PRACA ORYGINALNA

ORIGINAL ARTICLE

GENERAL IMMUNOLOGICAL REACTIVITY OF PATIENTS ORGANISM WITH CHRONIC HEPATITIS С

Iryna V. Balaniuk, Elena V. Myronyk, Yuriy O. Randiuk, Аndriy V. Andruschak

Higher Educational State Institution Of Ukraine «Bukovynian State Medical University», Chernivtsi, Ukraine

ABSTRACT

Introduction: Nowadays, the number of chronic carriers of hepatitis C virus (HCV) is considered to be from around 150 to 500 million by the most of infectionists and epidemiologists.

Being one of the most dangerous diseases of the liver of viral etiology hepatitis C increases annually.

The aim: To determine the level of general immunological reactivity of patients with chronic hepatitis C.

Materials and methods: This study does not contradict the principles of the Helsinki Declaration (2013), the European Convention on Human Rights and Biomedicine.

A clinical and laboratory examination of 31 patients with chronic hepatitis C was conducted during 2014-2015 on the basis of the infectious department of Chernivtsi Regional Clinical

Results: The initial condition of clinical and laboratory examination of patients with chronic hepatitis C is normally considered to be a clinical examination of each patient and first of all hemograms where absolute and relative number of major populations of immunocompetent cells, platelets, erythrocytes and erythrocyte sedimentation rates (ESR) were determined.

Conclusions: General immunological reactivity in patients with chronic hepatitis C increased to

30,07% and the factors activation and mechanisms of nonspecific anti-infection protection decreased that create a condition for prolonged persistence of hepatitis C virus and the progression of a chronic infectious process in patients organism.

Key words: Chronic hepatitis С, immunological reactivity of organism

Wiad Lek 2019, 72, 7, 1310-1314

Introduction

Viral hepatitis is a kind of pathology within the system «macroorganism-causative agent», and persistency of generally biological phenomena, the mechanism of which is in a direct relation to such cardinal problems of modern medicine as cancerogenesis, chronic infections, congenital developmental defects and others. Despite numerous literary sources available concerning viral hepatitis there are a lot of contradictions promoting further study of the relationships in the “virus-cell” system, the persistence of the virus and the response to its immune system. There is a high demand to elaborate the universal system of controlling diseases within the framework of a comprehensive program to fight infections as (hepatitis B and C) known as blood-borne infections. Hence there is the need to characterize a causative agent, pathogenesis of diseases, cell manifestation, diagnostics, and therapeutic prophylaxis [1].

The occurrence of viral hepatitis can`t be explained by only infection of the liver cells by hepatitis C virus (HCV), that is characterized by a high level of tropism and aggressiveness (virulence). The important condition for the progression of the disease, except for direct contact with the “virus-cell” system, is the presence of a specific immunological precondition, first of all autoimmune restructuring at the early stages of infection [2]. This conception is evidenced by the well-known fact of so-called “healthy carrier” when virus infection is present in the organism though the infectious process does not reach its highest manifestation in order to be qualified as a disease by a clinician. One should emphasize that pathogenesis and hepatitis C clinic are determined by the state of factors and mechanisms of nonspecific anti-infection protection mostly and the condition of the human immune system meaning a real possibility of transformation of the process into a chronic one and a life-long persistence of HCV. [3].

In addition, the severity of the disease course and favourable conditions of any illness prediction depend on the degree of intoxication as well as the adequacy of the immunological reactivity of the patient’s organism. [4].

The aim

To determine the level of general immunological reactivity of patients with chronic hepatitis C.

Materials and methods

This study does not contradict the principles of the Helsinki Declaration (2013), the European Convention on Human Rights and Biomedicine.

