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\begin{document}

\title{STATE OF IMMUNOLOGICAL REACTIVITY IN PATIENTS WITH CHRONIC CYSTIC
SINUSITIS}



\author[1]{Mahzuna Nasretinova}%
\author[1]{Alisher Khaitov}%
\affil[1]{Samarkand State Medical Institute}%


\vspace{-1em}



  
  \date{June 11, 2024}


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\textbf{Summary.} Diseases of the paranasal sinuses (DPN) are the most
common pathology in otorhinolaryngology. According to the literature, it
is known that cystic sinusitis is an infectious and allergic disease,
and the formation of cysts is considered as the result of an allergic
reaction to infection in sensitized patients. Adverse environmental
impact on the immunological system of the human body, reducing natural
resistance, increasing the degree of allergization of the population
contributes to a high level of General respiratory diseases. In this
regard, it is relevant to study the indicators of General and local
immunity in patients with chronic cystic sinusitis. We examined 138
patients with chronic cystic sinusitis aged 17 to 64 years. Conducted
immunological study of the state of cellular and humoral immunity in
accordance with the recommendations Of the Institute of immunology. A
comprehensive immunological examination revealed a sharp imbalance of
immunological parameters in blood serum, nasal flushes and cystic fluid
in patients with chronic cystic sinusitis. In the complex of etiological
and pathogenetic treatment in patients suffering from chronic cystic
sinusitis, it is necessary to include immunodulators and
immunostimulators.

\textbf{Introduction} . Diseases of the paranasal sinuses (DPN),
sinusitis-are among the most common pathologies in
otorhinolaryngology{[}3,6{]}. This is facilitated by changes in the
environmental situation in the world, the wide prevalence of both
allergic and viral respiratory diseases, the irrational use of
antibacterial drugs, and a decrease in local and General immune
mechanisms. According to the literature, it is known that cystic
sinusitis is an infectious and allergic disease. The formation of cysts
is considered as a result of an allergic reaction to infection in
sensitized patients{[}10{]}. To date, the causes of cysts have not been
clarified, so it remains relevant to further in-depth study of various
factors that may affect the course of the inflammatory process. In a
modern city, a person is exposed to a complex of environmental factors
that adversely affect their health. The leading one is multi-complex air
pollution, which occurs as a result of intensive development of industry
and transport {[}2{]}. We have identified an adverse effect of
environment on the immune system of the human body - the formation of
secondary immunosuppression, reduced natural resistance, increase the
degree of allergization of the population, resulting in high rates of
overall morbidity and, in the first place, the defeat of the respiratory
tract that is characterized by high radiation, dust and fumes in the
environment.

Currently, the influence of three factors - dust, carbon monoxide and
sulfur dioxide-on the incidence of acute respiratory infections,
bronchitis and pneumonia has been reliably proven. These agents and
their various combinations affect the incidence of angina, pharyngitis,
rhinitis, and sinusitis {[}5,8{]}. The increased content of harmful
substances in the inhaled air has not only a General adverse effect on
the body, but also leads to a violation of their normal functioning of
the nasal cavity, i.e. weakens its protective capabilities, which
increases the risk of rhinitis and sinusitis.In connection with the
above, it was considered relevant to study the indicators of General and
local immunity in patients with chronic cystic sinusitis {[}2,4,7,9{]}.

The aim of the study was the state of immunological reactivity in
patients with chronic cystic sinusitis.

\textbf{Materials and methods of research.} 138 patients with chronic
cystic sinusitis aged 17 to 64 years were examined, including 65 women
(47\%) and 73 men (53\%) who applied to the clinic No. 1 of the
Samarkand medical Institute. The number of workers and employees was
about the same. For examination, patients with chronic cystic sinusitis
were selected with a prescription of this pathology for at least 2 years
and there were no concomitant inflammatory diseases. The diagnosis was
made on the basis of patient complaints, anamnesis data documented in
outpatient records, clinical manifestations of the disease, x-ray,
computed tomography examination of the paranasal sinuses (PNS) and the
results of maxillary sinus puncture. To determine the regional
physiological norm, all the indicators used were determined in 54
clinically healthy donors aged 17 to 50 years of both sexes from the
number of volunteers with no history of chronic inflammatory diseases.
Immunological indicators of the physiological norm in flushes from the
maxillary sinuses were determined in 23 healthy persons from the number
of military conscripts. The conducted immunological study included a
detailed determination of 3 links of the immune system: all stages of
phagocytosis (\% of phagocytic cells, phagocytic number and phagocytosis
completion index - PCI) and nst-test, rosette formation reactions -
active, spontaneous, and with loads of levamizol and theophylline,
concentrations of immunoglobulins of classes A, M, G and sec - rotary Ig
A, as well as the content of lysozyme and circulating immune complexes
(CIC).

