[Differential approach to lymphadenectomy in patients with progressive fibrocavernous pulmonary tuberculosis].

The resection specimens from 31 patients with fibrocavernous tuberculosis (FCT) underwent a complex clinical andimmunological study, as well as a morphological one. It was ascertained that partial or extended lymphadenectomy did not always positively correlate with an adequate postoperative immune response and it depended on the morphological features of lymphatic apparatus lesion. The direct results of surgical treatment of patients with FCT suggest that in patients with specific lymphadenitis and cell-mediated immunodeficiency, the frequency of postoperative specific pleuropulmonary complications and their severity considerably exceed those if there is an adequate immune response. In patients with progressive FCT, baseline cell-mediated immunity deficiency is aggravated by surgery, increasing the risk of postoperative specific and nonspecific infectious pleuropulmonary complications.

[Some regularities of an immune response in patients with pulmonary tuberculosis and drug-resistant Mycobacterium strains].

Clinical and immunological studies were conducted in 62 patients with infiltrative pulmonary tuberculosis and 53 with disseminated one. As drug resistance and viability of mycobacteria increased, an immune response was found to develop as the humoral type and cellular immunity was suppressed. A more marked reduction in the activity of T helper cells type 1 of an immune response and the neutrophilic granulocytic system was revealed in patients with disseminated pulmonary tuberculosis. The maximum suppression of cell immunity was found in patients with multidrug-resistant mycobacterial strains. The observed changes in an immune response and in the production of cytokines (IL-2, IL-8) are informative signs correlating with deterioration of a specific process. Mycobacterial drug resistance and its suppressed cell immunity make chemotherapy policy difficult. The findings identify patients with mycobacterial drug resistance and high viability as a group of priority in the context of immunomodulator therapy.

[Immunogenetic aspects of the course and treatment of pulmonary tuberculosis].

The paper presents the clinical, X-ray, and laboratory characteristics of patients with pulmonary tuberculosis. Both general regularities and differences in the frequency of alleles of the HLA-DQB1* locus have been revealed in the groups of patients with pulmonary tuberculosis as compared with healthy individuals. There are specificities associated with the risk of pulmonary tuberculosis and the variants of the course of infection; thus, allele 05 of the HLA-DQB1* locus is positively associated with the incidence of tuberculosis. Specificity 03 of the HLA-DQB1* locus has been ascertained to be associated with the poor course of the disease. The most pronounced immunological changes have been observed in patients with the poor course of the disease, who are the carriers of specificity 05 of the HLA-DQB1* locus. The totality of immunological parameters and the data of genetic studies provide a basis for using the selective immunomodulator rIL-2 (roncoleukin) in the most seriously ill patients who are carriers of specificity 05.

[Immunological parameters and mycobacterial biological properties in infiltrative pulmonary tuberculosis].

Thirty-one patients with infiltrative pulmonary tuberculosis were clinically and immunologically examined. A relationship was found between the definite immunological parameters and the biological properties of mycobacteria. The higher viability of mycobacteria and the increase in the drug resistance have been shown to be associated with the decreased activity of lymphocytes and the suppressed production of interleukin-2, which suggests a decrease in the activity of type 1 T helper cells and a significant increase in the synthesis of tuberculosis antibodies with the lower serum concentrations of circulating immune complexes. This is an informative indicator of a severe specific process, as previously established. Moreover, the authors show certain differences in the changes of immunological parameters in patients with infiltrative pulmonary tuberculosis with varying mycobacterial properties. Thus, the results of the performed study make investigators pay a particular attention to the immunopathogenetic value of the biological properties of Mycobacterium tuberculosis.

[Parameters of acquired immunity and cation proteins of neutrophilic granulocytes in pulmonary tuberculosis]. / Pokazateli priobretennogo immuniteta i kationnye belki neitrofil'nykh granulotsitov pri tuberkuleze legkikh.

Clinical and immunological studies of 61 patients with pulmonary tuberculosis have indicated that the status of acquired and congenital (natural) immunity assessed by the intra- and extracellular levels of cation proteins of neutrophilic granulocytes is different in different clinical forms of pulmonary tuberculosis. The found correlations suggest that there is a relationship between the factors of acquired and congenital immunity and that cytokines are involved in the regulation of specific inflammation. More active degranulation of azurophilic granules of neutrophils occurs due to myeloperoxidase. Unlike other forms, fibrocavernous pulmonary tuberculosis shows a negative correlation between intra- and extracellular content of cation proteins. The findings make it possible to use the parameters of congenital immunity for more detailed characterization of an immune response in tuberculosis, which may be essential in developing new pathogenetic therapy regimens.

[Immunological changes in patients with pulmonary tuberculosis during glutoxim therapy]. / Dinamika immunologicheskikh pokazatelei u bol'nykh tuberkulezom legkikh pri lechenii glutoksimom.

