DIRECTED CYTOKINE THERAPY IN COMPLEX TREATMENT OF PATIENTS WITH OBSTRUCTIVE JAUNDICE OF CHOLELITHIC GENESIS.

The article analyzed the results of surgical treatment of 137 patients with obstructive jaundice of benign genesis. An immune status was studied in serum in dynamics before surgery. The rates of CD3, CD4, CD8, CD19, Ig A, M, G were determined on the first, third, seventh and fourteenth days after operation. The levels of TNFα, IFNγ, IL-2, IL-6, IL-4, IL-10 were investigated in serum and at the same time TNFα, IL-4, IL-6 were noted in the bile duct and IL-6 - in urine. Obstructive jaundice of cholelithiс genesis is characterized by disbalance of immune and cytokine status. The depth of disbalance depends on the degree of hepatic dysfunction and presence of purulent cholangitis. The directed cytokine therapy by ronkoleykin influenced positively on elimination of disbalance in immune and cytokine status and this therapy improved results of surgery in postoperative period.

[The state of cytokine status in patients with mechanical jaundice of benign origin].

The results of survey of 67 patients with obstructive jaundice (OJ) of benign origin are analyzedin the article. In all patients the cause of obstructive jaundice was choledocholithiasis. The degree of hepatic dysfunction (HD) was identified taking into account of cholestasis (total serum bilirubin and alkaline phosphatase activity in blood) and cytolysis syndromes (levels of alanine aminotransferase and aspartate aminotransferase). Liver dysfunction degree I was observed in 21 patients, degree II--in 14, degree III--in 10 and degree IV--in 9 patients. In 13 patients OJ was complicated with purulent cholangitis (PCh). Serum concentration of TNF-α, IFN-γ, IL-2, IL-4, IL-6, IL-10 was determined. Cytokine status imbalance was diagnosed in all patients with benign mechanical jaundice on admission. Levels of serum proinflammatory cytokines TNF-α, IFN-γ and IL-6 were greater and the level of IL-2 was lower than those in healthy people. The analysis has showed that severity of cytokine imbalance depends on the degree of LD and level of hyperbilirubinemia. Imbalance in cytokine regulation manifests in disorders of pro- and anti-inflammatory cytokinesratio.

[The cytokine profile in the patients with acute calculous cholecystitis and correction of its disorders].

The results of application of systemic cytokinotherapy and splenopid in patients, operated on for an acute calculous cholecystitis, are presented. While in patients of a control group the conventional basic therapy was conducted, to the patients of the main group the systemic cytokinotherapy and splenopid were conducted preoperatively and postoperatively on background of basic therapy during 3-10 days at average. In both groups preoperatively the reduction of interleukin-2 (IL-2) and gamma-interferon (IFNgamma) content were observed, as well as raising of the blood level of the tumor necrosis factor-alpha (TNF-alpha), IL-6 and IL-10. In the patients of a control group a tendency towards the studied indices normalisation was noted postoperatively, and in the patients of the main group the elimination of the organism cytokine state dysbalance was achieved. While doing comparative analysis of ratio of TNF-alpha/IL-10 and IL-2/IL-10 in the blood serum in the main group there was established, that up to the observation period end the both indices were close to the norm.