Главная Коллекция "Revolution" Медицина Порушення неврологічного та цитокіно-імунного статусів у хворих з наслідками ішемічних інсультів в період реабілітації

Порушення неврологічного та цитокіно-імунного статусів у хворих з наслідками ішемічних інсультів в період реабілітації

Теоретичне узагальнення результатів вивчення особливостей цитокінового та імунного статусів хворих з наслідками ішемічних інсультів у реабілітаційному періоді під час проведення реабілітаційного лікування. Дослідження основних субпопуляцій лімфоцитів.

Рубрика Медицина
Вид автореферат
Язык украинский
Дата добавления 23.08.2014
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ABSTRACT

Brovchenko M.S. Disorders of neurologic and cytokino-immune statues in patients with consequences caused by ischemic stroke in the period of rehabilitation. - Manuscript.

The dissertation is presented for the Scientific degree of Candidate of Medical Sciences in specialty 14.01.15 - nervous diseases. - National Medical University named after O.O. Bogomoletz, Kyiv, 2006.

The dissertation contain theoretical and practical generalization of the study results on peculiarities of cytokine and immune state in 100 convalescents after ischemic stroke during rehabilitation treatment, based on the investigation of main lymphocyte subpopulations, lymphocyte apoptotic antigens as well as levels of tumor necrosis factor (TNF), interleukin (IL)-1, IL-4 and IL-6, with the aim to offer a new solution of the actual scientific task -- optimization of diagnostics, treatment and rehabilitation in patients with ischemic stroke.

In patients with the ischemic stroke consequences during different rehabilitation periods, levels of СD3+ lymphocytes, СD19+ lymphocytes and main immune-regulatory subpopulations (СD4+ and СD8+ lymphocytes) were characterized by safe relative and absolute content, and had no statistically significant differences as compared to those in healthy persons. It was determined, that immunological peculiarities of the early rehabilitation period after stroke consist in the safe number of T-lymphocytes, the development of В-lymphocytosis as a result of the increased IL-4 content, the enhanced lymphocytes apoptosis in consequence of the TNF-б hyperproduction, the markedly increased level of all the three proinflammatory cytokines -- TNF-б, IL-1в, IL-6. Ability of the main Т- та В-lymphocytes subpopulations towards the activation and expression of the IL-2R б-chain was substantially decreased in early rehabilitation period, that testify to the oppression of the early activation reactions of lymphocytes; during the late rehabilitation and the residual periods the oppression of the activation processes in lymphocytes was observed, that was accompanied by the decrease of the percentage content of СD25+ and СD54+ lymphocytes and the non-significant increase of the lymphocytes ready for apoptosis. The peculiarities of the cytokine status in the late rehabilitation and the residual periods are as follows: normalization of the proinflammatory cytokines production simultaneously with relatively stable IL-4 serum concentration during the whole rehabilitation period.

The most severe immunological changes were revealed in case of the left brain hemisphere lesions, which consists in the marked В-lymphocytosis, the lowest number of the activated СD25+ lymphocytes and the high level of the activated cells that expressed Fas-receptor. For the first time a dissociation was revealed between indices of the cellular immune response and synthesis of proinflammation cytokines in patients with the right hemisphere lesions, that may be considered as a specific clinical-immunological feature of the strokes of such a localization.

It was also revealed, that substantial abnormalities in the neurological status of the patients are accompanied by more pronounced inflammation features -- increased serum levels of IL-1в, TNF-б and IL-6, decreased immune-regulatory index, high percentage of СD95+ lymphocytes.

Simvastatin add-on to the complex treatment during different rehabilitation periods in patients with the ischemic stroke consequences was characterized by the increase of immune-regulatory index, the decrease of the immunocompetent cell adhesion and migration processes to atherosclerotic plagues, the reduction of activated lymphocytes with CD95+ phenotype, and the normalization of the serum proinflammatory cytokines content.

Based on the cytokine-immune status abnormalities, a prognostic criteria for the lost functions restoration in patients with the ischemic stroke consequences are elaborated, which include: indices of the unfavorable prognosis (significant reduction of immune-regulatory index, high percentage of CD95 lymphocytes, increased level of IL-6) as well as indices of the favorable prognosis (normal levels of TNF, IL-1, IL-6, and increased level of IL-4).

Key words: ischemic stroke, immunity, lymphocytes subpopulations, cytokines, rehabilitation period.

СПИСОК УМОВНИХ СКОРОЧЕНЬ

ІЛ -- інтерлейкін

ІФН -- інтерферон

КТ -- комп'ютерна томографія

МРТ -- магнітно-резонансна томографія

ФНП -- фактор некрозу пухлин

CD (Cluster Designation) -- групова мітка

FAS-R -- FAS-рецептор

ICAM -- молекула міжклітинної адгезії

NO -- оксид азоту

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