Resume. There is a problem of diffidence of acute pain manifestations of abdominal tuberculosis (AT), which can be treated conservatively, with acute appendicitis (AA). Since the endogenous intoxication syndrome (EI) is one of the leading in inflammatory diseases pathogenesis, the purpose of the study is to find out the features of the content of middle mass molecules (MMM) in the blood and circulating immune complexes (CIC), as the markers of EI, in patients with different pathomorphological forms of AA and with AT.
Materials and methods. The study has involved 92 patients aged between 18 and 65 years with a suspicion of AA, who have got inpatient treatment at the surgical department of the Lviv Communal City Clinical Hospital of ambulance. Groups formed for the analysis of research results have been created after surgical intervention on the basis of the pathomorphological conclusion. 25 persons have entered the group of patients with acute catarrhal appendicitis (AKA), 32 patients have been in the group of patients with acute phlegmonous appendicitis (AFA); a group of 20 people – with acute gangrenous appendicitis (AGA), 15 people with AA, complicated by appendicular infiltration included, 28 patients with abdominal tuberculosis (AT) in different focal centers of localization aged from 18 to 55 years old (patients of the Lviv regional physio-pulmonary dispensary). A blood collection for research has been taken from the vein of a patient with acute abdominal pain who arrived to the hospital before surgery. The control group has consisted of 30 practically healthy individuals. For the evaluation of EI, the content of MMM in the blood has been determined using the Gabrielyan NI method with a wavelength of 254 and 280 nm with the following calculation of the distribution coefficient DK = MMM280/MSM254, and the total content of MMM as the sum of MMM280 and MSM254. The content of CIC in blood has been determined by method of Yu.A. Grinevich that means precipitation in poliethylenglicol 6000. Since the content of MMM in the blood is an indicator that reflects a change in metabolic homeostasis, in particular, the degradation of protein macromolecules; and the content of the CIC is an indicator of immunological intoxication, we think that it could be expedient to enter the ratio of these components in the general syndrome. This ratio (immune metabolic index of intoxication IMII) has been calculated according to the formula IMII = ((MSM280 + MSM254)/ CIC)∙100. Results are statistically processed using the STATISTIKA 6.0 application package. The results are presented as M ± m, the probability of difference between the groups has been estimated using the Mann-Whitney Criterion Results and discussion. It has been found that destructive forms of AA is manifested by a significantly higher level of MMM, over 2 times more (p < 0.05) and predominance of catabolic cytotoxic fraction MSM254. Also the increase in the content of CIC in the blood that reflects immune intoxication has been established. A median-molecular CIC is known as high cytotoxic.
Established index IMII has been significantly increased in 2 times with destructive forms of AA. The result indicates that the development of EI in these pathologies is more likely to be affected by tissue destruction and the content of MMM, that reflect this process, while in the case of AKA and AT, it tended to decrease.
The obtained results indicate that the comparison of biochemical and immunological markers of intoxication based on the calculation of indexes is more informative than the study of individual indicators, since it makes it possible to compare the contribution to the IS of biochemical and immunological mechanisms.
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