Influence of violations of non-specific and systemic cell response to the efficiency of the chemotherapy of pulmonary multidrug-resistant tuberculosis

Abstract

Objective — is to establish violations in the immune system that aggravate the course and reduce the effectiveness of the treatment of patients with multidrug­resistant pulmonary tuberculosis.Materials and methods. A comparative analysis of violations of the non­specific and systemic cellular immune response at the link was performed in 44 patients with a newly diagnosed destructive multidrug­resistant pulmonary tuberculosis (NDD MDR-TB) with effective, not very effective and ineffective antimycobacterial therapy (AMBT).Results and discussion. In patients with NDD MDR-TB inefficient and not very effective therapy, compared to patients treated efficiently, available pronounced humoral type immune response: increased by an average of 20—25 % content of ІgА (р < 0.05), ІgМ (р < 0.05), ІgЕ (р < 0.05) and the level of circulating immune complexes (p < 0.05); reduced content of cationic lysosomal proteins (CLP) of granulocytic leukocytes (р < 0.001), suppressed proliferative activity of T-lymphocytes on nonspecific (FSH, p < 0.05) and specific (PPD-L, p < 0.05) mytogens. In patients with treatment failure 2.0 times more frequently observed inhibition of 30 — 50.0 % or more proliferative activity of T-lymphocytes, the proportion of individuals with signs of tuberculin anergy of specific T-lymphocytes increased in 1.7 times and the proportion of patients with a decreased content of CLP granulocytes increased in 1.5 times. Significant disorders in the immune system were detected in 70 % of patients with ineffective and 29.4 % of patients with effective treatment.Conclusions. Progression specific process and reduce of the efficiency AMBT MDR-TB contribute: the presence of T-cell immunosuppression expressed by a decrease of more than 30.0 % of the T-lymphocyte pool and inhibition of their proliferative activity; tuberculin tolerance of specific T-lymphocytes, phago­cytic insufficiency is caused by a decrease of 30.0—50.0 % of the CLP content of granulocytic leukocytes.