CLINICAL, FUNCTIONAL AND IMMUNOLOGICAL CHARACTERISTICS OF SEVERE BRONCHIAL ASTHMA

A. Kraposhina, I. Demko, Elena A. Sobkio
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Abstract

Bronchial asthma is the most common and socially significant disease in humans. Among patients who cannot achieve control, a special group is patients with severe asthma. Objective: comprehensive assessment of clinical, functional, immunological features and pharmacotherapy of severe bronchial asthma in real clinical practice to optimize basic pathogenetic therapy. Materials and methods: 83 patients diagnosed with severe asthma were examined. Patients with severe asthma are divided into 2 groups: patients with and without fixed airway obstruction. Plasma concentrations of cytokines IL-4, IL-5, IL-9, IL-13, periostin, cathepsin S, TGF- were determined by solid-phase enzyme immunoassay. Immune status was investigated on the NAVIOS Flow Cytometer. Results: In both groups of severe bronchial asthma, we found a decrease in T helper and immunoregulatory index levels with simultaneous increases in cytotoxic T lymphocytes, natural T killers, naive T lymphocytes, activated T and B lymphocytes, and phagocytic index compared to controls. There were no differences in immune status between the groups and the resulting changes were independent of the presence or absence of fixed obstruction. In both study groups, we found an increase in cathepsin S and TGF- in plasma compared to control. We identified the most significant risk factors for the formation of fixed obstruction: taking SABA more than 4 inhalations per day (OR = 4.2) and FeNO concentration more than 20 ppb (OR = 6.0). There was a significant improvement in the clinical condition of patients with severe asthma with fixed obstruction while taking genetically engineered biological therapy for a year. Conclusion: To date, there is no unambiguous idea of the mechanisms of implementation of pathobiochemical reactions in the bronchial wall in severe asthma, which lead to the development of fixed airway obstruction. Severe asthma is variable and depends on the correct choice of management tactics.
重症支气管哮喘的临床、功能和免疫学特征
支气管哮喘是人类最常见和最具社会意义的疾病。在无法控制病情的患者中,有一个特殊的群体是严重哮喘患者。目的:在实际临床中综合评价重症支气管哮喘的临床、功能、免疫学特征及药物治疗,优化基础病理治疗。材料与方法:对83例确诊为重度哮喘的患者进行检查。重症哮喘患者分为有固定气道梗阻和无固定气道梗阻两组。固相酶免疫分析法检测血浆中细胞因子IL-4、IL-5、IL-9、IL-13、骨膜蛋白、组织蛋白酶S、TGF-的浓度。用NAVIOS流式细胞仪检测免疫状态。结果:在两组严重支气管哮喘患者中,我们发现与对照组相比,辅助性T淋巴细胞和免疫调节指数水平降低,同时细胞毒性T淋巴细胞、天然T杀伤细胞、幼稚T淋巴细胞、活化T淋巴细胞和B淋巴细胞以及吞噬指数升高。两组之间的免疫状态没有差异,由此产生的变化与是否存在固定阻塞无关。在两个研究组中,我们发现与对照组相比,血浆中组织蛋白酶S和TGF-均有所增加。我们确定了形成固定梗阻的最重要危险因素:每天吸入SABA超过4次(OR = 4.2)和FeNO浓度超过20 ppb (OR = 6.0)。重度哮喘合并固定梗阻患者在接受基因工程生物治疗1年后,临床状况有明显改善。结论:迄今为止,对于严重哮喘患者支气管壁上发生的病理生化反应导致固定气道梗阻的机制尚不明确。严重哮喘是可变的,取决于正确选择治疗策略。
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