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Rakhmanova Lola Karimovna, associate professor, of the Department of Childhood Illness No. 2 of the Tashkent Medical Academy Iskandarova Iroda Rustamovna, Ass Department of Propedeutics of Children's Diseases, Pediatrics and Higher Nursing Urgench Branch Tashkent
Medical AcademyTMA, E-mail: [email protected]
EFFICIENCY OF SYSTEMIC ENZYMOTHERAPY IN NEPHROTIC SYNDROME IN CHILDREN WITH LYMPHATIC DIETHESIS
Abstract: Immunopathological changes in the body in children with nephrotic syndrome in chronic glomerulonephritis with lymphatic diathesis are characterized by suppression of cellular immunity and an increase in the content ofASL of the kidneys, the CEC and hyperproduction of IL-2, which persist even during remission. Keywords: Nephrotic syndrome, lymphatic diathesis, children.
Currently, the prevention of progression of chronic kidney diseases and the search for effective therapeutic approaches are the most acute medical and social problem related to the priorities of the national health systems of most countries of the world [6, 10]. At the same time, the problems of progressing the steroid-resistant form of chronic glomerulonephritis (CGN) in children remain one of the topical issues in the world pediatric nephrology, which is determined by the high incidence of chronic renal failure (CRF), which is noted by more than about 50% of patients during the 5-10 years [10]. Therefore, from the clinical point of view, it is extremely important to search for clinical and immunological predictors of unfavorable renal outcome, which allow predicting the course of the disease with an individual assessment of the risk of developing CRF. In this regard, serious attention is paid to the nephrotic syndrome (NS) in CGN in children suffering from lymphatic diathesis (LD).
LD is characterized by a lack of local immunity of the respiratory and gastrointestinal tract, thymomegaly, hyperplasia of the lymphadenoid system, morphofunctional immaturity of the heart, kidney, adrenal gland leading to status lymphati-cus, anemia, lymphocytosis, dysproteinemia, hormonal imbalance and the subsequent formation and development of the syndrome of unclassifiable immune deficiency organism [3, 8].
The aim of the study was to study the effectiveness of systemic enzyme therapy (SET) in nephrotic syndrome in children with lymphatic diathesis.
Materials and methods. We observed 35 children aged 7 to 11 years with a nephrotic form of CGN with LD. The control group consisted of 25 practically healthy children of the same age. Clinical diagnosis was made on the basis of anam-
nesis, clinical and laboratory and functional research methods, immunological indicators, and LD markers [9]. The state of cellular immunity, antigen-binding lymphocytes (ASL) of the kidneys was studied by the method of Garib F. Yu. and coauthors [4, 5]. Phagocytic activity of neutrophils (FAN) by means of a test with nitrosine tetrazolium using latex particles [2]. Concentrations of circulating immune complexes (CEC) were determined by the precipitation method [1], interleu-kin-2 (IL-2) by the method of Ortaldo J., et al. [11].
The exacerbation of diseases in combined therapy have included the preparation of ETS Vobenzim (Mukos Phar-ma, Germany, tablets, state registration number B-250-95 № 1999) per 6 kg body weight, 1 tablet per day for 1 month.
Patients were divided into two groups: 1-group -CGN + LD (20 children) - c conventional therapy, 2-group-CGN + LD (15 infants) - with traditional therapy SET +.
The material used for the study was venous blood taken in the morning on an empty stomach. The digital data was processed by the method of variational statistics with the calculation of the reliability of the numerical differences in the Student.
Results and its discussion. According to the results of the conducted studies, it was revealed that of the observed patients on the sex of HC with CGN, boys were 60.0%, girls-40%, and by age 7-8 years, 72.0%. When CGN + LD78.0% were male, 22.0% - girls, confirming the literature data that the NA-th in CGN and LD th 1.5-2 times more common in males. In the analysis of clinical markers in LD patients were identified: the pathology of pregnancy and childbirth the mother (86.0%), Thymomegalia (48.0%), a large birth weight (55.0%), pasty face (67.0%) disproportion body (short torso, long limbs (43.0%), adenoids (49.0%), a steady increase in pe-
Section 11. Medicine
ripheral lymph nodes (73.0%), high infection index (72.0%). The frequency of child morbidity with intercurrent pathologies was 4-6 times during the year.
