Zaporožskij Medicinskij Žurnal (Apr 2019)
Prediction of bronchopulmonary dysplasia course in children by analyzing clinico-biochemical indicators
Abstract
At the present stage, one of the most important issues of pediatric pulmonology is to find ways of preventing the progression of chronic lung diseases. The concept of the natural course of disease has emerged among some pathological conditions, that is, the course of disease from the onset to symptoms resolution or control, which is understood as programs designed to reduce the incidence or prevalence or eliminate these diseases. In this regard, bronchopulmonary dysplasia is no exception and represents a chronic polyetiological disease associated with arrested lung development. The aim of the work is to improve the prediction of bronchopulmonary dysplasia course in children by analyzing the relationships between clinical and biochemical indicators and determine the risk factors for an unfavorable course of the disease. Materials and methods. A total of 63 patients were examined, among them 30 patients were diagnosed with the classical form of bronchopulmonary dysplasia, 18 – with the new form and 15 – with bronchopulmonary dysplasia of full-term children. The characteristics of clinical course of the disease were studied. The serum activity of proteinase – proteinase inhibitor system was investigated, namely vasoconstrictive proteinases (non-trypsin-like proteinases, chymase, tonin), apathogenic proteinases (calpaines) and tissue-destructive proteinases (metalloproteinase, endothelial elastase). The level of pro-inflammatory cytokines (tumor necrosis factor-α and interleukin-1ß) was determined in induced sputum. Informed consent from parents of the children was signed prior to the study. The work was carried out considering the ethical principles for medical research involving human subjects stated in the Declaration of Helsinki. Statistical processing of the obtained data was performed using the program Statistica 7.0 software package. Results. It has been found that partial pressure of CO2, blood pH, oxygen saturation, mean pulmonary artery pressure, hemoglobin level, heart rate and respiratory rate influence the components of proteinase - proteinase inhibitor system and pro-inflammatory cytokines levels which are directly involved in the pathological process, thus causing the development of pneumofibrosis, and altered activity of vasoconstrictive, apathogenic and tissue-destructive proteinases may increase the destructive capacity and enhance fibrotic processes with subsequent loss of organs and systems functions. Conclusions. The main indicators of the disease outcome prediction may be considered to be the blood acid-base state (partial pressure of CO2, blood pH), oxygen saturation, mean pulmonary arterial pressure, hemoglobin level, heart rate and respiratory rate, which depend to some extent on the components of proteinase - proteinase inhibitor system and pro-inflammatory cytokines levels.
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