Abstract
The study was carried out to assess the prospects for the combined use of leukocyte and cytokine indices in the bile duct obstruction of different genesis.We have performed a study of the patients with mechanical jaundice, either due to tumor (14 persons), or non-tumor genesis (16 persons). Concentrations of cytokines (IL-1, IL-4, IL-8, TNFα) were determined in blood serum before surgical intervention. The total activity of endogenous inflammatory mediators in the serum of patients was estimated as an index of inflammatory activity (IVA), which was calculated using the following formula: IVA = (IL-1 + TNFα)/IL-4. In addition, a number of leukocyte indices were calculated. The cellular component in the index estimation makes it possible to clarify the intensity of the inflammatory reaction, and to suggest the direction of the functional changes among the immunocompetent cells.It was shown that IVA in presence of malignancy is significantly higher than in benign conditions. Overactivation of immune response in tumors may be caused by a significant predominance of pro-nflammatory cytokines. Moreover, in cases of malignant tumor growth, both with or without cholangitis, the index scores of humoral and cellular components let us suggest the some problems with regeneration, due to pro-inflammatory domination of immune response, which does not ensure activation of the corresponding reactions. It has been established that the leukocyte intoxication index (LII) is increased,in patients with a combination of malignant disorder and cholangitis, and the immunoreactivity index (MDI) is lowered. In absence of cholangitis, the opposite pattern is observed, when LII is slightly lowered and MDI is elevated. Correlation analysis for the patients with cholangitis revealed a high association of cytokine imbalance and endogenous intoxication. A complex of cytokine and leukocyte indices is promising, when each of them reflects a certain part of the process, and their combination gives an integral picture of the pathology and allows to predict development of the disease. Such an approach, seems to increase the diagnostic significance of these immunological indices, primarily, the cytokine production, and may be used when predicting currence of complications in the surgical treatment of the disease.
Highlights
The study was carried out to assess the prospects for the combined use of leukocyte and cytokine indices
We have performed a study of the patients with mechanical jaundice
The total activity of endogenous inflammatory mediators in the serum of patients was estimated as an index of inflammatory activity
Summary
Исследование выполнено с целью оценки перспективности сочетанного использования лейкоцитарных и цитокиновых индексов при обтурации желчевыводящих путей различного генеза. Гиперактивация иммунного ответа при опухолях может быть обусловлена значительным преобладанием провоспалительных цитокинов. Установлено, что у пациентов с комбинацией злокачественного процесса и холангита лейкоцитарный индекс интоксикации (ЛИИ) увеличен, а индекс иммунореактивности (ИИР) снижен, а при отсутствии холангита наблюдается противоположная картина, когда ЛИИ несколько снижен, а ИИР повышен. Очевидна привлекательность использования комплекса цитокинового и лейкоцитарных индексов, когда каждый из них отражает определенную часть процесса, а их совокупность дает целостную картину патологии и позволяет прогнозировать развитие заболевания. «Методические подходы к оценке цитокинового “Methodological aspects of evaluating cytokine profile and баланса и лейкоцитарной реакции при обтурации leukocyte reaction in bile duct obturation of different origin”, желчевыводящих путей различного генеза».
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