Дифференцированная иммунотерапия в интеграционной программе реабилитации иммунокомпрометированных детей с врожденными расщелинами губы и нёба

Abstract

One of the development directions of osteoimmunology is the search for new therapeutic approaches in the pathology of bone tissue, in the pathogenesis of which the interaction between the immune and bone systems plays an essential role. In children with congenital cleft lip and palate (CCLP), the physiological deficiency of the immune system (IS) and its anatomical disorders lead to intense tension in the immature mechanism for maintaining immune homeostasis, which is accompanied by clinical features of immunodeficiency in the form of recurrent viral, bacterial and fungal infectious and inflammatory diseases of the respiratory tract, ENT organs and oral cavity. Objective. To develop an integration program for the rehabilitation of children with CCLP, which includes not only traditional complex rehabilitation, but also measures aimed at restoration of the normal functioning of IS with the use of new approaches to conduct differentiated immunotherapy for each age period. Patients and methods. The study included 210 children of different ages: 150 children with CCLP and 60 conditionally healthy children without CCLP. Immunophenotyping of lymphocytes was conducted by flow cytometry; testing of phagocytic activity of neutrophilic granulocytes (NG), spontaneous and induced production of reactive oxygen species in the NBT test, determination of the level of serum IgA, IgM, IgG and sIgA in oral fluid. Results. Common for all age groups of children with CCLP, NG dysfunctions of different severity were found: defects of phagocytosis, an increase of spontaneous activity of NADPH oxidase and dysfunction of adequate response in the form of partial or complete blockade of NADPH oxidase activity during additional antigenic bacterial load in the system in vitro. Taking into account revealed defects in the functioning of IS and peculiarities of the clinical status of immunocompromised children of different ages with CCLP who suffer from a high frequency of infectious and inflammatory diseases of the respiratory tract, ENT organs and oral cavity, we have developed programs of differentiated immunotropic therapy for children of different ages with CCLP. Considering revealed defects in the functioning of IS and peculiarities of the clinical status of immunocompromised children of different ages with CCLP who suffer from a high frequency of infectious and inflammatory diseases of the respiratory tract, we have developed and used an integration program of immunorehabilitation with a positive clinical and immunological effect. Conclusion. The developed integration program for the rehabilitation of immunocompromised children with CCLP with a high frequency of infectious and inflammatory diseases of the respiratory tract, ENT organs and oral cavity, organically including differentiated immunotherapy along with methods of surgical, orthodontic and social rehabilitation and speech therapy, optimizes the treatment of patients with this pathology. The principles of differentiated immunotherapy are based on the revealed clinical and immunological peculiarities of immunodeficiency, which have both common features and differences depending on age, infectious and inflammatory manifestations and the stage of surgical treatment of children with CCLP. Key words: congenital cleft lip and palate, immunocompromised children, immunotropic therapy, rehabilitation