The paper deals with the effect of glutoxim included into a preoperative preparation regimen on immunological parameters in patients with fibrocavernous pulmonary tuberculosis. On admission, all the patients had inadequate cellular immunity and activated humoral immunity. After termination of a course of glutoxim therapy, there was an increase in the baseline low values of lymphocytic proliferative activity, in the count of mature T lymphocytes, and in the production of IL-2 induced by phytohemagglutinin. At the same time the similar parameters remained unchanged in the control group. The drug exerted the most noticeable stimulating effect on cellular immunity in patients with a limited process. Glutoxim produced no noticeable effect on humoral immunity. The immunomodulating effect of glutoxim was followed by improvement of the clinical and X-ray pictures of the disease. In glutoxim-treated patients with baseline immunological disorders, progression was found to occur 1.5-2 times more infrequently than in the control group. Indications for the use of glutoxim in the treatment of tuberculosis are specified on the basis of the baseline immunological parameters of each patient.

[Cytokine production-adenosine deaminase activity relationship in pulmonary tuberculosis]. / Vzaimosviaz' produktsii tsitokinov i aktivnosti adenozindezaminazy pri tuberkuleze legkikh.

The serum activity of the enzyme adenosine desaminase (ADA) was studied in patients with infiltrative tuberculosis in relation to IL-1 beta, TNF-alpha, IL-2 productions, the magnitude of a lymphocytic proliferative response to PPD and PGA. There was an association of high ADA levels with the severity of a tuberculous process, with the least IL-2 production together with drastically increased IL1 beta and significant disorders in the TNF-alpha system. Moderate ADA increases reflect the regularly enhanced activity of immunocompetent cells in response to an infectious agent. The findings indicate that a simple biochemical test may be used for rapid preliminary evaluation of the severity of disease and immune performance.

[Roncoleukin immunomodulation in pulmonary tuberculosis]. / Immunokorrektsiia ronkoleikinom pri tuberkuleze legkikh.

The effects of roncoleukine (recombinant human interleukin-2) on clinical and immunological parameters were studied in patients with pulmonary tuberculosis. Twenty five patients with fibrocavernous pulmonary tuberculosis steadily progressive during the therapy were examined. Roncoleukine caused no complications and its clinical effect was recorded in 80.8% of cases. Changed immunological parameters noticeably tended to become normal. The increase in the baseline lower cellular immunological parameters was most pronounced. The paper shows it expedient to use roncoleukine as an immunomodulator in the treatment of severe pulmonary tuberculosis.

[Production of cytokines in different forms of pulmonary tuberculosis]. / Produktsiia tsitokinov pri razlichnykh formakh tuberkuleza legkikh.

The relationship of the production of interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2) to the pattern and etiology was studied in patients with pulmonary tuberculosis (n = 74) and nontuberculous lung diseases (n = 28). There was an inverse correlation between the production of the proinflammatory cytokines IL-1 beta and TNF-alpha and the main T-cellular immunity IL-2. An exacerbation of a tuberculous process is accompanied by an increase in IL-1 beta and TNF-alpha productions and by a decrease in inducted IL-2 synthesis. With favourable changes, there was, on the contrary, a reduction in the levels of IL-1 beta and TNF-alpha and a rise in IL-2. There were differences in the rate of cytokine synthesis in pulmonary tuberculosis, lung cancer, and pneumonia. Patients with cancer are most typified by the spontaneous mononuclear production of serum TNF-alpha and by the low level of IL-2 when PGA is stimulated. On the contrary, the least TNF-alpha synthesis and pronounced IL-2 production in pneumonia. A combination of the high production of PPD-induced IL-1 beta and PGA-stimulated IL-2 is more specific to patients with infiltrative pulmonary tuberculosis.

[Immune status characteristics as the basis for the prognosis of lung diseases]. / Osobennosti immunnogo statusa kak osnova dlia prognoza zabolevanii legkikh.

272 patients with pulmonary tuberculosis, 101 patients with pneumonia and 76 patients with cancer varying in severity have undergone a comprehensive immunological examination. Irrespective of the disease etiology, extension of the lesion in all the patients correlated with suppression of cellular immunity and activated IgA production. Increasing production of antituberculous antibodies in patients with disseminated tuberculosis and pulmonary cancer suggests unfavorable outcome of the disease. Genetic markers seem to relate with characteristics of pathological process in the lungs.

[Production of tumor necrosis factor-alpha and interleukin-1 beta in patients with pulmonary tuberculosis in relation to the course of a process and immunological features]. / Produktsiia faktora nekroza opukholei alpha i interleikina-1beta u bol'nykh tuberkulezom legkikh v zavisimosti ot techeniia protsessa i osobennostei immuniteta.

The production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) by peripheral mononuclears induced by prodigiosane, tuberculin, phytohemagglutinin and unduced and the serum levels of the above cytokines were studied. There was an relationship between the production of TNF-alpha in the patients' peripheral blood and the type and pattern of a tuberculosis process. The similar tendencies were found in the production of IL-1 beta. It was found that the production of IL-1 beta was higher in patients with a more predominant humoral immune response and that of TNF-alpha was greater in those with a more cellular response. There were the most marked relationships of cytokine synthesis to the degree of clinical parameters in prodigiosan cell induction of cells and to immunological parameters in tuberculin-induced cell stimulation.

