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"Emergency medicine" 6 (61) 2014

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Systemic inflammatory response syndrome peculiarities in patients with HIV/AIDS-associated tuberculosis

Authors: Shalmin О.S., Yasinskiy R.M., Lukomska V.M., Nosach S.G., Kucher Т.V.

Categories: Medicine of emergency

Sections: Clinical researches

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Keywords

systemic inflammatory response syndrome, HIV/AIDS-associated tuberculosis.

Introduction. Co-infection creates the preconditions for the occurrence of systemic inflammatory response syndrome (SIRS). It is known that acute phase reagents, hypercoagulability, functional state of vascular endothelium imbalance, and the endogenous intoxication syndrome have a significant role in the pathogenesis of SIRS.

Protein-synthetic liver disfunction, an imbalance in protein metabolism and oxidants-antioxidants system caused by liver toxic lesions, increasing proteins and lipids peroxidation processes and inhibition of antioxidant protection at infectious pathology take place.

Some aspects of SIRS in tuberculosis and HIV/AIDS are discussed in the literature. The changes in protein metabolism and oxidant-antioxidant ratio in both infectious diseases, and co-infection are partially explored. The following peculiarities of co-infection were identified: anemia, lymphopenia, thymol test and CRP increased, decreased levels of total protein, albumin and albumin-globulin ratio, increased globulin fractions and lipid peroxidation products levels in the blood, and reducing of antioxidant protection.

But hematological and biochemical parameters during the co-infection, depending on the presence of SIRS are left unstudied.

The aim. To identify the hematological and biochemical peculiarities in patients with HIV/AIDS-associated tuberculosis with systemic inflammatory response syndrome.

Materials and methods. 47 patients with HIV/AIDS-associated tuberculosis were examined. The first group included 21 patients with SIRS, the second groups - 26 patients without SIRS. Control group consisted of 39 healthy people.

SIRS was assessed clinically by the presence of 2 or more criteria for R. Bone et al.

Hematological parameters (complete blood count) were determined by standard methods. Additionally leukocytic intoxication index by formula J.F. Kalf-Calif and nuclear shift index were determined. Liver function tests, total protein and protein fractions were determined by standard methods. Among the acute phase reagents CRP, rheumatoid factor, antistreptolysin-O, fibrin, glycoprotein of serum, α1-antitrypsin were determined. The number of CD4 + cells was measured in ELISA.

Oxidative status was evaluated by indices of lipid peroxidation, such as malonic dialdehyde, diene conjugates, triene conjugates, Schiff bases; peroxidation of proteins indices – aldegide-phenyl-hydrazone, ketone-phenyl-hydrazone; products of protein defragmentation – intermediate mass molecules. Among the indicators of antioxidant protection we determined the activity of catalase and superoxide dismutase.

Results of research. An anemia, lymphopenia and proinflammatory changes in leukocytic formula in patients with SIRS were observed.

Comparing reagents acute phase in different groups, an increasing of all indicators compared to the norm was detected. Thymol test, fibrin, α1-antitrypsin are almost the same in all patients. There were the tendency to increase glycoprotein of serum, CRP, rheumatoid factor and antistreptolysin-O levels in patients with SIRS.

In patients with newly diagnosed HIV/AIDS-associated tuberculosis albumin-globulin ratio and albumin level were decreased, while globulin fractions were increased. Significantly lower levels of albumin-globulin ratio and albumin, as well as higher levels of γ-globulins were found in patients with co-infection and SIRS.

Intermediate mass molecules increased in all patients with newly diagnosed HIV/AIDS-associated tuberculosis compared with the control group. In patients with SIRS the significant increase of254 nm intermediate mass molecules was found.

Comparing indicators of oxidative status, we noted the increase of parameters of protein peroxidation in patients with SIRS compared with control, as well as with patients without SIRS for aldegide-phenyl-hydrazone in spontaneous oxidation. No significant changes from the products of lipid peroxidation were noted, but there was only the tendency to rise triene conjugates and Schiff bases levels in cases of SIRS. The activity of antioxidant enzymes decreased in all patients, a significant reduction in catalase activity was observed in co-infected patients with SIRS.

Conclusion. Anemia, lymphopenia, albumin and albumin-globulin ratio decreasing, increasing of γ-globulins levels, the intermediate mass molecules and protein peroxidation products, reducing catalase activity were determined in patients with HIV/AIDS-associated newly diagnosed pulmonary tuberculosis with systemic inflammatory response syndrome. This indicates the deepening of disorders caused by co-infection and the necessity of their correction in paper time.


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