Патогенетические аспекты комплексного лечения аллергических васкулитов кожи

Аннотация

Topicality and demand of the subject of dissertation Topicality and demand of the subject of dissertation. According to the world statistics data each year there is an increase the rates among of the blood diseases exactly of allergic vasculitis. According to data of many authors the incidence of allergic vasculitis per 100,000 capita is 13-20 people suffer more children between 4 to 7 years, the ratio of the disease among men and women equal to 2:1. In the Republic of Uzbekistan the incidence rate of allergic vasculitis has increased. According to the data of National Scientific and Practical Center of Dermatology and Venereology in the past 10 years the incidence of disease per 100 000 population representing 18.3%. Increasing the number of of disease is due to climate change, ecological degradation and higher insolation. Today, diagnostics based on the pathogenetic mechanisms the development of allergic vasculitis, improvement of existing treatment approaches as well as the elaboration of effective methods is an actual scientific problem. It is therefore necessary to develop proposals based on scientific investigation the status of hemostasis according to the type and severity of the of allergic vasculitis, depending on the type as well as the characteristics of the clinical manifestations of the disease. It should be noted that the diagnosis of these diseases and the development of effective treatments severity of the condition in patients with allergic vasculitis and accordingly the form composition of peripheral blood, hemostasis, changes in vascular endothelium, NO-system and assessment of endogenous intoxication, as well as the identification in patients with allergic vasculitis degree of violation of the immune system, the role of immunoglobulins in violation of microcirculation, the role of cytokines in the pathogenesis of inflammatory vasculitis is one of the important tasks. In the complex treatment of allergic vasculitis of skin scientific developed proposals based on the degree of violation of of the immune system as well as the evaluation of the effectiveness of complex treatment of superficial and deep forms and development of conclusions based on morphological changes in the forms of erythrocytes in the peripheral blood of patients with vasculitis is of particular importance. According to OP №1652 of President of the Republic of Uzbekistan for November 28, 2011 "Measures to deepening the reform of the health system" provide the same goals. This research work, allowing to identify patients with allergic vasculitis in the early stages, treat and conduct prevention and as a result, reduce the mortality rate, disability, as well as improve the quality of life and the prognosis and all this ultimately determines the significance and necessity of the thesis. Purpose of research: study of pathogenic mechanisms of allergic vasculitis and development of the modem approach to their diagnosis and treatment based on immunological, biochemical and morphological studies of the results. Scientific novelty of dissertational research. For the first time found an association degrees of severity of allergic vasculitis with changes of the hemostatic system, the state of lipid peroxidation - antioxidant protection, lipid peroxidation and antioxidant protection, endogenous intoxication based on a comprehensive study of its pathogenesis; revealed violations of the balance of T-hclpcr and T-supprcssor, which was accompanied by a sharp stimulation of helper subpopulations in both forms of dermatosis and against this background there was a significant increase in T-suppressor for superficial vasculitis and decrease for deep vasculitis; in patients with superficial form of allergic vasculitis was defined formula disorders of the immune system which allows to identify key indicators of hypoand hyperfunction of the immune system components of immunity: CD43 +, CD33 +, IgA3 + V13 +, CD83 +, Limf3 +, IgM 1 +, IgG 1 +; formula disorders of the immune system in patients with profound form of allergic vasculitis has the form: CD43 +, B-lim.3 +, IgA3 +, IgM3 +, CD83 +, CD33 +, Limf.3 +, IgGl +; for the first time revealed that violations of structural and metabolic status of peripheral blood erythrocytes in the acute phase of allergic vasculitis caused by intensification of lipid peroxidation, antioxidant defense systems failure of red blood cells and arc characterized by a modification of the lipid bi layer of erythrocyte membranes with changes in their surface architectonics and rheological characteristics. In turn, the destructive-modified red blood cells circulating in the blood stream in large amounts, increase the degree of thrombophilia and exacerbate the severity of intravascular microcirculatory disorders in allergic vasculitis; Have been developed algorithms of an estimation the general condition and the extent of disease activity and complex treatment of patients with allergic vasculitis. Conclusion 1. Injury of the capillaries arc noted at allergic vasculitis of surface skin, arterioles and venules of the skin, while deep skin allergic vasculitis affects medium and large caliber vessels, located on the border of the dermis and hypodermis, and in hypodermis only. Local skin manifestations arc primarily arising from common vascular disorders. 2. Activation of vascular-platelet hemostasis is expressed in allergic vasculitis, which is manifested in the increase of spontaneous and induced platelet aggregation and enhanced activity of von Willebrand factor by 2.5 times compared to the control. This testifies on connection of endothelial dysfunction and disorders of hemostasis (strong correlation r = -0,73), and is one of the major factors of occurrence and pathogenesis of allergic vasculitis. 3. Increased MDA and decreased SOD activity in the scrum of patients with deep skin vasculitis, was in direct proportion of the allergic vasculitis lesion depth. The level of NO in the scrum of patients with superficial form of allergic vasculitis, increased by 43.2% and in patients with deep form - by 50.4% relative to the control group data. 4. In patients with superficial and deep skin vasculitis arc formed the same type of immune responses in the form of activation of cellular and humoral units of immunity under leukopenia and lymphocytosis and was revealed impaired balance of T-helper and T-suppressor accompanied by sharp stimulation of helper subpopulations in both forms of dermatosis and in this background there was a significant increase in T-suppressor for superficial vasculitis and decrease at deep forms of vasculitis. 5. In patients with superficial form of allergic vasculitis defined formula of disorders of the immune system allows to identify key indicators of hypo- and hyperfunction of the immune system along the links Immunities: CD43 + CD33 + IgA3 + V13 + CD83 + Limf3 + IgMl + IgGl +, and in patients with profound form of allergic vasculitis has the form: CD43 + В -lim.3 + IgA3 + IgM3 + CD83 + CD33 + Limf.3 + IgGl+. 6. The destructive-modified erythrocytes before treatment, circulating in the blood flow in large amounts, increase the degree of thrombophilia and exacerbate the severity of intravascular microcirculatory disorders in allergic vasculitis. Under the action the complex treatment in preclinical was observed increasing share of discocytes in the affected area by 50.9%, and the finger - by 23.7%, which leads to normalization of the microvasculaturc, which in turn provides a more pronounced recovery and physiological parameters of blood . 7. Combined therapy has a positive effect on the immune reactivity of patients with allergic vasculitis, improvement of peripheral blood indexes, normalize hemostasis, POL-AOP, adequate nitric oxide (NO) production with vascular endothelium, thereby increasing of therapeutic effect. 8. In 92,2% of patients with superficial and deep vasculitis treated with combined therapy, was received a positive therapeutic effect, allowing for 3-4 days to reduce the length of stay in a hospital bed. The monitoring of patients for three years showed that the method of treatment would prevent relapses of the disease and lengthen the remission.