We studied the state of cellular and humoral immunity according to the
recommendations Of the Institute of immunology. Blood for research was
taken in the morning on an empty stomach from the ulnar vein. To
determine the cellular level of immunity, blood was placed in a
heparinized test tube at the rate of 20 units of heparin per 1 ml of
blood. The isolation of immunocompetent cells was performed by a
conventional method using a ficol-verografin gradient. Mononuclear
suspension was studied in a cell concentration of at least 1 million
cells per 1 ml.

To study the state of local immunity, cystic fluid was used, which was
obtained by means of a diagnostic puncture of the maxillary sinus and
was aspirated into a sterile syringe. Further calculations took into
account the 1:10 dilution.

\textbf{Results and discussion.} A comprehensive immunological
examination revealed a sharp imbalance of immunological parameters in
blood serum in patients with chronic cystic sinusitis. First of all,
attention is drawn to the marked decrease in all indicators of serum
immunoglobulin content, as well as secretory Ig A (table 1). It should
be noted that the physiological norm of the content of immunoglobulins
in blood serum is located within a fairly wide range. For example, the
amplitude of ''normal'' values for Ig A is from 1.7 to 2.55 g / l, and
for SIgA-from 1.65 to 2.65. The same significant fluctuation in their
indicators is observed in patients with chronic cystic sinusitis. It
seems more convenient to use this indicator in the form of the Ig a/
SIgA index in practical health care . In healthy patients, it is equal
to 1, i.e. 1: 1, and in patients with chronic cystic sinusitis, it
changes significantly and is 3:1.in all the examined patients, this
index was the most constant value, i.e. its fluctuations were minimal.

Analyzing the phenomenon of a sharp decrease in the content of
immunoglobulins of all classes in the examined patients, it can be
assumed that this is a manifestation of a fairly common congenital
immunodeficiency condition in all classes of immunoglobulins. In the
literature, this category of patients is described as a group of
frequently and long-term patients. In most cases, the anamnesis data
corresponds to this description.

When further analyzing the results of immunological examination of
individuals with chronic cystic sinusitis, the following Genesis of the
phenomenon of deficiency in all classes of immunoglobulins seems more
likely, namely: characterizing the indicators of the macrophage system,
it should be noted that the percentage of phagocytic cells is usually
increased, which is quite consistent with the classical course of the
inflammatory process, but the ability of phagocytes to capture and
digest the pathogenic object is reduced (table 2).

In this case, we are probably dealing with a congenital defect of the
a-link of the immune system, which entails, according to the theory of
the three-link immune system, a weak immunological signal to the B-link.
Thus, the decrease in serum levels of immunoglobulins of all classes in
patients with chronic cystic sinusitis appears to be mediated.

This assumption is supported by such an increase in the value of the nst
test to 56.5+3.4 (with a norm of 22.5-2.3).

Defect A-link - bad recognition, capture and digestion of pathogen -
creates conditions for the transition of the inflammatory process in
chronic, since it entails a high concentration of this agent in the
patient's body, i.e., a high degree of sensitization, as manifested in
the examined in the reaction of immunoparalysis.

The high percentage of phagocytic cells and the increased values of the
nst test are obviously compensatory. Describing the indicators of the
T-system in chronic purulent sinusitis (table 3), it should be noted
that the number of active test on the formation of the rosette in the
resection reaction in these patients is slightly increased compared to
the norm, but statistically unreliable.

During stress tests, a decrease in test on the formation of the rosette
with theophylline was detected, while the indicators of spontaneous
tissue-forming test on the formation of the rosette cells with
levamisole almost coincide with the lower limit of the norm, i.e. they
are statistically unreliable.

The most interesting indicator here is already known and actively used
by immunologists index-the ratio of T-helper /T-suppressor: normally in
healthy people, it is 0.5+0.03 or 1:2, and in patients with chronic
purulent sinusitis, its indicator was significantly changed and took the
value of 1.16+0.04, which corresponds to the ratio of 1:1 .

Analyzing the state of non-specific resistance, we noted a significantly
increased concentration of CIC in the blood serum in patients with
chronic cystic sinusitis (98.7+8.2 units of opt.pl) compared to the norm
(25:3.2 units of opt. pl). A high level of CIC corresponds to the
immunological manifestations of chronic inflammation in the body and may
reflect the failure of the phagocytosis process.