[Significance of immunologic testing of patients in surgery of pulmonary tuberculosis]. / Znachenie immunologicheskogo testirovaniia bol'nykh v khirurgii tuberkuleza legkikh.

Immunological testing of surgical patients with specific pulmonary tuberculosis revealed specific immunodeficiency in 68% of cases which appeared at higher risk of postoperative complications. A scheme of a simple immunological testing by 2 reactions is provided.

[Evaluation of clinical significance of tuberculin sensitization in patients with lung cancer]. / Otsenka klinicheskoi znachimosti tuberkulinovoi sensibilizatsii u bol'nykh rakom legkogo.

Immunological and morphological findings were compared for 85 patients with lung cancer. Tuberculin sensitization was found to reflect the activity of antitumor immunity. The proportion humoral to cellular response to tuberculin and the intensity of these responses in lung cancer patients provide significant information on tumor histology and stage.

[Immune system and pathogenesis of tuberculosis]. / Otsenka immuniteta bolnykh tuberkulëzom s uchëtom patogeneticheskikh osobennostei zabolevaniia.

Immune characteristics available for 225 patients with active pulmonary tuberculosis were considered with reference to the process severity and progression. Some combinations of immunological parameters reflecting T- and B- cell function proved to provide sufficient information on the disease severity and trends in its progress. Immunological criteria of negative or positive course of tuberculosis vary with prevailing inflammation: productive or exudative. An individual approach should be practiced in reading immunograms which require due regard for immunopathological changes in the lungs.

[Distribution of histocompatibility antigens in patients with pulmonary tuberculosis depending on disease course and immune response pattern]. / Raspredelenie antigenov gistosovmestimosti u bol'nykh tuberkulezom legkikh v zavisimosti ot kharaktera techeniia zabolevaniia i osobennostei immunnogo otveta.

Genetic relationships with tuberculous process and immunity were investigated within immunogenetic study of 178 patients with active pulmonary tuberculosis. Tuberculosis occurrence seemed to be associated with phenotypical antigen Cw2. Unfavorable outcome of the disease was observed in the presence of HLA A9, A11, B14, B40, B41 antigens. A pronounced specific humoral and cellular responses more frequently arise in carriers of antigens Cw2 and B13, while high proliferative activity of T-cells in carriers of A10, B7 and Cw2. Production of IgA, IgG and IgM is determined by different genetic factors. The results obtained are essential for prognosis of tuberculosis course and choice of individual therapy.

[Tuberculin sensitization in patients with lung cancer]. / Tuberkulinovaia sensibilizatsiia u bol'nykh rakom lëgkogo.

The data on immunological and morphological examinations of 85 lung cancer patients have been compared. Tuberculin sensitization indexes were shown to indicate the strength of antitumor immunity. Relationships between indexes of humoral and cellular immunologic response to tuberculin, on the one hand, and their actual levels in lung cancer patients, on the other, serve as fairly reliable indications of histological pattern of tumor and its extension.

[Immunological criteria in the differential diagnosis of lung diseases]. / Immunologicheskie kriterii differentsialnoi diagnostiki zabolevanii lëgkikh.

Immunological examination performed in 292 patients with pulmonary diseases which presented difficulties for differential diagnosis has shown essential differences in immunological status of tuberculous, pneumonia and cancer patients. The fact that immunological abnormalities were related to X-ray characteristics of the lesion made it possible to develop each X-ray syndrome-specific criteria of distinguishing tuberculosis from other pulmonary lesions. The advance of the disease caused unidirectional changes in immunograms for various pulmonary lesions. There is evidence of enhanced cell response to tuberculin in patients suffering from nontuberculous pulmonary lesions.

[Immunologic methods and their use for diagnosis in the treatment of pulmonary tuberculosis]. / Immunologicheskie issledovaniia i puti ikh ispolzovaniia dlia diagnostiki v lechenii tuberkulëza lëgkikh.

The immunological survey of 1,688 patients with tuberculosis and 486 with non-specific pulmonary diseases was made. Criteria were identified for immunodiagnosis. The use of current mathematical methods of analysis allowed the development of high performance immunodiagnostic systems for pulmonary abnormalities, which included diagnostic tables and discriminant analysis by employing a computer. The major immunological disorders were determined, which in agreement with the definite direction of a tuberculous process with the subsequent use of data for monitoring the patient's status and correcting the treatment. The most potent immunocorrective drugs were studied, indications for their use were specified, proceeding from the immunological characterization of a specific patient. It was shown that the comprehensive assessment of various links of the immune system is of undoubtful value for the diagnosis and prediction of diseases, and prescription of immunocorrective therapy for pulmonary tuberculosis.

[Correlation of specific immune response and tuberculous changes in the lungs]. / O sootvetstvii form spetsificheskogo immunnogo otveta kharakteru tuberkulëznykh izmenenii v lëgkikh.

A clinicoimmunological examination of 312 new-onset cases of tuberculosis was performed to investigate the relationships between factors of humoral and cellular immunity and tuberculous process. Specific immune response (SIR) and the trends in the disease progress showed some interdependences. The forms of SIR reported can serve criteria for alterations in the lungs and prognosis of the process outcome.