Aktualʹnaâ Infektologiâ (Sep 2016)
Modern Immunotropic Therapy of Patients with Coronavirus Infections
Abstract
Objective: to analyze the immune status of patients with coronavirus infections (CVI) and to improve the effectiveness of their treatment by including into the conventional scheme of a drug with antiviral and immunotropic action. Materials and methods. To achieve the objective, 150 patients aged 18 to 65 years with a diagnosis of acute respiratory moderate-to-severe and severe viral infection were examined during 2012–2015 at the infectious department of City Clinical Hospital № 4 of Kyiv. Subsequently, they were included in a group of patients with coronavirus infections (n = 36). The first (I, research one) group (n = 22) received ribonucleic acid 2 capsules 3 times a day, for 7 days, on the background of the main treatment. The second (II, control one) group (n = 14) underwent only conventional pathogenic therapy (detoxification and symptomatic). Verification of the diagnosis was carried out using molecular genetic studies (multiplex polymerase chain reaction with reverse transcription in real time) of the biological material — sputum. Complex of immunological studies of the peripheral blood included determining the receptors to monoclonal antibodies CD3, CD4, CD8, CD16, CD22 on blood lymphocytes, the content of T lymphocytes according to the data of spontaneous resetting ability of lymphocytes with sheep red blood cells by the method of M. Jondal et al. modified by K.F. Chernushenko et al. Statistical analysis of the findings was carried out with the aid of software system Windows, Word and Excel, Statistica 6.0, using the method of variation statistics with the definition of probability by means of the nonparametric Wilcoxon method for independent samples and Kruskal-Wallis analysis of variance. To compare two independent groups, we have used Mann-Whitney U-test. Results. An examination of 36 patients with coronavirus infections found that these diseases are accompanied by the development of secondary cellular immune deficiency with a decrease in major subpopulations of lymphocytes (CD3, CD4, CD22), indices of NBT-test of neutrophils and increased levels of CD16 lymphocytes. The total number of T lymphocytes and T helper cells was reduced (P < 0.05), but the level of natural killer cells (CD16) was significantly higher: in patients with coronavirus infections — 26.34 ± 2.22 %, and in patients with acute respiratory infections of other origin — 18.45 ± 1.23 % (normal values — 16.60 ± 0.80 %) (P < 0.05). This indicates the development in coronavirus infections of secondary immunodeficiency by the relative hyperkiller type. The level of B cells (CD22) in patients with coronavirus infections was significantly lower (P < 0.05), and 7 days after receiving ribonucleic acid in patients of the research group they reached an average of 24.06 ± 2.44 %, in patients from group II average values were 19.03 ± 2.05 % (P < 0.05). Immunoregulatory index ranged from 1.2 to 2.3. Conclusions. When CVI, there is a secondary immunodeficiency with relative hyperkiller type caused by a significant decrease in the total number of T lymphocytes and T helper cells. Reported patterns of immune status of patients indicate the formation of immune imbalance during the development of CVI that is obviously an important pathogenic factor in this pathology. The use of ribonucleic acid in the comprehensive treatment of patients with CVI not only helps to reduce the clinical manifestations of the disease, but also significantly corrects associated immune disorders, as well as provides the most favorable long-term results, eliminating the development of various bacterial complications. It is noted that the reduced concentration of T lymphocytes, particularly T helper subpopulation, as well as the signs of exhaustion of ability of peripheral blood neutrophils to respiratory explosion — there are the immunological symptoms characterizing feature of CVI with the lesions of the lower respiratory tract.
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