Dynamics of cytokines and role of immunocorrection in nosocomial pneumonia.

We have studied the changes in the serum level of the following cytokines during the course of treatment of nosocomial pneumonia (NP): pro-inflammatory--IL-1alpha and IL-6, chemoattractive--IL-8, anti-inflammatory--IL-4 and IL-10, and differentiating-activating--IFN-gamma and TNF-alpha. It has been found that at the time of admission of the patients the clinical severity of their condition was correlated with increased levels of all circulating cytokines except for IFN-gamma, the level of which was low. An adequate ethiotropic therapy helped to clear the clinical symptoms of infection and intoxication in 1-2 weeks. The level of circulating pro- and anti-inflammatory cytokines, IL-8, and TNF-alpha was decreasing, however, the level of IFN-gamma did not change significantly during 15 days. The ratio IFN-gamma/IL-10 did not change much but was slightly low during the treatment of the severe form of NP. Radical positive changes in the cytokine dynamics were achieved after the addition of leukinferon to the ethiotropic therapy.

Immunocorrection Therapy: Drugs and Prospects.

The analysis has been made for the basic immunocorrection drugs, used in clinical practice. By their features, the drugs are divided into 6 groups: immunoactive structures of pathogens, polyelectrolites, inductors of IFN-alpha, thymic hormones and their analogs, bone marrow regulators (myelopeptides) and cytokines. The first 3 groups of drugs are characterized by the inductive mechanism of action, whereas thymic hormones, myelopeptides and cytokines by the substitutive mechanism. The substitutive immunomodulators are preferential drugs at the advanced stages of infection. Immunocorrection should be used by the adequate courses and under the control of clinical dynamics, immunogram or differential blood counts. Transplantation of heterologous tissues and organs, transfusion of blood cell fractions and the first trimester of gestation may be called as contraindications for administration of immunocorrection. The high clinical efficiency of immunocorrection is shown on the usage of leukinferon in an extremely severe human pathology, such as sepsis, complicated by syndrome of polyorgan insufficiency.