Український стоматологічний альманах, 2016, № 1, Т. 1
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Перегляд Український стоматологічний альманах, 2016, № 1, Т. 1 за Автор "Biloklytska, G. F."
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Документ Зміни цитокінового профілю і вмісту анти-Hsp60 антитіл різної специфічності при генералізованому пародонтиті(Українська медична стоматологічна академія, 2016) Білоклицька, Галина Федорівна; Копчак, О. В.; Воробйова, Г. М.; Biloklytska, G. F.; Kopchak, O. V.; Vorobiova, A. M.Сучасні дослідження свідчать, що в основі прогресування генералізованого пародонтиту лежать порушення балансу між мікрофлорою і захисними факторами, які регулюються імунними механізмами. Мета. Дослідити в сироватці крові хворих на генералізований пародонтит зміни цитокінового профілю та його зв'язок із умістом анти-Hsp60 антитіл різної специфічності. Методи дослідження. Обстежено 32 хворих із генералізованим пародонтитом із використанням імунологічних методів. Результати. При генералізованому пародонтиті встановлено підвищення вмісту прозапальних цитокінів (ІЛ-6, ІЛ-8, ІЛ-1β, ФНП) на тлі зростання вмісту антитіл проти прокаріотичного Hsp60 та Hsp60 людини. Висновки. Визначено наявність аутоімунного процесу з ознаками системної запальної відповіді при генералізованому пародонтиті; Современные исследования свидетельствуют, что в основе прогрессирования генерализованного пародонтита лежат нарушения баланса между микрофлорой и защитными факторами, которые регулируются иммунными механизмами. Цель. Определить в сыворотке крови больных генерализованным пародонтитом изменения цитокинового профиля и его связь с содержанием анти-Hsp60 антител разной специфичности. Методы исследования. Обследовано 32 больных с генерализованным пародонтитом с использованием иммунологических методов. Результаты. При генерализованном пародонтите установленно повышение содержания провоспалительных цитокинов (ІЛ-6, ІЛ-8, ІЛ-1β, ФНП) на фоне роста содержания антител против прокариотического Hsp60 и Hsp60 человека. Выводы. Определено наличие аутоиммунного процесса с признаками системного воспалительного ответа при генерализованном пародонтите; Introduction. Periodontitis is considered as a multifactorial disease resulting from a combine impact of local and systemic factors on the background of altered reactivity. The stimulation of the immune system by periodontal bacteria results in the increased production of pro-inflammatory cytokines, which play an important role in the pathogenesis of the disease and is determined by activation of leukocytes, macrophages, fibroblasts and endothelial cells via nonspecific host response to infections, trauma, ischemia etc. The heat shock proteins are considered as an important antigen, which trigger this process. The quantitative characteristics and relationships between pro- and anti-inflammatory cytokines (cytokine balance) reflect the dynamics of inflammation and correlate with activity of certain cardio-vascular diseases, infections and malignant tumors, allowing the objective estimation of the disease severity and prognosis. However the role of blood cytokines in periodontal disease is still a subject of debate in the literature. Aim. To study the cytokine profile changes and their relationship with the content of anti-Hsp60 antibody of different specificity in the blood serum of patients with generalized periodontitis. Materials and methods. The prospective clinical and immunological study was performed in 54 persons aged from 21 to 73 years with mean age 35,8+15 years, which were divided into two groups: the main group - 32 patients with different degrees of periodontitis and control group - 22 patients with intact periodontium. Patients were recruited at the Department of Therapeutic Dentistry in P.L. Shupyk National Medical Academy of Postgraduate Education. All patients were examined according to the standard protocol, which included anamnesis, analysis of current medical data and general health state, clinical periodontal assessment, radiological examination and assay of cytokine profile. For immunological study the samples of venous blood were obtained from all patients in both groups. Assay of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-4 (IL-4), tumor necrosis factor (TNF-α) and antibodies for human and procariotic heat shock protein Hsp60 in serum of patients was performed using enzyme-linked immunosorbent assay (ELISA). Statistical analysis of received results was carried out using SPSS (SPSS Inc., Chicago, IL, USA) and MS Excel software. Results and discussion. Analysis of the obtained results showed that in patients of the main group the average content of pro-inflammatory cytokines as well as a content of antibodies against prokaryotic Hsp60 and human Hsp60 were significantly higher than in the control group. The average content of IL-6 in patients with periodontitis (the main group) was 17,3±3 pg/ml vs 9,8±2 pg/ml in the control group (p<0.05), the average content of IL-1β in the main group was 53,5±6,6 pg/ml vs 30,4±5,3 pg/ml in the control group (p<0.05), the average content of TNF-α - 23,8±2,6 pg/ml vs 9,7 ± 1,7 pg/ml (p<0.05), the average content of IL-8 in the main group was also higher than in the control (7,9±2,3 pg/ml vs 6,2±1,1 pg/ml), but the differences for this cytokine in studied groups were insignificant (p>0.05). On the contrary, the average content of anti-inflammatory cytokine IL-4 in patients of the main group was lower than in the control: 9,7±1,7 pg/ml vs 16,7±3,5 pg/ml however the differences appeared not significant (p>0.05). Conclusions. The immunological data revealed the significant increase in levels of pro-inflammatory cytokines (IL-6, IL-1β, TNF-α) as well as a growing content of antibodies against prokaryotic Hsp60 and human Hsp60 in patients with periodontitis compared to the control group. The content of anti-inflammatory IL-4 in the control group was higher than in patients with periodontitis; however the differences for this cytokine were insignificant. The increase of pro-inflammatory and decrease in anti-inflammatory cytokines in patients with periodontitis is probably one of the pathogenic mechanisms which determines the course of inflammatory and degenerative processes in periodontal tissues. High concentrations of pro-inflammatory cytokines and antibodies against prokaryotic Hsp60 and human Hsp60 in blood of the patients with periodontitis can be considered as negative prognostic criteria of further disease progression and systemic complication.