Стан загального імунітету в породілей із гнійними ранами під час воєнних дій

Abstract

Purpose - to study the immune status of women giving birth with an infection of an obstetric surgical wound in the conditions of war, which will make it possible to develop and implement a pathogenetically justified method of wound infection therapy in the postpartum period. Materials and methods. We studied the immune status of 66 women in labor with an infection of an obstetric surgical wound in the conditions of war from February 24, 2022 and compared it with the indicators of general immunity of 76 women in labor with an infection of an obstetric surgical wound in peacetime. The material for the study of general immunity was peripheral blood, which was taken from the moment of infection of the obstetric surgical wound. To assess the state of general immunity, the total number of T lymphocytes (CD3+), their immunoregulatory subpopulations - T helpers/inducers (CD4+) and T suppressors/killers (CD8+), the number of B lymphocytes (CD22+), NK cells (CD16+) were counted), the immunoregulatory index (CD4+/CD8+) was calculated, the concentration of circulating immune complexes and immunoglobulins of classes A, M, G, phagocytic index and phagocytic number were determined. Statistical data processing was carried out using the package of application programs Microsoft Excel 5.0 and using the standard version Statistica 8.0. The difference in indicators was considered statistically significant at Р<0.05. Results. In women in labor with purulent wounds under the conditions of war under stressful conditions, there is a greater suppression of systemic immunity than in women in labor with this pathology in peacetime, which was manifested by T lymphopenia (decrease in CD3+ by 1.4 times, decrease in the level of T cells with helper activity (CD4+) by 1.2 times, immunoregulatory index (Tx/Tc) by 1.3 times), a decrease in the number of B lymphocytes (CD22+) and NK cells (CD16+) by an average of 1.2 times, a decrease indicators of immunoglobulins of classes A, M, G by an average of 1.3 times, phagocytic index) and phagocytic number relatively by 1.3 and 1.6 times, which led to an increase in the level of circulating immune complexes by 1.1 times. The absence of a significant difference between indicators of general immunity in parturient women with purulent wounds of the perineum and anterior abdominal wall was confirmed, which confirms the established doctrine that wounds of different localizations heal according to general laws and the body, namely the immune system, reacts equally to the wound process of any localization. Conclusions. When prescribing the treatment of an infection of an obstetric surgical wound, do not take into account the localization of the wound, since wounds of different localizations heal according to general laws and the immune system reacts in the same way. In women in labor with purulent wounds in wartime conditions, under stress, there is more suppression of systemic immunity than in women in labor with an infection of an obstetric surgical wound in peacetime, which increases the development and spread of the purulent-inflammatory process, increases the risk of severe septic complications, which leads to the development and implementation of a pathogenetically justified method of therapy of obstetric surgical wound infection in wartime conditions. 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 the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.