Резюме
Победьонний А.Л., Семенець Ю.П., Сидоренко М.П., Чепелєв В.М. Вплив імунореабілітації на показники клітинного імунітету хворих із перенесеною черепно-мозковою травмою.
У статті відзначений позитивний вплив лікування із додаванням нуклеїнату поряд із традиційними засобами нейропротекції на стан клітинного імунітету у пацієнтів після черепно-мозкової травми у вигляді підвищення імунорегуляторного індексу та популяції CD3+-лімфоцитів.
Ключові слова: імунореабілітація, показники клітинного імунітету, черепно-мозкова травма.
Резюме
Победенный А.Л., Семенец Ю.П., Сидоренко М.П., Чепелев В.М. Влияние иммунореабилитации на показатели клеточного иммунитета больных с перенесенной черепно-мозговой травмой.
В статье отмечено позитивное влияние лечения с дополнительным приемом нуклеината наряду с традиционными средствами ненйропротекции на состояние клеточного иммунитета пациентов после черепно-мозговой травмы в виде повышения иммунорегуляторного индекса и увеличения популяции CD3+-лимфоцитов.
Ключевые слова: иммунореабилитация, показатели клеточного иммунитета, черепно-мозговая травма.
Summary
Pobedonnij A.L., Semenets Ju.P., Sydorenko M.P., Chepelev V.M. Influence of immune rehabilitation on cell immunity of the patients after traumatic brain injury.
Positive influence of treatment with nucleinatum on the cell immunity at the patients after traumatic brain injury were presented in article. It was demonstrated at the improvement of immune index at increased amount of CD3+.
Key words: immune rehabilitation, cell immunity, traumatic brain injury.
Рецензент: д.мед.н., проф. І.В. Лоскутова

УДК 616.017.1:616.831-001-08

Луганська обласна клінічна лікарня

Луганская областная клиническая больница

91045, г. Луганск, кв. 50 лет Обороны Луганска, 14

Lugansk regional clinical Hospital

91045, Lugansk, 50 Rokyv Oborony Luganska Block, 14

siderman@ukr.net

Traumatic brain injury (TBI) remains one of the most heavy types of traumatism that often results in fatal consequences, and among those patients that survived, complete functional renewal is observed very rarely.

The aim of the work is investigation of  the state of indexes of cell immunity for patients with previous TBI of moderately severe on the ambulatory stage on the background of application of immunoactive medication of nucleinas for immunoreabilitation. 27 persons with the consequences of TBI of moderately severe, a brain closed wound of moderately severe after operative measure concerning hematoma or ping-pong fracture after release from the neuro-traumatology department  of the Luhansk regional clinical hospital (a basic group) took part in the research. The state of cell immunity was examined for patients before release and after one month of care. The patients of the basic group were put on nucleinas in a dose of 1 capsule (0,25 g) 4 times in twenty-four hours after meal during 3 weeks with  generally accepted neuroprotection remedies. The group of comparison consisted of  22 traumatized persons after release from the neuro-traumatology in-patient department, who did not get immunoreabilitation. The middle age of examined patients was (32,6±4,2) years. There were 46 men and 3 women among examined patients. All of the patients with previous TBI after release from the in-patient department had existing features of secondary disease of immunity with decrease of CD 3+, CD4+-cells and immunoregulatory index. In a month after release from the in-patient department  on the background of three-week realization of treatment with addition of nucleinas  with the aim of rehabilitation  was marked improvement of all studied indexes. The content of CD3+-lymphocytes in absolute calculus for the patients of the basic group increased to (1,16±0,03) g/l, was higher than analogical index of the group of comparison on 9,4% (P <0,05). Despite of that for the patients of the group of comparison the content of CD3+-cells increased on 3,92% from the  initial one, the increase of its level for the patients of the basic group was more intensive - on 10,5% from the initial one. In relative values the size of CD3+-lymphocytes for the persons of the basic group was unimportant higher than such value for the patients of the group of comparison (on 6,8%)  and on 10,4%  probably lower than reference norm. The concentration of CD4+-cells for the patients of the basic group increased less intensively, than in the group of comparison, and  equaled in absolute calculus (0,72±0,03) g/l, but was for certain more than analogical index in the group of comparison in 1,16 times. The indexes of CD4+-lymphocyte for the patients of the basic group essentially did not change after application of nucleinas and were even equal in absolute numbers (0,44±0,05) G/l, and in relative - (23,22±1,45)% . The analogical dynamics had the index of CD4+-cells in the group of comparison. Indicated positive changes of the content of CD4+ -  and CD8+-cells on the background of treatment with adding of nucleinas to traditional neuroprotective remedies on the ambulatory stage had a reflection in the dynamics of immunoregulatory index CD4/CD8, that in the basic group began to equal (1,64 ± 0,06), that was more from analogical one in the group of comparison on 16,3% ( P<0,05).

Thus, for patients with previous TBI after the period of medical immunoreabilitation with remedy of nucleinas on the ambulatory stage was more intensive, than in the group of comparison, increase of general population of T-lymphocytes, increase of the content of CD4+-cells and increase of immunoregulatory index, that was observed in other researches [8]. Positive changes of immune status, in our view, will favourably influence on the clinical motion of TBI during renew period.

Література

1. Герасимов М.М. Клинические и иммунопатологические особенности при черепно-мозговой травме различной степени выраженности / М.М. Герасимов, А.И. АбуСалех // Иммунология. – 2007. - № 3. – С. 182-183.
2. Лисяный Н.И. Врожденный и приобретенный иммунитет головного мозга  / Н.И. Лисяный // Імунологія та алергологія. – 2008. - № 1. – С. 68.
3. Черний В.И. Черепно-мозговая травма  церебропротекция: нейромидин в аспекте доказательной медицины / В.И. Черний, Т.В. Островая, И.А. Андронова // Медицина неотложных состояний. – 2008. - № 2 (15). – С. 99-105.
4. Влияние анальгоседации на цитокиновый профиль у пострадавших с тяжелой политравмой / И.Р. Малыш, А.И. Трещинский, И.П. Шлапак, Л.В. Згржебловская // Анестезиология и реаниматология. – 2008. – № 1. – С. 74-77.
5. Дранник Г.Н. Клиническая иммунология и аллергология / Дранник Г.Н. – М.: Медицинское информационное агенство, 2003. – 603 с.
6. Лісяний, М.І. Цитокіновий профіль у хворих з різним перебігом легкої повторної ЧМТ / М.І. Лісяний, М.В. Каджая // Імунологія та алергологія. – 2009. – № 2-3. – С.109-113.
7. Моноклональные антитела в изучении показателей клеточного иммунитета у больных рожей / В.М. Фролов, И.С. Гайдаш, Н.А. Пересадин [и др.] // Лабор. дело. – 1989. –№ 6. – С. 71-72.
8. Прилуцкий А.С. Применение нуклеината в комплексной терапии рецидивирующей герпетической инфекции / А.С. Прилуцкий, А.С. Сергиенко, Д.А. Лесниченко // Новости медицины и фармации. – 2008. - № 256. - С. 19-21.
9. Depressed interleukin-12–producing activity by monocytes with adverse clinical course and a shift toward Th2 type lymphocyte pattern in severely injured male trauma patients / Z. Spolarics, M. Siddiqi, Siegel JN.H. [et al.] // Crit. Care Med. – 2003. – Vol. 3, № 6. – P. 1722-1729.
10. Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study [Text] / N. A. Mushkudiani, D. C. Engel, E. W. Steyerberg [et al.] // J. Neurotrauma. – 2007. – Vol. 24. – P. 259-269.