Tynitovska O. Clinico-immunological investigation of the efficacy of mucosal immunization of patients with chronic tonsillitis and patients after tonsillectomy

The survey involved 150 patients aged from 18 to 40 years, those with chronic tonsillitis and patients after tonsillectomy (performed up to two years earlier), and the control group of patients. The subject of study in this survey was the clinical state of the patients, immunological study of biological material (oropharyngeal secretion and peripheral blood serum) and bacteriological examination of palatine tonsil mucous tunic swabs of patients with a varying state of the structure of pharyngeal lymphoid tissue ring after application of mucosal vaccines with different modes of administration. It has been proved, that in case of both, chronic tonsillitis and after tonsillectomy the status of local immunity remains in the state of hypoergy, where the humoral component of protection is considerably reduced in the form of decrease by 1.5 – 2 times of the IgA secretory level in the oropharyngeal secretion and the antiviral factor - α-interferon. For the first time factors have been established with the anti-inflammatory effect, such as IgG and interleukine-1β, with their increased concentration (IgG by three times, interleukine-1β by 2.5 times) in the oropharyngeal secretion of the said groups of patients under study. They are the markers of the inflammatory process in the pharynx mucous tunic. It has been shown, that antimicrobial humoral systemic immunity, according to the results of streptolysin-O neutralization test, is in the state of the high level of tension: in 35% of patients with chronic tonsillitis and in 90% of the examined patients after tonsillectomy. Under the conditions of the experiment in vitro it was established in the tonsils cell cultures that both, local effect vaccine Respibron, and systemic effect vaccine OM-85 reliably reduced production of the anti-inflammatory cytokine IL-1β, had no effect on the production of IL-10 (anti-inflammatory cytokine). As to the production of cytokines Th-1 by lymphocytes (IFN-γ) and Th-2 (IL-4), there have been demonstrated differently vectored lines of action – Respibron reliably backed up the production of IL-4, while OM-85 backed up production of IFN-γ. There has been determined the likelihood of the increase (by 1.6 times) of the level of total IgE in blood of patients with chronic tonsillitis under the effect of Respibron vaccine. This has not been observed when administering OM-85. OM-85 produced a more dramatic effect on the level of transient flora in oropharyngeal secretion of both, patients with chronic tonsillitis and patients after tonsillectomy without any effect on the quantitative composition of resident flora of oral cavity which can be considered as a positive influence on the opportunistic pathogenic flora. There have been obtained clinical data that following the intake of mucosal vaccines the number of complaints of patients with chronic tonsillitis and patients after tonsillectomy connected with exacerbation of chronic pharyngitis declined by 3 times, and patients after tonsillectomy chronic pharyngitis and chronic laryngitis (by 2-3 times). There has also been established a reduction (by 75%) of incidence of acute respiratory diseases of upper respiratory tract in both, patients with chronic tonsillitis and patients after tonsillectomy. It has been established that immunological survey of the patients of both groups conducted later (after 6 months) following intake of both vaccines showed a sufficiently stable positive result by the content of IgE and γ-interferon in blood and secretory IgA in oropharyngeal secretion. Preliminary data have been confirmed that an increase in the remote period of the level of cytokine in oropharyngeal secretion may indicates the “preparedness” of mucous tunic for exacerbation and requires preventive and curative measures. Thus, this dissertation generalizes and resolves the scientific problem – determination of the state of mucosal immunity of patients with chronic tonsillitis and patients after tonsillectomy, and efficacy of the use of mucosal vaccines.