ACTIVITY OF CYTOKINE SYSTEM IN PATIENTS WITH DESTRUCTIVE CHOLECYSTITIS

BEKOV T.A, ATYKANOV A.O.

Key words:

DESTRUCTIVE CHOLECYSTITIS, CHOLELITHIASIS, CYTOKINES, CLINICAL TRIALS, HEPATO-BILLIARD AREA SURGERY

Abstract:

Introduction. Cytokines, to one degree or another, can have a systemic effect against the background of inflammation of the hepato-billiard system. The development of the inflammatory process is associated with pro-inflammatory cytokines, which lead to the accumulation of neutrophils and macrophages in the focus of infection and stimulate their phagocytic, bactericidal activity, induce the process of antigens of a specific immune response.Purpose of the study. Evaluation of the activity of the cytokine system in patients with acute and chronic calculous cholecystitis during an exacerbation after treatment.Materials and methods. The object of the survey were 133 patients admitted to the Department of Surgery of the City Clinical Hospital in Osh with a diagnosis of destructive cholecystitis, which made up two clinical groups. The first group included 79 patients with acute calculous cholecystitis. The second group consisted of 54 patients with chronic calculous cholecystitis. As a control group, 38 adults diagnosed with dyskinesia (hypomotor, hypermotor) of the billiard tract were examined. The immunoenzyme assay using standard kits of reagents from Vector-Best (Russia) was chosen as the method for studying cytokines.Results and discussion. In the group of patients with ACC (1st clinical group), there is a significant increase in blood plasma, relative to control values, in the concentration of IL-1β, IL-4 and IL-6, and the content of TNF-α does not reach significant changes. In group II, during this period, there is a significant increase in the content of IL-6, and other cytokine indicators do not reach significant values compared to the values of the control group.With purulent cholecystitis, the value of IL-6 becomes significantly higher compared to the value in ACC, and the value of TNF-α also becomes significantly higher. A comparative picture of the dynamics of changes in cytokine parameters in clinical groups at discharge showed that in patients of the Ⅱ group in blood plasma, the concentration of IL-1β and TNF-α exceeded the values of Ⅰ of the group, and the content of IL-4 was reduced.Determination of sensitivity (Se) and specificity (Sp) of cytokine parameters showed that IL-6 reaches the highest values, which amounted to 88 and 81%, respectively; IL-1β values were 66 and 71%; IL-4 - 63 and 57%; TNF-α - 65 and 60%.Conclusion. Inflammatory, congestive and stone-forming processes in the gallbladder are accompanied by a marked increase in the concentration of pro-inflammatory cytokines in the blood. Apparently, the initial link of cholelithiasis is dyskinesia of the billiard tract, and later, with an increase in the concentration of cytokines, inflammation is revealed in the form of cholecystitis with the formation of gallstones.