Dynamics of markers of cellular immunity in patients with an increased body mass index in polytrauma
Background. The immune system is a collection of lymphoid tissue, which, in conjunction with other adaptation systems of the body, provides specific antigenic-structural homeostasis of the internal environment. Therefore, the purpose was to study the dynamics of markers of cellular immunity in patients with an increased body mass index (BMI) in polytrauma. Materials and methods. In 224 polytrauma patients with different baseline BMI, the immunological state (the subpopulation composition of lymphocytes) was analyzed in the period of 1 day — 1 year from the date of injury. Severity of patients’ condition was the same at the time of admission — 14.0 ± 5.8 on the APACHE II score. Patients were divided into 3 clinical groups, depending on the baseline anthropometric indicators and BMI. Thus, group I included 88 individuals with BMI at admission of 29.9 (26.1 ± 3.1) kg/m2, group II — 84 patients with BMI at admission of 30.0–39.9 (35.2 ± 3.8) kg/m2, group III — 52 persons with BMI at admission > 40.0 (46.2 ± 5.8) kg/m2. The control group consisted of 60 volunteers. The study was conducted on 1, 3, 7, 14, 30 and 360 days from the moment of polytrauma. Results. Patients with BMI ≥ 29.9 kg/m2 were characterized by short-term mild imbalance of regulatory T-cells and T-deficiency that was most significant in the first week of the disease and had adaptive nature; early recovery (up to 14 days) of cellular immunity functions; the absence of long-term aftersensation. Patients with BMI of 30.0–39.9 kg/m2 had T-deficiency, which was most pronounced during its first month, combined with a slight imbalance of T-lymphocyte subpopulations, a decline in the membrane functions of these cells for up to 1 month, and the presence of a remote non-intensive aftersensation in the form of reduced number of T-lymphocytes, T-suppressors, T-active lymphocytes to the lower limit of normal values, high-amplitude fluctuations of T-helper/inductors, with a violation of membrane functions for up to 1 year. For patients with BMI ≥ 40.0 kg/m2, T-deficiency is typical in all periods of the examination with the most pronounced intensity. Its manifestations were greatest during the first month of the disease and persisted even up to 1 year. There was a decrease in T-lymphocytes by 40 % or more of normal values, which persisted for more than one week and did not have a tendency to further growth, a progressive decrease in T-active lymphocytes by more than 40 % that was accompanied by a pronounced violation of the interaction of regulatory T-cells (T-helpers and T-suppressors). Conclusions. Thus, in patients with increased BMI, in each of the comparison groups, an individual response to mechanical injury was detected, which is most likely due to the baseline BMI of the examined patients.
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