The detected decrease in the lysozyme index in blood serum - 3.28+0.18
mkg/l (at the norm of 3.7\selectlanguage{ngerman}±0.09 mkg/l) may be a sign of exhaustion of
this system due to the age and severity of the inflammatory process
occurring against the background of a defect in the a-link of the immune
system. The immunological characteristics of patients with chronic
cystic sinusitis are supplemented by a study from the maxillary sinuses,
the results of which are presented in table 4.

In cystic fluid in chronic cystic sinusitis, there is an almost double
increase in the content of serum Ig A, Ig G and a noticeable decrease in
serum Ig and secretory lgA compared to the same indicators in healthy
volunteers. This ratio of serum immunoglobulins is quite consistent with
the reaction of the B-link immunity to chronic inflammatory process, but
a significant decrease in the content of SigA, apparently, pathognomonic
for this category of patients, because it reflects the initial weakness
of the local immune system of the nasal cavity and paranasal sinuses.

In flushes, as in blood, with a wide range of values of Ig A and SigA,
the ratio of Ig A/Slg a was the least subject to fluctuations and at the
same time the most constant. In healthy patients, it was 0.98+0.032, and
in patients-1.86-0.04. For convenience, we have expressed this ratio in
the form of an ''immunoglobulin'' index, which is 1:1 in healthy people
and 2:1 in patients.

Indicators of non-specific resistance in cystic fluid from the maxillary
sinuses in chronic cystic sinusitis are presented in table 5.

An increase of almost twice the normal CIC content in flushes from
inflamed maxillary sinuses corresponds to immunological manifestations
of the inflammatory process.

The fact that in the body of patients with chronic cystic sinusitis, the
level of CIC is increased both in the blood serum and in sinus flushes,
suggests a possible participation of the autoimmune process in the
pathogenesis of this disease.

The content of lysozyme in flushes from the maxillary sinuses, as well
as in the blood serum, is reduced. Obviously, this phenomenon is still
systemic. It is possible that the reduced antibacterial capabilities of
local immune factors in the maxillary sinus-secretory immunoglobulin and
lysozyme are a predisposing factor in the formation of a chronic process
in this organ.

\textbf{Conclusions}

1. Chronic cystic sinusitis develops against the background of a
significant immunological imbalance - a decrease in the indicators of
immunoglobulins and lysozyme in both blood serum and exudate from the
maxillary sinuses.

2. the most accurate immunoglobulin imbalance characterizes the ratio of
Ig A/Sig A, which is normally 1:1 both in the blood serum and in sinus
flushes, and in patients suffering from chronic cystic sinusitis, it is
3:1 in the blood serum and 2: 1 --from the cystic contents of the
maxillary sinuses.

3. Patients with chronic cystic sinusitis, disturbed the ratio
T-helper/T-suppressor = 1:1 (in healthy individuals - 1:2).

4. The complex etiologic and pathogenetic treatment of patients
suffering from chronic cystic sinusitis, you need to include
immunodulators and Immunostimulants, particularly active against A-of
the immune system.

