INDICATORS OF THE CELL-MEDIATED IMMUNITY IN SURGICAL PATIENTS WITH GASTRODUODENAL ULCERS COMPLICATED BY BLEEDING

Abstract

The aim: To determine the peculiarities of indicators dynamic of cellular level of immunity in patients with gastroduodenal ulcer complicated by bleeding and microbial contamination the periulcerous area. Materials and methods: 80 patients with gastroduodenal ulcers complicated by bleeding were studied. Among patients in the main group, 18 (22.5%) cases were patients with bleeding gastric ulcer, 56 (70%) patients with bleeding ulcer of duodenum. The study of cellular immunity are B - CD19, Natural killers(NK) - CD16, T-helpers - CD4, T-regulatory - CD8. Results: An active bleeding according to the Forrest classification in patients with gastric ulcer 81.7% and in patients with ulcer of the duodenum 88.3%. Depending on the endoscopic hemostasis, there was a marked decrease in T-lymphocyte indices with CD4 growth to the reference rates in cases of active bleeding (from 13±2.4% to 26.4±1.2% p<0.05) and in hemostasis with high recurrence rate from 20.8±2.3% to 31.3±2.9% and from 22.6±1.3% to 39.8±2.9% p<0.05, respectively. Conclusions: The study found a decrease in CD16 from 3.6±1.1% to 2.6±1.1% (p<0.05) and an increase in the level of CD4, CD8, CD19 to 37.4±1.1%, 4.4±1.1% (p<0.05) and 30.8±1.2% (p<0.05), respectively, indicating that there is a decrease in the immune response in patients with gastroduodenal bleeding of ulcerative genesis. In patients with microbial contamination of the periulcerous area by Streptococcus β-haemoliticus (107 CFU) and Klebsiella pneumoniae (106 CFU), gastric ulcers decreased the level of CD8 population from 7.3±2.1% to 7.3±2.1% to 6.4±7% (p<0.05) and from 5.8±2.8% to 4.1±2.3% (p<0.05), respectively, which may create favorable conditions for the development of recurrent bleeding.