Динамика клинических и иммунологических показателей при патогенетической терапии острого или обострения хронического фарингита

Abstract

Objective. To study the anti-inflammatory properties of Tonsilgon N preparation and its effect on the indices of local immunity of oropharyngeal mucosa in patients with acute or exacerbation of chronic pharyngitis without a pronounced systemic inflammatory syndrome. Patients and methods. 60 people diagnosed with acute catarrhal pharyngitis with intoxication syndrome were examined. Group 1 – 30 people took the drug Tonsilgon N in the form of alcohol solution, group 2 – 30 people – sage in the form of tablets for resorption in the oral cavity according to the scheme of 25 drops or 1 tablet every 2 hours for the first 3 days of treatment, then 3 times a day until day 7 inclusive. Pharyngoscopy was performed by an otorhinolaryngologist at each visit on day 1, day 3–4 and day 7–8 of the disease. Using a 10-point visual analogue scale (VAS) with scores from 0 (no sign) to 10, we evaluated the severity of symptoms (pain when swallowing, a feeling of parching in the oropharynx, a feeling of a foreign body in the oropharynx, dry cough, weakness, headache) and the condition of the oropharyngeal mucosa. Additionally, at 3 visits, scrapings from the oropharyngeal mucosa were made with a cytobrush probe and the content of IL-6 and sIgA proteins was determined by enzyme immunoassay. For the control group, 30 conventionally healthy people were taken, not differing in sex and age from the main group of patients and having no inclusion criteria. Results. All patients by day 7 of observation had no expressed complaints, none of them had progression of inflammatory process or development of any complications, patients did not need further continuation of treatment. Pain at swallowing, feelings of foreign body in the oropharynx, feelings of feathering and intensity of hyperemia of the mucous membrane of the posterior pharyngeal wall when treated with Tonsilgon N on the 3–4 day of observation compared to the group of patients taking Sage. On the 7th day of observation at Tonsilgon N treatment all analyzed clinical manifestations of pharyngitis were absent, and in Sage group in some cases weakly expressed symptoms of pain at swallowing, feeling of foreign body in the oropharynx, feeling of fever, intensity of hyperemia of the mucous membrane of the back wall of the pharynx (Me = 0 [0;1] points) and dry cough (Me = 0 [0;0.5] points) remained. On day 1 of observation, an increase in IL-6 protein content compared with normal was noted in pharyngitis, and sIgA levels were low. Further, both groups showed a decrease in IL-6 level, in group 1 in the group receiving Tonsilgon N, its level on the 2nd and 3rd visit was lower compared to group 2. The amount of sIgA on the first day with pharyngitis was minimal, then in group 1 its values increased on day 3 but remained below control, and in group 2 further decreased, on day 7 of observation in group 1 sIgA slightly increased but was below control. In group 2 the sIgA level was determined in minimal values. Conclusion. Tonsilgon N or sage therapy showed a clear relief of clinical symptoms of tonsillopharyngitis during the treatment period without taking non-steroidal anti-inflammatory drugs, and their reduction was significantly faster with Tonsilgon N. Decrease of proinflammatory cytokine IL-6 on the background of treatment was faster on the background of treatment with Tonsilgon N. Increased synthesis of sIgA against the background of Tonsilgon N treatment allows to explain the rapid onset of clinical recovery in patients and to identify an additional mechanism of action of this drug on the local immune response of the oropharyngeal mucosa. It can be assumed that Tonsilgon N is not only pathogenetic, but also immunoregulatory, creating the most effective response of the body to inflammation. Key words: pharyngitis, oropharyngeal mucosa, interleukin-6 (IL-6), secretory immunoglobulin A (sIgA), enzyme-linked immunosorbent assay (ELISA), treatment, Tonsilgon N, sage