Застосування методів консервативної терапії в дітей з післяопіковими рубцевими деформаціями та їх вплив на метаболізм сполучної тканини

Abstract

One of the factors of scarring is changes in the connective tissue (CT). Defeat of CT is accompanied by changes in the content of glycosaminoglycans (GAG), activity of lysosomal enzymes, levels of mineral metabolism. To eliminate the influence of inflammatory phenomena and disorders of CT metabolism on the formation of scar tissue, it is urgent to use conservative rehabilitation measures. Purpose - to determine the effectiveness of measures of conservative therapy of post-burn scars in children for the clinical course and metabolism of connective tissue. Material and methods. 27 children aged 5 to 18 were supervised. The group of healthy children without clinical manifestations of inflammatory reactions consisted of 17 people. Conservative treatment of children with scarring included local, drug, physiotherapy, balneological and efferent therapy methods. The impact of treatment measures was assessed on a modified scar score scale, which consisted of a patient (parent) scale and a researcher scale. Laboratory criteria of effectiveness were the amount of ceruloplasmin (CP), lactic (MC) and sialic (SC) acids, GAG content, lysosomal enzyme activity (bone and alkaline phosphatase), mineral metabolism (total calcium). Laboratory parameters in patients were studied in the period from 150 to 170 and 310 to 340 days after injury. SPSS v was used for statistical analysis. 17.0. Results. Improvements in clinical signs of scar tissue were 1.7-fold according to objective estimates and 1.6-fold according to patient estimates. Laboratory monitoring showed the effectiveness of conservative treatment of convalescents, which was manifested in a reduction in GAG levels 1.6 times after 6 months and 2.0 times after a year. There was a decrease in the activity of acid phosphatase in 1.6 times, alkaline phosphatase and its bone fraction in 1.4 times. In addition, after treatment, there was an increase in ceruloplasmin activity by 1.5 times at all times. A 1.5-fold increase in the number of MCs was determined at all observation times. After treatment, the amount of MC decreased by 1.2 times (P<0.05). Significant confirmation of an increase in the level of SC in 1.4 times (P<0.05) was observed only on the 160th day of the study. At other times, the increase in the IC was unreliable. Conclusions. Long-term studies have shown that in children after thermal trauma in the process of productive scarring there are deviations in the metabolism of CT in the direction of increasing its synthetic function, metabolic disorders and inflammation continue. The use of complex conservative therapy in children with post-burn scars during convalescence allowed to reduce the severity of inflammatory reactions, improve CT metabolism and reduce scarring. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: post-burn scarring in children, connective tissue, metabolism, inflammation, conservative therapy.