Immune status changes in patients with phlegmon in the maxillofacial region relation with purulent process prevalence

Abstract

Introduction. Significant portion of patients with acute purulent-inflammatory diseases of the face and neck often has a pronounced secondary immunodeficiency. One manifestation of violation of protective functions in this group of patients are changes in the synthesis of interleukin blood. Knowledge about the of the immune changes in the early stages of the face and neck abscesses development can be used for choosing the right timely empirical therapy. However, the currently available data regarding immune abnormalities in this pathology are controversial. Perhaps this is due to the influence of geographical, environmental and socio-economic factors on the immune status of patients and the results of studies. Thus, to obtain an objective picture of the nature of changes in the body's defenses of patients with inflammatory processes of the face and neck, it is advisable to carry out the study of the state of immunity for each region separately, and that was the basis for this study Aim. to improve pyoinflammatory facial diseases diagnostics on the background of the status study. Materials and Methods. Serum cytokines (IL-1, TNFα, IL-6, IL-8, IL-4) concentration in 60 patients with maxillofacial phlegmon were determined with ELISA method. All patients were residents of Zaporozhye and the Zaporozhye area. Patients were divided into III groups: the 1st included 40 (66.7%) patients with a checkered phlegmons space; 2 nd group – 15 (25.0%) patients with phlegmons of the more than one space; the 3 rd group – 5 (8.3%) patients with diffuse face and neck phlegmon, and with mediastinitis. The average age of patients was 37.0±7 years. 21 healthy subjects were included into control group. 5 ml of the peripheral blood was taken from the antecubital vein under aseptic conditions; and was placed in sterile tubes containing 25 IU of heparin per 1ml. Blood was centrifuged at 3000 rev./min for 10 minutes. Serum was dispensed at 0.3 ml. in plastic tubes, frozen and stored before use at minus 20°C. cytokines concentration was determined with commercial test systems OOO cytokine Vector-Best (St. Petersburg). The results were recorded according to absorbance measured in a spectrophotometer – analyzer Sunrise (Austria) at 450 nm. The cytokines were determined by constructing a calibration curve using the computer program «Calibration» in picogram per milliliter (pg/ml) units. The results and discussion. All phlegmons of the maxillofacial region, regardless of their degree of prevalence are accompanied by an increase in the blood levels of pro-inflammatory interleukins majority. IL-4 concentration in the blood of patients with phlegmones was close to normal range (0.43±0.03, р>0.5). Serum IL4 concentration was increased only in patient with pyoinflammatory changes in more than one area. This indicates adequate response of the immune system against massive antigen load of the immune system (0.93±0.05, p<0.001). IL 4 serum levels in patient with mediastinitis were lower than in the control group (0.25±0.03, p<0.01). this indicated immunosupression in such cases.