A clinical and laboratory examination of 31 patients with chronic hepatitis C was conducted during 2014-2015 on the basis of the infectious department of Chernivtsi Regional Clinical Hospital with certain paraclinical techniques being included. The research comprised patients of both sexes (21 males and 10 females), at the age of 26-63 years who were treated in the hospital. The average age of the examined patients was 44.55 ± 1.14 years. Among them, 15 (48.39%) were older than the middle age, and 16 (51.61%) younger than that one. The control group consisted of 30 practically healthy individuals (21 (70%) male patients and 9 women), at the age of 46.81 ± 2.41years. 21 patients had «chronic hepatitis C genotype of hepatitis C virus (HCV) that is 1b, without liver disorders, 7 patients with chronic hepatitis C, genotype HCV 1b, with liver disorders», 2 patients with «chronic hepatitis C, genotype HCV 3a, without liver disorders» and one patient with «chronic hepatitis C, genotype HCV 3b without liver disorders». 24 (77,42%) patients with chronic hepatitis C had their disease course without any liver disorders. The whole blood was taken from all the patients with chronic hepatitis C and practically healthy individuals for studying the level of immunological reactivity of the patients` organism which was displaced in a clean tube with EDTA anticoagulant – K2 * 2 H2O, without damage of the structure of leukocytes, red blood cells and prevents platelets aggregation. The test tubes were carefully shaken, 5-10 times to a good complete mixing. The automatic hematological analyzer of the HB series was used for calculation of blood elements of the peripheral blood and their analysis. The absolute and relative number of the main populations of immunocompetent cells was calculated according to the recommendations contained in the analyzer`s manual.

Based on the obtained results of absolute and relative number of the main populations of immunocompetent cells the immune-hepatological indicators were found, which determined general immunological reactivity of the patients` organism with hepatitis C. The obtained digital data were statistically processed by the variational calculations with the authenticity of the difference of signs determination by Student criterion, with mean values (M) and standard error (± m) usage, Student criterion (t) and probability index (Р). Р<0,05 was considered to be the reliable one. The statistical calculation was carried out on the IBM Pentium-IV computer, by the Microsoft Excel Professional for Windows XP package and Stat Plus Professional 2009 program.

Results and discussion

The initial condition of clinical and laboratory examination of patients with chronic hepatitis C is normally considered to be a clinical examination of each patient [5,6] and first of all hemograms where absolute and relative number of major populations of immunocompetent cells, platelets, erythrocytes and erythrocyte sedimentation rates (ESR) were determined (Table I).

A relative number of granulocytic leukocytes grows at a rate of 8,06 % in patients with chronic hepatitis C, though their absolute number tends to decrease by 9.29%. The growth of the relative number of granulocytic leukocytes is due to the increase of the relative number of neutrophilic granulocytes at a rate of 8,88 %, and the rate of the erythrocyte sedimentation rate up significantly by 73,03 % (Р <0,01). The data indicated below are indicative of inflammatory process in patients with chronic hepatitis C. Non-specific factors and mechanisms of anti-infection protection response to inflammation, and first of all granulocytic leukocytes: neutrophil granulocytes including their subpopulation – segmental neutrophils (an increase in the relative amount of 8.26%), stab nucleus neutrophils (an increase in the relative amount of 20.65%). The relative number of eosinophilic granulocytes is reduced by 17.37%. On the background of relative number of granulocytic leukocytes growth (all subpopulations of neutrophilic granulocytes) the absolute amount of these leukocyte forms tended to decrease by 10.07%, general type of neutrophil granulocytes – by 9.29%, segmental neutrophils – by 9.8%. The absolute amount of platelets was decreasing by 20.34% in addition. The agranulocyte population of leukocytes (leukocytes, monocytes and macrophages) in patients with hepatitis C was changed due to the relative amount of agranulocytes at the rate of 8.19% decrease, absolute (by 60%) and relative ( by 36.90%) amount of monocytes / macrophages, and the absolute number of lymphocytes tended to decrease (by 24,07 %). The changes in the absolute and relative number of granulocytic and agranulocytic forms of polynuclear, mononuclear leukocytes and lymphocytes are given in the research, they are also indicative of inflammatory reaction and endogenous intoxication and in case the fight against it the polymorphonuclear granulocytes prevail. The changes of the absolute and relative number of major populations of immunocompetent cells are also shown in the research affecting general immunological reactivity of the patients` organism with chronic hepatitis C. The results of immunological reactivity of the patients` organism with chronic hepatitis C can be seen in Table II.

