The changes of immunological reactivity at COU undergo considerate changes depending on the degree of ureteropelvic obstruction and the potency of secondary infectious process. Other factors can influence the intensity of immune alterations, but in the literature available we haven´t come up the data for how a surgical stress and anesthetic management during an operative intervention at COU in children influence different components of immune response.
Purpose of the research. The purpose is to study the immunologic reactivity changes in children with COU; to substantiate the balanced treatment policy taking into account the diagnosed immune alterations.
Problems of the research. 1) to study changes of cellular and humoral immunity values in children with COU; 2) to investigate the dynamics of cellular and humoral immunity values´ change before and after the operative intervention in this group of patients; 3) to substantiate the balanced treatment policy taking into account the diagnosed immune alterations.
Materials and methods of the research. We examined 40 children (general group) from 5 to 15 years old with COU complicated with secondary chronic obstructive pyelonephritis. Among them there were 28 (70%) boys and 12 girls. The surgical organ-saving treatment was prescribed for all of them. General clinical, clinical and laboratorial, biochemical and instrumental examinations were performed for the general group. Alongside with this CD3- and CD22-lymphocyte content (PCR with homogeneous antibodies), CD4- and CD8-lymphocyte value in blood (method of indirect immunofluorescence with homogeneous antibodies) were detected in all the children the day before and the day after the surgery; immunoglobulin (G, A, M) levels (method of radial immunodiffusion using antichain serums) and concentration of circulating immune complexes in blood serum (precipitation method) were investigated as well. The material obtained at the immunologic reactivity parameters´ investigation in the observed patients was compared to the specified indexes´ investigation results in 232 children of the same age of I-II health groups living in Kirov and Kirov Region (the control group). All the patients were provided with a standard complex anesthesia service: general inhalant endotracheal anesthesia with halothane + intravenous induction of stupefacient analgesics. The Haynes-Anderson´s operation was carried out for hydronephrosis patients; Cohen´s operation was carried out for patients with vesicoureteral reflux; Marshall-Stevenson´s operation - for obstructive ureterohydronephrosis patients.
Results. Immunologic reactivity changes in the general group of patients with COU before the influence of surgical stress and anesthesia service manifested in the authentic reduction of CD3-lymphocytes´ and CD8-cells´ relative count in blood; G and M immune serum globulins´ value increase. After the surgical aid and its anesthetic management the authentic reduction of CD3-lymphocytes´ relative count, relative and absolute count of CD4-lymphocytes and CD8-cells, and G and M immune serum globulin increase.
Conclusions:
- There are evident immunological status changes in children with congenital obstructive uropathy.
- These abnormalities redouble under the influence of a surgical stress and preparations of anesthetic management.
- The diagnosed immune alterations define the advisability of using immunotropic preparations in anesthetic management of the operations concerning children´s COU.
The article is admitted to the International Scientific Conference « Advanced educational technologies and principles of academic process organization», Rome-Florenciya-Venice, 2007 March 10-17; came to the editorial office on 07.02.07