Особливості клітинного імунітету у хворих на розсіяний склероз

Abstract

В роботі вивчався стан клітинного імунітету у хворих на розсіяний склероз (РС) із різним типом перебігу захворювання. Обстежено 68 хворих з верифікованим діагнозом РС на основі критеріїв MacDonaldetal віком від 19 до 65 років (37 жінок, 29 чоловіків). Первинно прогресуючий тип перебігу встановлено у 19 пацієнтів, вторинно-прогресуючий - у 23, ремітуючо-рецидивуючий тип перебігу - у 26 пацієнтів. Контрольну групу склали 80 практично здорових чоловіків-добровольців віком 25-45 років. Нами встановлено, що у хворих на розсіяний склероз, незалежно від типу перебігу захворювання спостерігається активація кілерної та гуморальної ланки імунітету та збільшення кількості CD25+, що свідчить про активацію лімфоцитів; В работе изучалось состояние клеточного иммунитета больных рассеянным склерозом (РС) с различным типом течения болезни. Обследовано 68 больных с верифицированным диагнозом РС на основании критериев MacDonaldetal возрастом от 19 до 65 лет (37 женщин, 19 мужчин). Первично прогрессирующий тип течения установлено у 19 пациентов, вторично-прогрессирующий - у 23, ремитирующе-рецидивирующий тип течения - у 26 пациентов. В контрольную группу вошли 80 практически здоровых мужчин-добровольцев возрастом 25-45 лет. Нами установлено, что у больных рассеянным склерозом, независимо от типа течения заболевания наблюдалась активация киллерного и гуморального звена иммунитета и увеличение количества CD25+, что свидетельствует об активации лимфоцитов; Multiple sclerosis (MS), according to modern notions, is a multifactor chronic progressive disease, characterized by the damage to the central nervous system, a significant pathophysiological mechanism of which being inflammation and autoimmune processes. However, mechanisms of MS immunopatho- genesis have not been studied completely. The condition of cell-mediated immunity in patients with multiple sclerosis with different types of disease course has been studied in the research. In general, 68 patients with verified MS diagnosis based on MacDonald et al criteria aged from 19 to 65 years (37 females, 29 males) have been examined. Primary progressive type of the course has been established in 19 patients, secondary progressive course - in 23, relapsing- remitting course - in 26 patients. Control group included 80 generally healthy men-volunteers aged 25-45 years. Population and subpopulation composition of lymphocytes in the blood was determined using monoclonal antibodies to differential antigens of lymphocytes: CD3+, CD4+, CD8+, CD19+, CD56+. To determine processes of early lymphocyte activation, expression on the surface of CD25+ lymphocytes was estimated. Correlation CD4+/CD8+, CD3+/CD19+, CD3+/CD56+ was calculated, proliferative index - (CD4++CD19+)/ CD25+. The results of investigation were analyzed by the method of variation statistics by means of STATIS- TICA 6 (Statsoft, USA) program. Based on our research, it has been shown that total leukocyte count in the blood in multiple sclerosis was by 33% higher than in control. In patients with primary progressive multiple sclerosis, total count of circulating leukocytes was by 1.46 times higher than in control, in relapsing-remitting course - by 29% higher than in control. According to our data, in MS amount of granulocytes and lymphocytes decreases in peripheral blood (MS 24.65±2.0%, control group 34.0±1.51%), relative amount of neutrophils is increased to 68.72±2.7 % (control group 55.2±2.0 %), relative amount of stab cells is higher (MS 5.21±0.4%, control group 2.01±0.18%) as compared with control. In patients with MS, the decrease in absolute amount of T-helpers by 28%, the increase in amount of T-cytotoxic lymphocytes by 38% in relation to control has been established. Respectively, CD4+/CD8+ correlation probably decreases. Similar tendency was also observed in groups with different types of MS course. Largely, absolute amount of CD4+-lymphocytes (31%) was decreased in the group with relapsing-remitting type of the course. Reduction of CD3+ is typical for MS exacerbation, while normalization - for MS remission. Simultaneously, the increase in relative and absolute amount of B-lymphocytes and NK- cells has been established, respectively the decrease in CD3+/CD19+ and CD3+/CD56+ correlation has been recorded. Our investigation showed elevation of circulating lymphocytes in patients with MS regardless of the type of the disease course. It has been established that expression of CD25+ on lymphocytes intensifies in multiple sclerosis, indicating their activation due to antigenic stimulation. Elevation of CD25+lymphocytes in the blood can be regarded as the increase in amount of activated T-lymphocytes, which may include regulatory T-lymphocytes. Simultaneously, CD8+lymphocytes are regarded as cytotoxic cells of antitumor and antiviral immune defense, which provoke delayed hypersensitivity. Thus, meaning of CD4+/CD8+ index acquires not immunoregulatory significance, but meaning of the index which presents relation of regulatory processes, represented by T-helpers, to effector ones, provided by T-cytotoxic lymphocytes. CD56+lymphocytes are natural killers, able to destroy target cells directly, and they also represent antiviral and antitumor immunity. Based on conducted investigations, it has been established that relative amount of NK-cells in multiple sclerosis is increased by 1.7 times, absolute amount - by 2.4 times (p<0.05) as compared with control. Investigation of indices of cell-mediated and humoral immunity in patients with MS is a current issue and perspective direction for the study of MS pathogenesis mechanisms.