[Population-based epidemiological study of pulmonary tuberculosis in a number of rural regions of Tatarstan].

The paper presents the results of a population-based, geneticoepidemiological, and immunological study conducted in two regions of Tatarstan. The population-based risks for tuberculosis were established for males and females. Based on the population and family data, the authors calculated the genetic liability to tuberculosis, namely hereditability that is in the range of 0.8 to 1.0 and includes the contribution of nongenetic and environmental factors. Analysis of the results of immunogenetic studies of the northwestern region of Tatarstan has ascertained that patients have an association with the HLA antigen B22, in the Kama Region there is an association with other HLA antigens: B12 and B16. The higher frequency of the HLA antigens B28 and CW1 in healthy individuals as compared with that in patients with pulmonary tuberculosis (PT) suggests the resistance of PT carriers of these antigens for the disease. A study of the distribution of HLA genes by polymerase chain reaction has established the association of the disease with the DR-B1-15 genes in the Kama Region.

[Distribution of HLA antigens in patients with tuberculosis and healthy individuals in the Tatar population]. / Raspredelenie antigenov kompleksa HLA u bol'nykh tuberkulezom i zdorovykh lits v Tatarskoi populiatsii.

The paper presents the results of a study of the distribution of Class I HLA antigens in an ethnic Tatar group (in patients with pulmonary tuberculosis and healthy individuals) in 4 districts of Tatarstan. It has been ascertained that an association with HLA-B22 antigen exists in patients with active pulmonary tuberculosis.

[Comparative clinical, X-ray, and immunogenetic characteristics of respiratory tuberculosis actively detected in risk groups and in individuals turning for medical help]. / Sravnitel'naia kliniko-rentgenologicheskaia i immunogeneticheskaia kharakteristika tuberkuleza organov dykhaniia, aktivno vyiavlennogo v gruppakh riska i u lits, obratibshikhsia za meditsinskoi pomoshch'iu.

Clinical, X-ray, and immunogenetic parameters were comparatively assessed in two groups of first identified patients diagnosed at annual fluorographic studies in groups at risk for tuberculosis and in individuals visiting general health care facilities for symptoms of inflammatory bronchopulmonary disease. Great differences were established in the clinical and X-ray manifestations, the course of the disease, and the patients' immunogenetic status in these groups. Tuberculosis in the patients identified on their referral to general health care facilities is characterized by more severe clinical manifestations, a greater spread of inflammatory and destructive changes in the lung, and massive bacterial isolation. There were certain associations of the HLA antigens A2 and A 11 as markers indicative of tuberculosis resistance with the antigens B35 and Cw4 suggestive of predisposition to tuberculosis in patients with chronic bronchitis.

[Epidemiological and immunogenetic analysis of tuberculosis and diabetes mellitus association]. / Epidemiologicheskii i immunogeneticheskii analiz vzaimosviazi tuberkuleza i sakharnogo diabeta.

The prevalence of insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) among adults in two Moscow okrugs was studied. It was 0.218 and 1.678%, respectively, the latter form being encountered 7.7 times more frequently. Patients with pulmonary tuberculosis followed at tuberculosis control dispensaries (n = 69,012) were found to have diabetes mellitus in 236 cases (120 with IDDM and 116 with NIDDM). The prevalence of IDDM among the tuberculosis control dispensary patients was 1.7%, which was 8 times greater than that in the general population. That of NIDDM was 1.68%, which did not significantly differ from that in the population. Epidemiological analysis showed that there was a highly significant association of tuberculosis with diabetes mellitus in the population. The risk for IDDM was 3.6% in patients and exceeded that in the population while the risk for NIDDM in the population was the same as that in the population. Analyzing the distribution of immunogenetic HLA-1 and HLA-2 markers showed that patients with tuberculosis concurrent with IDDM were intermediate between a group of patients with isolated tuberculosis and isolated IDDM.

