients with a mild course of pyoinflammatory processes, treated by conventional methods, however, an increase in indicators was statistically unreliable (p>0.05). Thus, the specified level of host defense factors (BIR - 80.9 ± 1.2; PAL - 75.4 ± 1.6; PN - 3.1 ± 0.16; titer complement 0.12 ± 0.01) proved to be sufficient to fight against an infection.

The nonspecific defense indicators were at a lower level in the second group of patients with moderate severity of inflammatory processes compared with the first group. During treatment using conventional methods indicators BIR, PAL, PN and complement titer had a positive dynamics and almost reached the levels of indicators in the first group of patients. This indicates that after the elimination of suppurative focus the body is able to restore on its own the level of nonspecific host defense factors.

Blood irradiation was not included into the complex of treatment in the third group of patients with severe purulent process. By the end of treatment the patients of this group had positive changes of nonspecific host defense (p>0.05), but they were rather low and needed correction.

The complex of medical measures was supplemented by extracorporeal laser irradiation of the blood in the fourth group of patients.

After performed treatment the level of BIR increased from 65.3 ± 4.6 to 78.0 ± 3.9 (p<0.05), PAL from 51.6 ± 3.15 to 69.3 ± 3.35 (p< 0.01), PN from 1.36 ± 0.49 to 2.25 ± 0.71 (p<0.01), complement titer from 0.21 ± 0.015 to 0.09 ± 0.018 (p<0.05).

The complex of treatment was supplemented by extracorporeal ultraviolet irradiation of the blood in the fifth group of patients. the treatment studied parameters increased in the following way: BIR from 64.1 ± 2.34 to 74.9 ± 2.1, PAL from 52.8 ± 1.84 to 64.9 ± 1.95 (р< 0.01), PN from 1.6 ± 0.1 to 2.7 ± 0.9 (р<0.01), complement titer from 0.21 ± 0.02 to 0.05 ± 0.01 (р<0.01).

Analyzing the obtained results of performed study, it should be noted that in case of mild and moderate severity of the inflammatory process the indicators of nonspecific host defense are high enough and hardly change during the treatment. In case of an unfavorable course of disease the indicators of BIR, phagocytosis, and the complement system significantly decrease and require correction.

Conclusions

  • Severe inflammatory process is accompanied by an increase in endogenous intoxication and the inhibition of factors of nonspecific defense system.

  • Laser and ultraviolet irradiation of the blood stimulates host defenses, accelerates wound healing and wound healing (p<0.01).

  • Used methods of blood photomodification have no significant advantages comparing to each other in stimulating nonspecific host defense factors (p>0.05).

  • The proposed method for blood immunological reactivity determination is an objective and informative indicator of nonspecific host defense in patients with acute purulent surgical pathology.

Prospects for further research

Development of medical diagnostic algorithm of endogenous intoxication and secondary immunodeficiency will improve treatment outcomes of acute surgical infection.

References

1 

G Paly, V Neporada, N Zhelyba, inventors. Method for determining immunological reactivity of the organism. USSR Patent 330241/28-13. 1984 March 30.

2 

E Konovalov, D Kavkalo, L Volynets, et al. Effect of intravascular laser irradiation of blood (ILIB) on the functional activity of physiological systems in patients with septic complications. In: Proceedings of the Conference “Effects of low energy laser on the blood”. Kyiv; 1989. p. 102-103.

3 

A Heynits, S Moskvin, A Achilov. Intravenous laser irradiation of blood. Moscow: Tver, Publishing House “Triad”; 2008. 144 p.

4 

A Komplatadze, V Nosov, V Protsenko, et al. Ultraviolet irradiation of blood in complex treatment of patients with acute paraproctitis. Sibirskiy meditsinskiy zhurnal. 2008;6:94-96.

5 

V Saenko, V Desiateryk, T Pertseva, V Shapovalyuk. Sepsis and multiple organ failure: a monograph. Krivoy Rog: Mineral; 2005. 466 p.

6 

V Shimon, R Slivka, V Pantio. The impact of regional and infusion of low laser radiation on indicators of endotoxemia in treatment of chronic osteomyelitis of the lower limbs. Travma. 2011;3 (12):96-101.



Copyright (c) 2017 N. Zheliba, S. Khimich, R. Chornopyshchuk, I. Oshovskyy, P. Shevnya

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


IFNMU Logo

Free counters!