RESUMO
The article deals with the characteristics of sup-population composition of T-regulator: cells with suppressor activity and production of immunoregulatory cytokines suppressing immune response (IL-10, TGF-beta) in patients with infiltrative tuberculosis of lungs. It is proved that the leading role in formation of immunodepression and tuberculin anergy under infiltrative tuberculosis of lungs is played by T-regulatory, cells with phenotype CD4+CD25+Foxp3+. It is demonstrated that the immunodepression mediated by cytokine production is connected with increasing of both basal and BCG-induced secretion of IL-10 on the background of decrease of level of production of TGF-beta by mononuclear leukocytes in vitro.
Assuntos
Anergia Clonal , Interleucina-10/imunologia , Linfócitos T Reguladores/imunologia , Fator de Crescimento Transformador beta/imunologia , Tuberculose Pulmonar/imunologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Linfócitos T Reguladores/patologia , Tuberculina/administração & dosagem , Tuberculina/imunologia , Tuberculose Pulmonar/patologiaRESUMO
Subpopulation structure of T-regulatory cells and proliferative activity of blood lymphocytes in vitro in patients with different clinical forms of pulmonary tuberculosis were studied in this work. It has been shown that Trn--natural T-regulatory lymphocytes (CD4+CD25+Foxp3+) play a leading role in formation of immune suppression under infiltrative, disseminated and fibrosis-cavernous pulmonary tuberculosis. Besides, their number is increased in blood of both tuberculin-positive and tuberculin-negative patients. Negative correlation between the number of Trn and proliferative activity of blood lymphocytes (basal, mitogen- and antigen-induced)has been established, which testifies about participation of Trn in suppression of lymphocyte proliferation and Th1- and Th2-immune response.
Assuntos
Proliferação de Células , Tolerância Imunológica , Subpopulações de Linfócitos T/imunologia , Linfócitos T Reguladores/imunologia , Tuberculose Pulmonar/imunologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Subpopulações de Linfócitos T/patologia , Linfócitos T Reguladores/patologia , Células Th1/imunologia , Células Th1/patologia , Células Th2/imunologia , Células Th2/patologia , Tuberculose Pulmonar/patologiaRESUMO
64 patients with lung tuberculosis were operated on after chemotherapy course using regimens I and III. 69 patients were operated on after the treatment by DOTS/PLUS protocol. The obtained operative material was bacteriologically tested. Bacterial growth in samples of patients treated with DOTS/PLUS protocol caused by multydrug resistance of mycobacteria. The noncoinsidence of the drug resistance spectrum in sputum and resected samples was registered in 33% of patients treated by DOTS/ PLUS protocol and 25% of patients, treated by using regimens I and III.
Assuntos
Antituberculosos/uso terapêutico , Protocolos Clínicos/normas , Mycobacterium tuberculosis , Assistência Perioperatória/métodos , Tuberculose Resistente a Múltiplos Medicamentos , Tuberculose Pulmonar , Adulto , Técnicas Bacteriológicas/métodos , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Cooperação Internacional , Cuidados Intraoperatórios/métodos , Pulmão/microbiologia , Pulmão/patologia , Masculino , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Seleção de Pacientes , Assistência Perioperatória/normas , Pneumonectomia/métodos , Escarro/microbiologia , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/patologia , Tuberculose Resistente a Múltiplos Medicamentos/cirurgia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologia , Tuberculose Pulmonar/cirurgiaAssuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Espondilite Anquilosante/tratamento farmacológico , Tuberculose Miliar/induzido quimicamente , Adulto , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Antituberculosos/uso terapêutico , Seguimentos , Humanos , Infliximab , Masculino , Espondilite Anquilosante/sangue , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/sangueRESUMO
The paper describes the results of comparatively analyzing the parameters of apoptosis, micro- and macroelement spectrum of peripheral blood lymphocytes in healthy donors and in patients with chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis. In drug-responsive and drug-resistant pulmonary tuberculosis, unidirectional pretreatment changes were generally recorded in the activity of apoptosis and the spectrum of chemical elements of peripheral blood lymphocytes, which were most pronounced after completion of a phase of intensive antituberculosis chemotherapy. After termination of a complete course of the therapy, apoptotic activity lowered with the cationic composition of cells being normalized. The parameters differentiating pulmonary tuberculosis from COPD were ascertained, these included increases in the count of apoptotic cells and the cell concentrations of Ca2+, Zn2+, and Mg2+.
