Cytokine Activity Indicators Dynamics after Non-Drug Rehabilitation including Intravenous Laser Blood Irradiation in Patients with a Lower Limb Post-Thrombophlebitic Syndrome: a Randomized Study

Abstract

INTRODUCTION. Previous studies have established the association of venous thrombosis risk factors with inflammation, and the important role of inflammatory mediators as prognostic markers of recanalization of veins after deep vein thrombosis and the progression of postthrombophlebitic syndrome (PTPS). Pro-inflammatory cytokines, as key inflammatory mediators, are part of several cascades of pathophysiology in venous thrombosis, as well as predictors of the occurrence and prolongation of acute thrombosis and its resolution. To date, new oral anticoagulants are used, but their use in medical practice does not lead to a decrease in the number of patients with PTPS.
 AIM. To study the dynamics of proinflammatory cytokine levels under the influence of a complex non-drug method including intravenous laser irradiation of blood (ILBI) in patients with PTPS.
 MATERIALS AND METHODS. We conducted a randomized study that included 60 patients aged 58.3 ± 12.56 years with lower extremity PTPS (CVI C4–C5 according to CEAP clinical classification) divided into 2 groups. The subjects of the 1st group (main, n = 30) received: ILBI, pulsed magnetotherapy and dry-air carbon dioxide baths. After a complex of physiotherapy procedures, patients underwent therapeutic gymnastics in the gym according to the Brunner U. method. Subjects of the main group received the above rehabilitation complex against the background of phlebotonics (combination of diosmin and hesperidin) and the use of knitwear of 2–3 compression classes. Patients of the 2nd group (control group, n = 30) received standard elastic compression (2–3 compression class), similar drug therapy with phlebotonics and therapeutic gymnastics in the gym according to the method of Brunner U.
 RESULTS. After the course of rehabilitation, the patients of the main group showed positive dynamics of the main clinical symptoms of the disease, a decrease in malleolar volume, correction of microcirculatory disorders and activity of proinflammatory cytokines, accompanied by an improvement in transcapillary metabolism and tissue hypoxia. In patients of the control group, only a decrease in the number of leukocytes and fibrinogen in peripheral blood was recorded, while no changes in the expression of proinflammatory cytokines were observed. In this group of subjects, there was a positive trend in the regression of edema in terms of malleolar volume.
 CONCLUSION. As a result of the application of the proposed rehabilitation complex, which includes, along with the traditionally used physical factors (pulsed magnetotherapy, dry-air carbon dioxide baths and therapeutic gymnastics) ILBI procedures, not only decongestant, hypocoagulating effects, positive dynamics of the main clinical symptoms of the disease were noted, but also correction of microcirculatory disorders and the level of pro-inflammatory cytokines was achieved, accompanied by an improvement in transcapillary metabolism and trophic tissues.