\textbf{Table 1. the content of immunoglobulins A, M, G and SIgA in
blood serum in patients with chronic cystic sinusitis and in healthy
individuals.}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\textbf{Subject} & \textbf{The concentration of immunoglobulins (M+m)} &
\textbf{The concentration of immunoglobulins (M+m)} & \textbf{The
concentration of immunoglobulins (M+m)} & \textbf{The concentration of
immunoglobulins (M+m)}\tabularnewline
\midrule
\endhead
& \textbf{Ig A} & \textbf{Ig M} & \textbf{Ig G} &
\textbf{SIgA}\tabularnewline
Ill & \textbf{1,25+0,23} & \textbf{0,66+0,073} & \textbf{7,93+0,87} &
\textbf{0,91+0,41}\tabularnewline
Healthy & \textbf{1,89+0,19} & \textbf{1,55+0,061} & \textbf{9,76+0,7} &
\textbf{2,1+0,3}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 2 Indicators of phagocyte activity in patients with
chronic cystic sinusitis in healthy}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\textbf{Subject} & \textbf{The studied indicators (M+M)} & \textbf{The
studied indicators (M+M)} & \textbf{The studied indicators (M+M)} &
\textbf{The studied indicators (M+M)}\tabularnewline
\midrule
\endhead
& \%f. K & f. number & NRF & Nst-test\tabularnewline
\textbf{Ill} & \textbf{71,97+7,8} & \textbf{2,4+0,32} &
\textbf{0,433+0,046} & \textbf{56,5+3,4}\tabularnewline
\textbf{Healthy} & \textbf{55,2+2,04} & \textbf{6,84+0,35} &
\textbf{0,76+0,01} & \textbf{22,5+2,3}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 3 Indicators of the functional ability of the T-system in
patients with chronic cystic sinusitis}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\textbf{Patients} & \textbf{The studied indicators (M+M)} & \textbf{The
studied indicators (M+M)} & \textbf{The studied indicators (M+M)} &
\textbf{The studied indicators (M+M)}\tabularnewline
\midrule
\endhead
& test on the formation of the rosette active & test on the formation of
the rosette spontaneous & test on the formation of the rosette
(theophylline) & test on the formation of the rosette
(levamisole)\tabularnewline
Ill & 59,85+3,1 & 53,77+2,1 & 43,26+3,6 & 50,35+3,8\tabularnewline
Healthy & 52+2,8 & 55+2,0 & 53,5+5,2 & 54,3+4,5\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 4 Content of AMG class immunoglobulins from cystic fluid
and in flushes in patients with cystic sinusitis and healthy individuals
(M+m)}\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
\textbf{Patients} & \textbf{The concentration of immunoglobulins (M+m)}
& \textbf{The concentration of immunoglobulins (M+m)} & \textbf{The
concentration of immunoglobulins (M+m)} & \textbf{The concentration of
immunoglobulins (M+m)}\tabularnewline
\midrule
\endhead
& \textbf{Ig A} & \textbf{Ig M} & \textbf{Ig G} &
\textbf{SIgA}\tabularnewline
Ill & \textbf{0,713+0,09} & \textbf{0,102+0,013} & \textbf{0,219+0,02} &
\textbf{0,265+0,018}\tabularnewline
Healthy & \textbf{0,36+0,001} & \textbf{0,195+0,009} &
\textbf{0,143+0,017} & \textbf{0,29+0,015}\tabularnewline
\bottomrule
\end{longtable}

\textbf{Table 5 indicators of non-specific resistance of cystic fluid
and in flushes in patients with cystic sinusitis and healthy
individuals.}\selectlanguage{english}
\begin{longtable}[]{@{}lll@{}}
\toprule
\textbf{Patients} & The studied indicators (M+M) & The studied
indicators (M+M)\tabularnewline
\midrule
\endhead
& CIC(unit opt. pl) & Lysozyme (mkg / l)\tabularnewline
Ill & 51,27+5,2 & 2,06+0,06\tabularnewline
Healthy & 28+4,6 & 3,36+0,07\tabularnewline
\bottomrule
\end{longtable}

\textbf{List of references.}

1. Kryukov A. I., Turovsky A. B., Zap'kin G. Yu. and others.Complex
therapy of chronic maxillary sinusitis //Medical Council 2015 no. 3 p.
18-22

2. Lamkova A. H. Prevalence of cysts of the maxillary sinuses depending
on the environment of habitation // Russian rhinology. - 2011.  2. - P.
46

3. Lopatin A. S. Acute and chronic rhinosinusitis. A. S. Lopatin, V. p.
Gamov. M.: MIA, 2011: 46.

4. Nasretdinova M. T. et al. Violation of the antioxidant protection
system in children with chronic purulent sinusitis and its complex
correction //Tajik state medical University named after Abuali Ibn Sino.
- P. 87.

5. Nasretdinova M. T., khayitov A. A., Salimova sh. s. Improvement of
diagnostics of various forms of fungal rhinosinusitis //Bulletin of the
doctor. - p. 27.

6. Piskunov G. Z., Piskunov S. Z., Kozlov V. S., Lopatin A. S. Disease
of the nose and paranasal sinuses: endomicrosurgery.Moscow: collection
''Top secret''; 2003.

7. khayitov A. A., Khushvakova N. Zh., Nasretdinova M. T. Diagnostics of
indicators of key cytokines in patients with acute bacterial
rhinosinusitis //Innovative technologies in children's medicine of the
North Caucasus Federal district, 2017, pp. 93-95.

8. Chesnokova N. L., Mareev O. V., Kapustina N. Yu. chronic sinusitis:
pathogenetic factors of development, justification of new principles for
improving the effectiveness of complex therapy / / Practical
medicine-2011. - p. 7-9.

9. Samuylov Yu. y. Determining the state of local immunity of the nasal
mucosa in rhinological practice // Russian Otorhinolaryngology 2007 no.
1 (26) p. 151-156

10. European position papar on rhinosinusitis and nasal polyps 2012 / W.
J. Fokkens {[}et al.{]} / / Rhinol. Suppl. -- 2012. --  23. -- P.
1--298.

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