Assuntos
Apoptose , Linfócitos/química , Linfócitos/patologia , Tuberculose Pulmonar/sangue , Alumínio/sangue , Antituberculosos/uso terapêutico , Cálcio/sangue , Cátions , Cobre/sangue , Humanos , Ferro/sangue , Magnésio/sangue , Masculino , Manganês/sangue , Pessoa de Meia-Idade , Tuberculose Resistente a Múltiplos Medicamentos/sangue , Tuberculose Pulmonar/tratamento farmacológico , Zinco/sangueRESUMO
Case histories of 147 patients with new-onset destructive pulmonary tuberculosis (PT) (infiltrative, disseminated, fibrocavernous) with the pathogen of the disease showing multidrug resistance (MDR) were analyzed, by evaluating the efficiency of treatment involving sputum abacillation after termination of the inpatient stage of treatment. A control group included 220 patients with PT of the similar lesion and clinical forms, who preserved drug resistance (DR) to antibacterial agents. Most patients with MDR disseminated destructive PT are young people aged 36.6 +/- 1.6 years, this disease-associated disabled individuals (65.3%), alcoholics (48.3%), opium addicts (11.5%), ex-prisoners (26.5%), single, homeless; more frequently suffer from gastrointestinal (40%) and chronic nonspecific lung (24.5%) diseases. The course of MDR PT is significantly more commonly complicated by the development of respiratory failure (48.9%) and hemoptysis (6.1%) (in DR PT 19.1 and 2.3%, respectively). In terms of negative smear tests and the results of sputum cultures, the abacillation rates were 70.1 and 67.3%, respectively (in DR PT, these were 88.18 and 86.34%, p = 0.01). A negative reaction of sputum occurred in 42.1% of patients at 2-3 months of treatment while its culture did in 46.2% at 4-5 months. In the control group wherein drug sensitivity of M. tuberculosis was preserved, sputum abacillation occurred in the larger proportion of the patients within the first 2 months (in 68.6 and 56.3% of cases with sputum smear and culture, respectively). The efficiency of inpatient therapy is greatly affected by short-term treatment caused by voluntary withdrawal and irregular uses of antituberculous drugs, mainly due to alcoholization.
Assuntos
Assistência Ambulatorial/métodos , Antituberculosos/uso terapêutico , Cooperação do Paciente/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Adulto JovemRESUMO
The data of modem literature and the results of original investigations on mechanisms of immunopathological alterations in tuberculosis infection are presented. The role of cellular and humoral parts of immunity in pathogenesis of pulmonary tuberculosis is discussed and cytokine-mediated mechanisms of disorders in a specific immune response are analysed.
Assuntos
Sistema Imunitário , Tuberculose Pulmonar , Apoptose/imunologia , Linfócitos B/imunologia , Citocinas/imunologia , Humanos , Sistema Imunitário/imunologia , Sistema Imunitário/patologia , Linfócitos T/imunologia , Tuberculose Pulmonar/imunologia , Tuberculose Pulmonar/patologiaRESUMO
The characteristics of the functional activity of phagocyte blood cells in patients with destructive pulmonary tuberculosis caused by medicinal sensitive and medicinal resistant infective agents were studied. In the process of pulmonary tuberculosis, irrespective of the medicinal sensitivity of infective agents before and during treatment, a decrease in the phagocytic activity of neutrophil granulocytes and the level of the expression of Fcgamma- and C3b-receptors on monocytes with a simultaneous increase in the spontaneous production of oxygen metabolites in neutophils and a rise in the adsorptive capacity of monocytic cells were observed.
Assuntos
Neutrófilos/imunologia , Tuberculose Pulmonar/imunologia , Adulto , Antituberculosos/uso terapêutico , Células Sanguíneas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monócitos/metabolismo , Neutrófilos/metabolismo , Oxigênio/metabolismo , Fagocitose , Receptores de Complemento 3b/metabolismo , Receptores de IgG/metabolismo , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
The authors studied functional characteristics of mononuclear leucocytes in patients with drug-sensitive and drug-resistant pulmonary tuberculosis. The study found decrease of the number of C3b- and Fcchi-receptorpositive monocytes and increase of their saturation activity in both categories of pulmonary tuberculosis before and after antituberculous therapy. The study revealed increase of interferons alpha and chi production and, at the same time, decrease of tumor necrosis factor alpha, which was more prominent in cases of drug-sensitive tuberculosis, and depression of interleukin 2 secretion, more prominent during chemotherapy in cases of drug-resistant tuberculosis.
Assuntos
Leucócitos Mononucleares/metabolismo , Tuberculose Resistente a Múltiplos Medicamentos/sangue , Tuberculose Pulmonar/sangue , Adulto , Antituberculosos/uso terapêutico , Biomarcadores/sangue , Feminino , Humanos , Interferon-alfa/metabolismo , Interleucina-2/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores de Complemento 3b/metabolismo , Receptores Fc/metabolismo , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
The paper presents the results of a study of spontaneous and stimulated production of TNF-alpha, INF-gamma, INF-alpha, IL-2 by peripheral mononuclear leukocytes in patients with disseminated destructive drug-resistant pulmonary tuberculosis. It also shows marked changes in the levels the studied cytokines in relation to the type of a stimulant (lipopolysaccharide, phytohemagglutinin, tuberculin) and during antituberculous chemotherapy.
Assuntos
Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Citocinas/efeitos dos fármacos , Citocinas/metabolismo , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/metabolismo , Tuberculose Pulmonar , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/metabolismo , Tuberculose Pulmonar/fisiopatologiaRESUMO
The cytogenic status of peripheral lymphocytes was studied in 67 patients with drug-sensitive pulmonary tuberculosis. The latter was found to be attended by cytogenetic disorganization whose signs were present before and 2 months of intensive chemotherapy. In pulmonary tuberculosis, structural disorganization in the lymphocytic chromosomal apparatus was characterized by the elevated levels of cells and with changes in the structure and number of chromosomes. They are most pronounced in infiltrative and disseminated tuberculosis than in caseous pneumonia, as well as 2 months after rather than before chemotherapy. Patients with infiltrative pulmonary tuberculosis had also decreased lymphocytic activity of DNA reparation, followed by its normalization after a course of chemotherapy.