[Significance of hereditary predisposition factors in the development and course of pulmonary tuberculosis]. / Znachenie faktorov nasledstvennoi predraspolozhennosti v razvitii i techenii legochnogo tuberkuleza.

Comprehensive clinical, genetic, epidemiological, and immunogenetic studies have established that tuberculosis is a multifactorial disease whose development and natural history are due to the interaction of environmental factors, primarily, to infection and hereditary predisposition. Associations between tuberculosis and various HLA loci B antigens, as well as HLA locus D-DR2 antigen have been detected in different populations. The HLA genotype was shown to differ in patients with favourable and unfavourable tuberculosis natural history. The comprehensive study of genetic markers allows one to make a prompt assessment of the nature of a tuberculous process, to define its prognosis and to correct treatment.

[Course of infiltrating pulmonary tuberculosis depending on the patient's genotype]. / Techenie infil'trativnogo tuberkuleza legkikh v zavisimosti ot genotipa bol'nogo.

To compare the disease course with regard to genetic markers carriage, the authors have examined 84 tuberculous patients. It was established that carriers of antigen HLA-DR2 and haptoglobin phenotype 2-2 have large cavities of destruction and more advanced dissemination. This trend is more evident in combination of above markers. These carriers are also noted to exhibit less advantageous run of pulmonary tuberculosis as shown by longer terms of the bacterial isolation and cavern healing.

[Relations of genetic markers with the development of infiltrative tuberculosis]. / Vzaimosviaz' geneticheskikh markerov s razvitiem infil'trativnogo tuberkuleza.

The examination included 84 patients with infiltrative pulmonary tuberculosis. A relationship of genetic markers to the development of the disease was studied. The incidence of antigens HLA of I (Cw4) and (DR2) classes is higher in patients with infiltrative pulmonary tuberculosis than that in healthy subjects. The incidence of certain alleles of protein loci is also increased: phenotype CB for locus ACR and phenotype 1-1 for locus ADA.

Tuberculosis in patients with various HLA phenotypes.

Tuberculosis patients and healthy subjects from six ethnic groups of the Soviet Union were HLA-A, -B, -C, and DR typed. The frequencies of the HLA-A, -B and -C antigens differed amongst the ethnic groups. With all groups, however, patients with tuberculosis showed a significantly increased frequency of HLA-DR2 and a reduced frequency of HLA-DR3 type. Unfavourable dynamics of tuberculosis was significantly associated with an increased incidence of B15 and DR2 and a reduced incidence of B27 and DR3. Family studies revealed that the inheritance of susceptibility to tuberculosis (from parent to offspring) is associated with the inheritance of certain HLA haplotypes. Tuberculosis patients bearing the DR2 antigen had increased levels of IgG antibodies to PPD and the frequency of B7 and, more particularly, DR2 was higher in anergic patients.

[HLA antigens in lung diseases]. / Antigeny HLA pri bolezniakh legkikh.

Altogether 337 patients with tuberculosis, 63 patients with sarcoidosis, 41 with exogenous allergic alveolitis, and 36 with chronic bronchitis were examined. Four hundred and 30 healthy persons comprised the control group. It was established that HLA genes play an important part as factors which control the level of susceptibility to some pulmonary diseases (tuberculosis, sarcoidosis, exogenous allergic alveolitis). Hypersusceptibility to different pulmonary diseases is associated with different HLA genes, namely with HLA-B14 in tuberculosis, HLA-B7 in sarcoidosis, and with HLA-B8 in exogenous allergic alveolitis. The susceptibility to pulmonary diseases may be under polygenic control; in particular during tuberculosis, both HLA-B14 gene and HLA-B15 gene play a role in the resistance control. The development of a disseminated chronic process coupled with disintegration may be associated with the latter gene, which may be due to a lower resistance. It stands to reason that in addition to HLA genes, other genetic systems are likely to determine the character of susceptibility to tuberculosis.