Features of oral immunity indicators in patients with phlegmons of the maxillofacial region against the background of insulin-independent diabetes mellitus

Abstract

Objective: studying the interrelations of the local oral immunity indicators which allow to predict the severity of phlegmons course in patients with maxillofacial region phlegmons against the background of insulin-independent diabetes mellitus. Materials and methods. 44 patients were included in this prospective study. The main group: 19 patients with the maxillofacial region phlegmons and the type 2 diabetes mellitus as a concomitant pathology (PH+DM). The comparison group: 20 patients with the maxillofacial region phlegmons with no diabetes mellitus among the concomitant pathologies (PH). The control group: 5 patients were undergoing routine surgical treatment in the maxillofacial surgery department. The groups were comparable in age, gender, and phlegmon treatment (p > 0.05). Levels of the proinflammatory and anti-inflammatory cytokines, the humoral immunity factors and the microbial adsorption reaction (MAR) index to the oral epithelial cells were determined in the saliva of patients on the 1st and 5th days. The obtained data were statistically processed. Results. On the 1st day of hospital treatment the PH+DM group revealed an increase in interleukin-6, a decrease in interleukin-10 and lactoferrin as compared to the PH and control groups (p < 0.05). On the 5th day of the treatment the interleukin-6 and tumor necrosis factor-α levels did not differ between PH+DM and the control groups (p < 0.05). The interleukin-4 and interleukin-10 levels were lower in the PH+DM and PH groups than in the control group on the 5th day (p < 0.05). The lactoferrin level in the PH+DM group was lower than in the PH and control groups (p < 0.05). The significant negative correlation was found between the MAR index values and SOFA (Sequential organ failure assessment score) points in patients with sepsis, R = -0.9 (p < 0.05). Conclusion. The delayed regression of the saliva inflammation indicators was specific for the PH+DM group patients in comparison with the PH group patients. The MAR index below 10% may be a predictor of unfavorable course of the phlegmon development.