Clinical manifestations of HC with CGN + LD were characterized: the onset of the disease was gradual (78.0%), "chalky" pallor (65.8%), lethargy (85.0%), edema (74.7%), tachycardia (68, 3%), hepatomegaly (26.9%), oliguria (100.0%), headache (56.2%), proteinuria (100.0%), hypo-proteinemia (86.0%), hypercoagulability (65.0%%), and hypercholesterolemia (45.0%). The main disease in children with CGN + LD was accompanied by anemia (73.5%), adenoids (42.7%), chronic tonsillitis (83.0%), helminthiosis (35.1%), recurrent bronchitis (45.0%), GTS (36.2%), gas-troduodenitis (15.2%).
Clinical observations showed that patients who received wobenzyme showed a decrease in clinical manifestations of NS and LD after the end of the course of treatment (shortening the periods of intoxication, normalization of peripheral blood and urine parameters (hemoglobin, leukocytes, ESR, proteinuria, erythrocyturia, leukocyturia, diuresis daily), prolongation of the period of clinical remission, as well as a decrease in the incidence of morbidity with intercurrent pathologies in comparison with children of group 1. At the same time, 85.0% of patients had reliable rates tion of coagulation, reduced the level of gamma-globulin (p < 0.001), decreased somewhat Dyspro-teinemia and increased serum albumin, which indicates an improvement of redox processes in the body.
When studying the status of the immune status (Table), it was found that the patients had a significant decrease in comparison with a healthy group of T-lymphocyte (CD3), T-helper (SD4), (p < 0.001), T-suppressor (SD8) < 0.01), FAN (p < 0.001),; increased kidney ALS, CEC (p < 0.001), hyper-production of IL-2. The content of B-lymphocytes (CD19) was not significantly different from that of healthy children.
The results of the study showed that in children with HC at CGN + LD vobenzim positively affects the normalization of clinical and immunological changes in the body. Since 82.0% of patients observed receiving complex therapy with vobenzyme showed a significant increase in the content of CD3, CD4, normalization of IL-2 production (p < 0.001), SD8 (p < 0.01); decrease in the index of ASL of the kidneys, CEC (p < 0.001), with a more frequent and significant improvement observed after 1 month, unlike traditional basic therapy. The high therapeutic efficacy of vobenzima is explained by the fact that the drug pathogenetically plays a role in the normalization of immunemeostasis, optimization of inflammation, pronounced anti-edematous action, increased cytotoxic activity of macrophages, inducing or inhibiting cytokines, including IL-2, removing circulating in the blood and fixed in tissues immune complexes, as well as inhibition of their formation [7].
In the 1-group of children receiving traditional treatment, despite the improvement in health, biochemical, functional parameters and renal inflammation, decreasing slightly towards the end of treatment, the dynamics of observation again increased, and in 5 patients moderate proteinuria, erythrocyturia and leucocyturia persisted, which was due to recurrence of the process to the kidneys. Normalization of clinical manifestations of HC in CGN, such as "chalk" pallor, lethargy, edema, tachycardia, hepatomegaly and headache was detected only in 64.0% of patients.
Conclusions
1. Immunopathological changes in the body in children with nephrotic syndrome in chronic glomerulonephritis with lymphatic diathesis are characterized by a decrease in CD3, CD4, CD8, an increase in the content of ASL of the kidneys, CEC and hyperproduction of IL-2, which persist even during remission.
Table 1.- Dynamics of immune status in children with HC at CGN with LD (M ± m)
Indicators Control group, n = 25 Traditional therapy, (1-group) (n=20), P1 Traditional therapy + wobenzyme, (n = 15), 2-group, P P1 P
CA3,% 54.67 ± 0.94 40.35 ± 1.2 49.65 ± 1.2 p < 0.001 p < 0.001
CA4% 33.13 ± 0.83 24.32 ± 1.6 30.85 ± 1.5 p < 0.001 p < 0.001
CA8,% 19.90 ± 0.72 13.54 ± 1.2 17.14 ± 1.6 p < 0.001 p < 0.01
CA19,% 11.60 ± 0.89 14.26 ± 0.76 12.51 ± 0.65 - -
ASL blood,% - 5.0 ± 0.62 2.0 ± 0.54 - p < 0.001
ASL of the kidneys 0.002 ± 0.003 0.078 ± 0.001 0.024 ± 0.006 p < 0.001 p < 0.001
OAH,% 50.50 ± 1.11 36.09 ± 0.37 45.56 ± 0.43 p < 0.001 p < 0.001
IL-2 2.8 ± 0.09 3.1 ± 0.06 2.9 ± 0.07 p < 0.01 p < 0.01
Note: the reliability of differences compared with a group of healthy children. ASL are compared between groups 1 and 2
2. Immunocorrecting and anti-inflammatory actions of plex therapy of children with nephrotic syndrome in chronic
vobenzim allow to recommend for wide application in com- glomerulonephritis with lymphatic diathesis.
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