Документ Регенераторний потенціал кісткової тканини у хворих на генералізований пародонтит II, II-III ст. та аналіз його значення при проведенні хірургічних втручань на пародонті(Українська медична стоматологічна академія, 2016) Білоклицька, Галина Федорівна; Панченко, Леся Михайлівна; Браун, Юлія Євгеніївна; Biloklytska, G. F.; Panchenko, L. M.; Braun, Iu. E.Проведення хірургічної фази в комплексному лікуванні генералізованого пародонтиту II, II-III ступеня необхідно виконувати з урахуванням регенераторного потенціалу кісткової тканини, що забезпечить правильний вибір методики хірургічного втручання як на етапі клаптевої операції, так і при підготовці до імплантації; Хирургическую фазу в комплексном лечении генерализованного пародонтита II, II-III степени необходимо проводить с учетом регенераторного потенциала костной ткани, что обеспечит правильный выбор методики хирургического вмешательства как на этапе лоскутной операции, так и при подготовке к имплантации; The contemporary surgical approaches for operations on periodontal tissues have been considerably modified [5,12,15,16], became to be less invasive [5,15] and mainly aimed to provide regeneration of periodontal tissues simultaneously preventing the tissues relief [7,11,13,15,16]. However, generalized periodontitis (GP) still becomes to be the most widespread pathology of periodontal tissues which can be seen amoung working category of citizens [3-5,12,15,16]. Having big choice of modern devices and treatment protocols, the problem of effective treatment of GP appears until present times as unsolved [8,12,14,16]. GP characterized by its chonic course that can be followed by progressive periodontal tissue distraction and their loss [3,4,15,16]. During this process such significant structures as: alveolar bone, periodontal ligament and root cement, whose are characterized [3,4,7,10,12,13-16] by very slow reparation, need very longtime terms for regeneration that depends on condition of neighboring tissues of periodontal wound [3,4,12-16]. The complicity of periodontal tissues structure and their anatomical connections during functioning determine the main problems in reaching aimed regeneration using modern methods [3,4,10,11,13-16]. Using of modern types of surgical incisions, the protection of marginal soft periodontal tissues [5,15] can be accepted and due to sanation of existing periodontal lesion with manual currets and ultrasonic devices [5,12,15,16] the possibility to protect the marginal alveolar bone margin in area of periodontal pocket (PP) can be reached. Using such approach we can abandon from drilling of marginal bone PP walls [5,12,15] as it was established in previous surgical approaches. The maximal protection of marginal bone level in area of PP is the guarantee for better fixation and stabilization of blood clot in wound and bone substitute materials, postoperative longterm wound stability and also minization of recessions and unsuficient aestetic results after surgical procedure [5,11,15,16]. The condition of bone tissue and it`s regenerative potential in area of existing periodontal defect [1,3,4,5,8,11,13,14] may play crucial role in time of surgical interventions in patients with GP during surgical phase of complex periodontal therapy and preoperative prepartion stage of such patients to implants. Taking into consideration the stated details the modern surgical treatment of GP aims to provide development of enhanced treatment protocol concerning bone tissue preparation in area of PP with support or stimulation of regenerative potential in area of infected periodontal wound. The knowledge of stated details promotes clinically based usage of special devices and surgical approaches for maximal bone sanation in area of PP and protection of marginal bone of periodontal defect. The main aim of presented study was to investigate the regenerative potential of bone tissue in area of periodontal defect in patients with GP of II, II-III stage. For this in patients with GP stage II, II-III the cancellous alveolar bone was taken during surgical procedure on periodontal tissues according to MIST (Cortellini P., Tonetti M., 2007, 2009) from bony walls and bottom of bone PP. The date was comparwd with healthy patients who had indication for tooth extraction according to orthodontic or prosthodontic indications. The further investigation with vital osteogenous stromal cells was provided in vitro according to methodic of O.Y. Fridenstein (1973) in modification of Astachova V.S. (1982) [1,2,9]. The vital osteogenous cells – stromal fibroblasts were collected from patient and put into sterile box with nourishing solution “199”. According to the presented study the collected vital cells were immediately transferred to laboratory passing the preparation stages. The bone osteogenous progenitor cells are characterized by ability to multiply making colonies under influence of special conditions and presence of feeding serum prepared from mortaly irradiated cells of rabbit bone marrow. If the new built cell line from one osteogenous progenitor cell consists of more than 50 cells it can be called as colony. If the amount of cells is less than 50 cells it can be called as cluster [1,2]. The presence of GP may change the quality of bone in area of lesion that can influence on cells activity reducing their ability to multiply. This can lead to reduction of bone regenerative potential in area of PP. The presented results can be useful in development of new surgical approach working in area of PP providing deep precise sanation and stimulation of bone tissue. These can be crucial for treatment of patients with GP in aim to reduce toothloss and provide long term stability of clinical results.