Comprehensive phenotypical characterists of immunocompetent peripheral blood cells (CD3, CD4, CD8, CD19, CD25, CD45RO, CD95 and HLA-DR) is presented. Proinflammatory cytokines (IL-lβ, IL-6 and TNFα) and lymphokines of Thl-type (IFNγ and IL-2) were studied in serum of patients with chronic obstructive and nonobstructive bronchitis on the background of secondary immunodeficiency state (IDS), also patients with subacute and chronic rheumatoid arthritis (RA) in the course of immunorehabilitation (IR). Disorders in activation processes of immunocompetent cells in peripheral blood of patients with chronic bronchitis (CB) were revealed that manifested in a decreased quantity of activated T-lymphocytes expressing CD25 and CD45RO antigens, as well as significant increase in the number of CD95-cells. The levels of IFNγ and IL-2 were shown to decrease in blood serum of patients with CB, thus evidencing lower functional activity of Th1. Proinflammatory cytokines were demonstrated to prevail in blood of these patients. A step-by-step scheme for IR of CB patients with secondary IDS is suggested which can be also applied when treating patients with other immunopathological states. High efficiency of combined application of immunomodulators for system and local use in patients with CB of various severities was shown.
It was shown that RA patients are characterized by an elevated expression of activation markers on the surface of T-lymphocytes (CD25 and HLA-DR), significant increase in. the number of activated CD45RO-bearing T-memory cells and CD95-cells thus evidencing increased readiness to apoptosis. Direct correlation between the number of T-lymphocytes which express the marker of prolonged activation (HLA-DR) and duration of the disease in RA patients was established. It was shown that in serum of RA patients, proinflammatory cytokines prevail. Positive correlation between the levels of IL-lβ and IL-6 in serum and activity of the process was revealed.
Immunological monitoring at all IR stages of IDS patients was substantiated. The level of TNFα was shown to positively correlate with the number of CD95-cells in patients with chronic pathologic processes. Comprehensive clinical immunological analysis of a huge amount of clinical materials allowed elaborating technical approaches and tactics of IR of patients with disorders in immune system. It was shown that the choice of immunomodulators, scheme and methods of IR are determined by peculiarities of the clinical course of the disease, its severity, activity of inflammation process and immune state indices.
Results of ambulatory and sanatorium-resort IR programs were analyzed. They proved to be more efficient as compared to routine pharmaceutical and therapy measures. It was demonstrated that these complex IR programs should include adequate basic medicamentous therapy, set of immunomodulators of directed action, methods of nonmedicamentous treatment, as well as resort and preformed physical factors taking into account clinical immunological and pathogenic peculiarities of a person at every stage of IR. It was shown that step-by-step IR restores not only the number of regulatory immune cells, but also their functional activity and the level of proinflammatory cytokines which play an important role in the chronic inflammatory processes. It also provides stable clinical remission. It was demonstrated that prolonged, rational, complex, step-by-step IR allows to decrease the number of recurrences (by 95-98% in average), prolong remission by 4-to 5-fold, reduce drug uptake and improve ability for work and quality of life.
The work is submitted to Scientific Conference "Basic and applied research", Brazil (Rio de Janeiro), February 19 - March 3, 2009. Came to the Editor´s Office on 22.12.2008.