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"Child`s Health" 4 (47) 2013

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The possibilities of acute bronchopulmonary diseases’ monitoring based on analysis of expired air condensate

Authors: Y.V.Odinets, A.F.Ruchko, T.Y.Cherednicova, Kharkov State Medical University, Pediatric Department N2

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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pneumonia, surfactant, expirate, children

In recent years the character of children nonhospital pneumonia experienced some changes: they continue to be followed by frequent complications, and in 30 - 40 % cases pneumonia turns to lingering type. Until now there are no clear criteria to predict the transformation of light forms of illness intu more severe forms during dynamic child observation.  There are a lack of studies that set the clear criteria for degree of pulmonary system inflammation process, its prolongation possibility and necessity for implementation of restoration therapy on rehabilitation stages for recurrences prevention. The aim of our research is the actual problem of improvement of medical assistence for children with complicated and lingered forms of pneumonia which was solved by improvement of diagnostic approaches in measuring investigation of surfactant through monitoring of common lipids, cholesterol and phospholipids in expired air condensate, their peroxidation (by analysis of diene conjugate, malonic dialdehyde – initial and second peroxidation products) and antioxidant defense according to superoxide dismutase and catalase levels.

There were examined 74 children, from 6 to 18 years old, 32 boys and 42 girls. They made up the main observation group. The control group comprised 30 somatically healthy children of corresponding age. Diagnosing and treatment of patients were conducted in according to «Child’s first aid proceedings within specialty “pediatric pulmonology”». Special study was conducted over the state of surfactant examination by indices of lipids, their peroxidation and indices of antioxidant defense in condensate of expired air in children with pneumonia. The biochemical analysis was conducted in Kharkov national medical university research laboratory.

Among all cases of pneumonia 65,2 % were non complicated; 20,5 % were complicated by general toxic syndrome; in 14,3 % cases suppurative complications were discovered; 32,1 % had the tendency for lingering non-hospital pneumonia.

In acute period of non-hospital pneumonia the level of common lipids in expired air condensate reliably increased (p<0,05) in compare to control group.  Pneumonia with suppurative complications and general toxic syndrome were followed by some increase of common lipid levels in compare with non-complicated forms of pneumonia.  The long-standing lungs inflammation reflected in lipids content – the degree of their increase was highest in compare to control group. These results showed the existence of significant disorder in surfactant system at the stage of acute lungs inflammation. Therefore the level of common lipids can be considered as a marker of surfactant damage and one of criteria of early prediction of lingering course of pneumonia. The level of phospholipids in expired air condensate in acute period of lungs inflammatory process reliably decreased (p<00,5) proportionally to severity of inflammatory process and complication development in compare to control group (55,42 ± 5,22 microMole/L). The most significant change occurred in patients with suppurative complications and lingering course of pneumonia. Cholesterol content in expired air condensate among children with non-hospital pneumonias also reliably increased (р < 0,05) in compare to control group (187,77 ± 29,5 microMole/L) – accordingly to severity of illness and existence of complications: long-term illness registered in maximum changes in surfactant system which followed by significant increase of cholesterol content in expired air condensate and was explained by surfactant quantitative change in long-term massive membrane destruction. The cholesterol increased consumption for reparative processes in cell membranes of children with pneumonia leads to decrease of its content in expired air condensate. During analysis of all mentioned indices of expired air condensate of children with pneumonia in period of clinical recovery it was discovered the tendency to their normalization, but cases of reaching the normal level were rare.

In acute phase of complicated pneumonia course was revealed the reliable (р < 0,05) increase of initial and second levels in product of lipids peroxidation (diene conjugate and malonic dialdehyde) in compare to control group (33,5 ± 4,6 microMole/L and 1,16 ± 0,36 microMole/L, accordingly). This indicates the activity of inflammatory process in organism and reflects intensity of damage effect of lipids free radical oxidation on biomembrane of lungs. At the stage of clinical recovery the diene conjugate decreased, but malonic dialdehyde was lower than control level. The activity of catalase antioxidants and superoxide dismutase at the beginning of treatment reliably increased (р < 0,05) in compare to control group. In time of clinical recovery the content of mentioned antioxidant ferments didn’t return to normal level, which is explained by retention of inflammation process activity and retardation of metabolic process restoration. Thus, we concluded about discrepancies in clinical, X-ray and metabolic recovery and necessity of further observation over the patient rehabilitation process within the outpatient clinic facilities. The analysis of children expired air condensate with complicated and lingered non-hospital forms of pneumonia provides the possibility in obtaining the profound pathobiochemical understanding about processes of metabolic disorders in deep departments of respiratory system and its role in disease pathogenesis, the detection of markers for diagnostic of surfactant injury and its regeneration with protective therapy and, also, for prediction of inflammatory process outcome.

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