Журнал «Здоровье ребенка» 6 (49) 2013

Entry. Numerous researches showed that direct connection is between intensifying of bronchial asthma (BА) for children and acute respiratory viral infections (ARVI), correlation is marked between the seasonal getting up of morbidity on ARVI and frequency of hospitalizations in connection with intensifying of BA. Frequent ARVI in children considerably reduce efficiency of base therapy, assist the increase of frequency of intensifying of BA, worsen motion, prognosis of disease and results of treatment.

Recrudescent respiratory infections in children assist the hyperproducts of IgE, to the decline of synthesis of interferon, development of hyperreactivity of bronchial tubes and sensitization of organism to the uninfectious allergens. Therefore for treatment and prophylaxis of ARVI both interferons and inductors of endogenous interferon are more often used in recent year. A recombinant ɑ-2b-interferon deserves in pediatric practice of most attention, that has also antioxidant effect due to the vitamins of С and Е, that are included in its composition.

Aim of our research - to define the efficiency plugging of recombinant ɑ-2b-interferon in complex therapy of BA in children, that are often ill ARVI.

Materials and methods. Under a supervision there were 125 children by age 5-15 with bronchial asthma of middle and heavy degree. In 64 from them (51,2%) in anamnesis frequent ARVIS were marked. The main group consisted of 34 children who were included to the basic treatment recombinant ɑ-2b-interferon, the group of comparison consisted of 30 children who received basic and symptomatic therapy. All patients underwent clinical and laboratory examination, collection aleric anamnesis, peekfloumetria, instrumental studies. We determined the content of total IgE, Allergen-specific IgE using multiple alergic-sorbentn chemiluminescence test (MAST CLA), evaluated the content of the primary products of free radical processes diene conjugates (DC) and secondary - thyobarbituric acid active products (TBA-AP). Antioxidant defense status was determined by the activity of ceruloplasmin (CP), glutathione peroxidase (GP) and glutathione reductase (GR).

Research results. A allergic testing by the method of MAST CLA in children with asthma showed a high frequency of sensitization to mites Dermatophagoides pteronissinus (in 66.6% of children) and Dermatophagoides farinae (in 58.3% of children), to pollen of trees and grasses (in 54.2% of children) and to house dust (50.0% of children). In 37.5% of children polyallergy is set - a combination of home, food allergies and pollinosis. Recombinant ɑ-2b-interferon was administered for prolonged scheme to 150,000 IU for children under 7 years, in older than 7 years - 500,000 IU daily for 1 suppository twice a day every 12 hours for 10 days, in the future - through the day along the same lines to one month.

In the study of systemic immunity indices in children with asthma found that the vast majority of them there dysimmune globulinemia - a significant increase of total IgE, lowering - IgA and IgM in normal indicator IgG. The content of total IgE in serum of children with asthma was 1089,81 ± 78,56 IU / ml (in healthy children - 34,21 ± 2,37 IU / ml), while marked by great fluctuations in the concentration  - from 78, 89 IU / ml to 3500,56 IU / ml and above. In children with asthma on admission cellular immunity characterized by decrease in the number of T-lymphocyte mainly due to subpopulations CD4 and a decrease therefore of immunoregulatory index (CD4/CD8) almost 2 times. It is also found that children with virus-induced asthma in exacerbation period there is a significant reduction of INF-γ. About the activation of free radical processes in attack period in children with asthma suggests increasing the initial (DC) and secondary (TBA-AP) peroxide oxidation of lipids products. Also marked inhibition of antioxidant protection (AOP) in children with asthma, reflected by a decrease in enzyme activity glutathione block - glutathione peroxydase and glutathione reduktase. As the activity of ceruloplasmin (CP) - copper-containing ferrooxydase that performs the basic function of antioxidant in plasma, it was significantly increased in all the examined children. This could indicate compensatory mechanism for activation of AOP, but considering the properties of CP as acute phase protein, can also be considered to increase its activity as a sign of inflammation.

In comparative assessment of indicators of immune status in the dynamics of the disease in children with BA under the influence of treatment by recombinant ɑ-2b-interferon, found a positive trend of most of the investigated parameters of immunity, there was a significant increase in concentration  INF-γ and lower total IgE. There have been positive changes in the system of AOP - the tendency to normalization the activity of enzymes glutathione block (GP, GR), which reduces the intensity of lipid peroxidation. Application of recombinant ɑ-2b-interferon  in children with asthma reduces the frequency of ARVI by 2.4 times, reduce the frequency of exacerbations of disease in 3,3 times.

Conclusions:

1. Application of recombinant 2b-interferon in asthma contributes to the modulation of the immune response by cellular and humoral types, under its influence increases contents of INF-γ, decreases the concentration of total IgE.
2. Under the influence of treatment marked decrease in the intensity of lipid peroxidation and positive changes in the antioxidant defense system. Evidence of this is the reduction of degradation of lipid peroxidation products contents (MDA-AP, DC) and a trend to normalization the activity of enzymes glutathione block (glutathione peroxidase and glutathione reduktase) and ceruloplasmin.
3. Appointment of recombinant 2b-interferon is safe, well tolerated and does not cause side effects. Using of recombinant 2b-interferon is promising as one of the measures to prevent BA attacks in children, who often suffer from ARVI.