Interconnection between indices of microbiocoenosis of intestine and the local immunity in children with reactive arthritis

Abstract

Aim. To improve the diagnostics and prognostication of ReA clinical course in children on the base of study of intestinal microflora and the local immunity (secretory immunoglobulin А (sIgA)). Materials and methods. There were examined 40 children with ReA in an acute period in 9–12 month after the beginning of disease. 23 healthy children formed the control group. The examination of children was carried out in municipal children cardiorheumatologic department of CIHP “Kharkov municipal children clinical hospital № 24” and Kharkov municipal children polyclinics (№ 1, 2, 7, 12, 13, 14, 23). ReA diagnosis was set according to the order of MHP of Ukraine from 19.07.2005 № 362 «Report on diagnostics and treatment of diseases of musculoskeletal system and connective tissue in children МКХ-Х М00-М25 arthropathy». The definition of the degree of disorder of large intestinal microbiocoenosis was carried out on the base of the order of MHP of Ukraine from 29.01.2013 №59 «Unified clinical report on medical help for children with diseases of alimentary organs». The sIgA definition is based on the use of “sandwich”-variant of hardphase immune-enzyme analysis. The study was carried out using the laboratory set of reagents for immune-enzyme definition of secretory IgA in biological liquids «Secretory IgA-IEA» LLC «HEMA» (№ FSR 2009/06385 from 16 of December 2009 year). An assessment of results of the studies was carried out using the STATISTICА program for Windows (10.0 version), Microsoft Excel 2012, MATLAB 2015a. Results. The study of the state of intestinal microflora in acute PeA period demonstrated that in all patients were revealed the disorders of intestinal microbiocoenosis such as decrease of the titers of the main indices of intestinal micro flora, decrease of the number of bifido- and lactobacteries. On the background of depression of the normal intestinal microflora there was observed proliferation of opportunistic microorganisms. As to degree of dysbiosis in ReA acute period its II degree was defined in 62,5 %, and the І in 37,5 % of patients. In 9–12 month after the beginning of disease in patients with ReA who received the basal therapy with probiotic correction was observed the favorable dynamics of the dysbiotic disorders degree. So the І degree of dysbiosis was detected in 67,5 % of patients, the part of patients with II dysbiosis degree was 32,5 %. At comparison of the data of intestinal microflora in children with remission and prolonged or relapsing ReA clinical course was established that at remission I dysbiosis degree was the dominative one and at prolonged or relapsing clinical course the II dysbiosis degree was diagnosed in all patients. The study of the local immunity state demonstrated that in ReA acute period the level of secretory immunoglobulin A reliably exceeded the norm. There was revealed the reliable direct connection between sIgA level and dysbiosis degree. In 9–12 month after beginning of disease it was observed the normalization of sIgA level. In children with relapsing and prolonged ReA clinical course sIgA level remained reliably increased comparing with group at the phase of remission. The received results testify that the changes in sIgA metabolism in patients with ReA has a secondary character and the established growth of sIgA content in patients with ReA carries out compensatory function. Conclusions. 1. In all patients with ReA were established the disorders of intestinal microbiocoenosis. In acute period II degree of dysbiosis (subcompensated one) was detected in 62,5 %, and I degree (compensated one) – in 37,5 %. In 9–12 month after beginning of disease I degree of dysbiosis was detected in 67,5 %, and the II degree in 32,5 % of patients, it was more often in children with relapsing and prolonged ReA clinical course. 2. In ReA acute period sIgA level in saliva reliably exceeded norm. 3. There was revealed the reliable direct connection between sIgA level in saliva and dysbiosis degree. 4. In 9–12 month after the beginning of disease in the group of children with remission was observed the normalization of sIgA, and in children with relapsing and prolonged ReA clinical course sIgA content remains high, it is prognostic factor of transition from acute clinical course to prolonged or relapsing one