Respiratory diseases, in particular acute bronchitis, are a common problem in paediatrics that requires close attention from specialists. Understanding the interaction between thyroid hormones and immune system responses is of great importance for revealing the pathophysiology of respiratory diseases in children, including acute bronchitis. Thyroid hormones play an important role in regulating various mechanisms of the immune response. Investigating these relationships is important for developing more effective and personalised treatments.
Studies aimed at evaluating the effectiveness of immunomodulators, such as bacterial lysates, in the treatment of respiratory diseases in children, including acute bronchitis, are of great importance in modern medicine. These immunomodulators can activate the immune system, helping to reduce the severity and duration of the disease. Studies of the effectiveness of these agents in children with acute bronchitis are of great practical importance, as they can point to ways to reduce the frequency of disease, avoid relapses and reduce the need for antibiotics.
The aim of the dissertation was to improve diagnostic methods and increase the effectiveness of treatment of preschool children with acute bronchitis based on the established risk factors, clinical and pathogenetic mechanisms of the disease, hormonal and immunological status of the child, by using an immunomodulatory drug.
The following methods were used to analyse and substantiate the study results: clinical and anamnestic, laboratory (clinical blood test, determination of hormone content in blood serum (thyroid-stimulating hormone, total and free fractions of iodothyronines, reverse triiodothyronine, antibodies to thyroperoxidase, cortisol), as well as changes in the cellular (CD3+, CD4+, CD8+, CD16+, CD22+) and humoral immunity (IgA, IgM, IgG), opposition cytokine pools (IL-4 and INF-γ), instrumental and statistical data processing methods.
In the course of the study, 135 preschool children (3 to 6 years old) with acute bronchitis were examined during the period of acute illness and convalescence. They were divided into two groups. The first group consisted of 92 children with acute bronchitis, and the second group included 43 patients with acute bronchitis and signs of euthyroid sick syndrome. Each of these groups was divided into two subgroups depending on the inclusion of an immunomodulator in the standard treatment regimen. The control group consisted of 28 practically healthy children.
In the course of the dissertation study, it was found that in children with acute bronchitis, almost every third case (43 (31.85 ± 4.02 %)) had subclinical functional shifts in hormonal status indicators, which are characteristic of the euthyroid sick syndrome of the first type or "low T3 syndrome". Thus, in children with acute bronchitis with signs of euthyroid sick syndrome, a significantly increased concentration of reverse triiodothyronine and cortisol in the blood serum, as well as a significant decrease in the level of total and free triiodothyronine fractions, compared with patients in the first and control groups, were found.
According to the developed mathematical model for calculating the risk of developing severe acute bronchitis in preschool children, the most informative clinical and anamnestic factors are chronic upper respiratory tract disease in close relatives of patients and parental smoking, especially if both parents have this habit, a four-point cough and auscultatory wheezing according to the BSS-ped scale. Among the hormonal parameters, total triiodothyronine and cortisol are of medium risk, and reverse triiodothyronine is of high risk. As for immunological status indicators, CD4+, CD8+, CD16+, and CD22 are medium risk factors. Also, the combination of changes in CD4+ and free triothyronine, CD3+ and free triothyronine, CD3+ and total triiodothyronine significantly increases the risk of severe acute bronchitis in preschool children.
In the course of treatment of preschool children with acute bronchitis, it was found that the use of the investigated immunomodulatory drug had a positive effect, which is confirmed by a faster objective improvement of the condition, a reduction in the frequency of prolonged hyperthermia, the period of catarrhal syndrome, the duration of antibacterial agents and the total duration of therapy, and the effect on the hormonal and immunological status of patients.
