Журнал «Здоровье ребенка» (62) 2015. Тематический выпуск "Детская гастроэнтерология"

Introduction. Today an acute intestinal infection (AII) remains one of the most urgent problems of modern medicine. The current study opportunistic pathogens (OP) and diseases caused by them is becoming more and more popular. To date, it is proved that H. pylori infection in various countries has a very wide range of variation, ranging from 72% to 95%. H. pylori, long persistence in the gastric mucosa leads to the formation of chronic pathological process in the mucous membrane, and subsequently leads to violation of physiological regeneration of glandular epithelium body. This in turn affects the local factors protect the gastrointestinal tract and increase the risk of developing it in the pathological process involving the various agents of AII, including OP.

The purpose: improving the diagnosis, treatment and dispensary observation of children with AII caused by opportunistic flora on the background of infection H. pylori, on the basis of studying the characteristics of the immune response of patients.

Materials and methods. The study involved 72 children aged 1 month - 5 years, 52 of them – patients with ALL which caused by bacteria of family Proteus, Klebsiella, Enterobacter, Citrobacter (25 of which were had infection H. pylori), 20 - healthy children (control group). Along with routine research methods used immunological: patients in the acute phase and during convalescence determined the content of interleukin (IL) (-1b, -4, -6, tumor necrosis factor a (TNF a)) (enzyme-linked immunosorbent method), populations and immune cell subsets (CD3+, CD4+, CD8+, CD14+, CD19+) in the blood (method monoclonal antibodies), immunoglobulins (Ig) (A, M, G) of serum (radial immunodiffusion simple method); lysozyme activity (nephelometric method of V.G. Drofeychuk) and the level of secretory immunoglobulin A (sIgA) in coprofiltrates (enzyme-linked immunosorbent method). 

Results and discussion. In the acute phase at all patients with AII caused by OP, has been a significant increase of IL-1b, -4, -6, TNF a, reduction of CD3+, CD4+, CD8+-lymphocytes and increased CD19+, CD14+, Ig A , M, G was within the normal parameters. When analyzing the performance of local immunity showed a reduction of lysozyme activity and the level of sIgA. A significant change in levels of IL-1b, -4, -6, TNF a, content of CD3+, CD4+ and CD8+-lymphocytes and factors of local immunity at patients against infection with H. pylori in respect to the relevant parameters of patients without H. pylori infection. In the period of early recovery at patients with AII caused by OP without H. pylori infection levels of CD3+ and CD4+ lymphocytes, IgG, sIg A and lysozyme activity were increased and were at the level of child health, and IL-1b, -4, -6, TNFa - decreased and did not differ by more than 1,5-2 times compared to the control group. Patients with background additional H.pylori infection, showed a slight increased levels of CD3+, CD4+, CD8+-lymphocytes, decreased levels of IL-1b, -4, -6, TNFa, CD19+, however, all parameters were significantly different from that of healthy children, the level of all investigated immunoglobulins, sIg A and lysozyme activity remained within the parameters of the acute period. A significant difference cytokine status indicators, levels of lymphocytes, immunoglobulins and local immunity factors at patients with H. pylori infection further in relation to the same indicators uninfected patients. We used the method of maximum correlation path could distinguish pathogenic patterns of functioning of the immune system of patients. In children with intestinal infections without H. pylori infection disease causes increased of level of IL-1b, which by correlation chain combined with increased TNFa and IL-6, reduced number of CD3+, CD4+, CD8+-lymphocytes; increased levels of Ig G, sIg A and lysozyme activity. Increasing levels of cytokines and reduced parameters of T-cells with the growth of disease severity in the final stage leads to enhancement of antibody and local immunity factors, which is typical for normocompensatory variant of functioning of the immune system. An patients with H. pylori infection we saw increased levels of IL-6, IL-1b, TNF a and which is coupled with a decrease in CD4+, CD3+, CD8+-lymphocytes, Ig A, Ig G and local immunity factors. This implies that the background cytokine hyperactivity depression operation of T-cell immunity to lead to the ultimate objective of the depression levels of antibodies and local factors that characterize the hypocompensatory variant of functioning of immune system. 

Conclusions. At patients with intestinal infections caused by OP, with or without H. pylori infection are formed by different architectonic and mode of functioning of the immune system. At patients without H. pylori infection functioning of the immune system goes into operation normocompensatory variant, with background H. pylori infection - hypocompensatory variant. Data on hypocompensatory variant of the immune system of patients with acute intestinal infections caused by OP with H. pylori infection is theoretically justify the appointment of immune therapy of these patients. Given the more torpid normalization of immunity of patients with H. pylori infection in order to facilitate the evaluation of completeness recovery of patients before discharge from the hospital recommended the study of immunity indices and the preservation of their changes can be used to justify the expansion of the scope of rehabilitation phases of clinical supervision for convalescents.