Contents of the absolute and relative number of major populations of immunocompetent cells are indicative of activation and adequate response of the factors and mechanisms of inborn immunity to the causative agent and the processes caused by it when interacting with hepatocytes, netrophils, B-lymphocytes and monocytes macrophages. The inborn and specific acquired immunity is known to tightly interact and significantly complement each other. The determination of immune-hematological indicators, which characterize the immunological reactivity of the patients` organism with chronic hepatitis C, showed the increase of immune reactivity of the patients` organism with chronic hepatitis C of 30.07%. The tendency of the lymphocytic index decrease at the rate of 7,69 % reflects the notion of humoral response and predominance of cellular immune response and the growth of the neutrophils and monocytes ratio indicates the advantage in anti-infective protection of the patients` body with chronic hepatitis C of the microphage protective system over the macrophage one. The ratio index decrease of the relative number of lymphocytes and eosinophils to 19,32 % and the increase to 18.33% ratio of eosinophils and lymphocytes shows the predominance of delayed type hypersensitivity over the one of an immediate type. This is confirmed by the invariability of the allergy index. The insignificant (Р> 0,05) increase of the lymphocytes and monocytes ratio index (6.91%) is indicative of an affector unit of the immune response predominance over the effector one. As the decrease of the agranulocytes ratio and the erythrocyte sedimentation rate (ESR) to 55,28 % and the leukocyte ratio index and ESR to 61,54 % indicate intoxication, which is connected with the autoimmune process, and to a lesser extent with the infectious agent which is also confirmed by the lymphocytic granulocytic index decrease to 8,78 %.

Thus, chronic hepatitis C progression is accompanied by the increase of the immunological reactivity of the organism at the expense of the increase of the leukocyte shift index, ratio index of lymphocytes and monocytes, neutrophilic lymphocytic coefficient, index of the ratio of neutrophils and monocytes, as well as of reducing non-specific reactivity. Such changes from the point of nonspecific and specific immune defense (advantage of cellular immune response over humoral protection) create the conditions for the persistence probability in patients` organism with chronic hepatitis C and formation of a chronic process with possible complications in the future (autoimmune processes) [7-10].

Conclusions

1. General immunological reactivity in patients with chronic hepatitis C increased to 30,07% and the factors activation and mechanisms of nonspecific anti-infection protection decreased that create a condition for prolonged persistence of hepatitis C virus and the progression of a chronic infectious process in patients’ organism.

2. The mechanisms of affector unit in the immune response prevail over the effector processes in the immunological reactivity of the patients` organism with chronic hepatitis C which is confirmed by the activation of the microphage system over the acrophage one.

3. The cellular immune response and the reduced humoral link of the immune system (probably due to the infection of B-lymphocytes) prevail in patients with chronic hepatitis C which enables the virus to avoid the humoral control and persist in the organism for some period of time.

References

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The work is performed with in the limits of the department’s scientific work. Molecular-genetic and clinical-pathogenetic features of the combined the pathology of internal organs, the role of infectious, metabolic factors in its development, differentiated approaches to treatment.

Authors’ contributions:

According to the order of the Authorship.

Conflict of interest:

The Authors declare no conflict of interest.

CORRESPONDING AUTHOR

Iryna. V. Balaniuk

Higher Educational State Institution Of Ukraine

“Bukovynian State Medical University”

Chernivtsi, Ukraine

tel: +380950740004

e-mail: balanyk85@gmail.com

Received: 04.02.2019

Accepted: 07.06.2019