Optimization of complex diagnosis and treatment of patients with psoriasis on the background of herpes virus infection of types 1, 2

Abstract

Objective — improving the diagnosis, increasing the effectiveness and evaluation of safety of antiviral therapy in the complex treatment of patients with psoriasis (P) and activated chronic herpes virus infection of type 1, 2 (HSV 1, 2) taking into account the molecular, genetic, and immunological mechanisms of these diseases, development of approaches to predicting the course of dermatosis.Materials and methods. To achieve this purpose and solve the relevant tasks during 2017—2020, we examined 120 patients with clinical, general laboratory, biochemical, molecular, genetic, and immunological methods.Results and discussion. In patients with P + HSV 1, 2, a higher (by 2.1 times; p < 0.05) level of miR-155 expression was determined compared to that in patients with activated HSV 1, 2 only, and miR-146a expression was 1.8 times lower (p < 0.05) compared with the index in patients with P. A direct relationship was established between the number of lymphocytes and miR-155 expression in patients with P + HSV 1, 2 (r = 0.46; p < 0.05). After complex therapy with antiviral drugs, miR-155 expression in patients with P + HSV 1, 2 was reduced, especially compared with the group of patients who received basic therapy (p < 0.05).In patients with P + HSV 1, 2, an increased number of regulatory T-lymphocytes was detected compared to that in patients with P (p < 0.05). At the same time, the number of T-helpers in these two groups was greater (p < 0.01) compared with that in healthy individuals. Conducted antiviral treatment led to an increase in the number of regulatory cells (p = 0.0503) after treatment and compared to the patients who received only basic therapy (p = 0.0122). Relationships were improved between B-lymphocytes and T-regulatory cells (r = 0.41; p < 0.05), between T-helpers and T-cytotoxic lymphocytes (r = –0.51; p < 0.05).Patients with P + HSV 1, 2 had a 3.5 times increase in the level of IFN-a in the blood compared to healthy people and 2.8 times increase in the same index compared to patients with P; IL-23 in the blood was 2.6 times higher than in the healthy persons and 1.9 times higher than in patients with activated HSV 1, 2; the level of TGF-b in the blood was decreased by 1.9 times compared to that of healthy persons and by 2.1 times compared to patients with activated HSV 1, 2. The use of antiviral drugs in the complex treatment of patients with P + HSV 1, 2 showed a decrease in the synthesis of IFN in saliva (p = 0.0398) and IL-23 (p = 0.0278) in the blood, as well as an increase in the level of TGF-b (p = 0.0438).Conclusions. An improved method of treatment and assessment of its clinical and immunological effectiveness on the basis of an integrated scale for patients with P + HSV 1, 2 are proposed, which provides for the use of inosine pranobex and/or acyclovir depending on the severity of HSV 1, 2 against the background of standard therapy for 90 days. This promotes higher effectiveness of the treatment of such patients compared with those receiving only basic therapy.