Patalakha O. Peculiarities of Immune Response and Optimization of Generalized Parodontitis Treatment of Patients with Toxic Hepatitis in Case of Opioid Dependence

Immunological impairments in the examined patients with generalized parodontitis exacerbations on the background of opioid genesis toxic hepatitis were characterized by non-specific resistance insufficiency which was observed in lower fagocitar monocites activity indices particularly in digestion index, as well as in NK-cells quantity; immunotoxicosis syndrome took place -- circulating immune complexes concentration increased mainly due to their most toxic medium molecular fraction. The drug addict patients with hepatobilliary system pathology during inflammatory destructive process exacerbation in the parodont had cytokine status disballance in the blood serum with lower interferonogenesis activity (lower concentration of γ-IFN and higher level of IL-6, IL-8 and IL-10). In case of opioid narcomania when the inflammatory destructive process in the parodont is exacerbated on the background of toxic hepatitis the Th2-type of immune response prevailed which demonstrated a considerable decrease in opposing cytokines integral indices: γ-IFN/IL-10 and IL-6/ IL-10. Spontaneous and stimulated production of IL-6 and γ-IFN was observed to be suppressed by immunocompetent cells which testified to non-specific immunity macrophagial-monocital link exhaustion. Decrease in stimulated secretion of IL-8 on the background of its spontaneous production characterizes systemic inflammatory process and stimulates locally-destructive process in the parodont. High level of anti-inflammatory cytokine IL-10 production in addict patients during generalized parodontitis exacerbation testifies to unstable processes in the liver and activizes autoimmune mechanisms in the damaged parodontal tissues. The participation of free radical oxidation in the generalized parodontitis genesis in patients with toxic hepatitis of opioid genesis has been proved. This was revealed in oxidated lipid concentration products in the blood (POL) – malon dialdegide (MDA) and diane conjugate (DC) on the background of suppressed activity of antioxidant protection enzymatic system – catalaze (CT), superoxidismutaze (SOD) and glutationperoxidaze (GPO) which testifies to the presence of oxidative stress. In the observed patients the presence of endogene intoxication syndrome was revealed – “medial molecules” accumulation in the blood and in the stomatopharynx secretion. Introducing modern immunoactive agents of nucleine acid (derinat, nuclex) in combination with hepatoprotector which has anti-oxidant activity (antral) into the generalized parodontitis treatment complex on the background of opioid genesis toxic hepatitis promoted the patients’ immune status improvement: fewer general CIK due to their medium and little molecular fractions, non-specific resistance recovery (fagocitar monocyte activity, growth of NK cells quantity, optimization of cytokine blood profile and mixed saliva (lower IL-6, IL-8, IL-10concentration and higher y-IFN). Using defined combination of farmacological preparations improved biochemical indices concentration. These indices are characteristic of functional liver state, eliminated laboratory signs of endogene intoxication syndrome (lower “medium molecules” level in the blood and enteropharynx secretion), higher antioxidant blood characteristics. In this case in 83 % of cases the studied indices became normal, particularly in patients with small period of drug dependence. The results obtained enable us to consider as being pathogenically grounded the use of nucleine acids preparations in combination of (derinate) with hepatoprotector (antral) in the treatment of generalized parodontitis exacerbation in patients with toxic opioid hepatitis. During immunorehabilitation the drug dependent patients who had generalized parodontitis with toxic hepatitis 2-3 months after the end of the exacerbation treatment innate immunity and lower endogene intoxication syndrome were recovered by means of combination of nuclex with mexidol which increased the duration of generalized parodontitis remission achieved. While elaborating the program of pathogenic treatment of patients with inflammatory destructive processes in the parodont with opioid genesis toxic hepatitis it is expedient to use immunocorrection by means of nucleic acids preparations in combination with antioxidant activity preparations which promoted immune homeostasis recovery and improved reparative processes in the parodont.