CLINICAL AND IMMUNOLOGICAL STATUS OF PATIENTS WITH GENERALIZED PARODONDITIS ASSOCIATIED WITH CHRONIC HEPATITIS B VIRUS (HBV) INFECTION
It was established that the leading role in the occurrence and progression of inflammatory and inflammatory lesions dystrophic parodontal played somatic diseases, including diseases of the hepatobiliary system. Especially close connection with generalized parodontitis observed hepatitis B. This may be due to the degree of inflammatory activity as hepatitis and the severity of immunopathological disorders induced by hepatitis B virus.
The purpose of the study is to research clinical and immunological parameters in patients with generalized parodontitis, amid chronic HBV infection.
Materials and methods of research. An in-depth analysis of 98 studies of patients with generalized parodontitis( GP) associated with chronic HBV infection (CHBV).
In the first group included 64 patients with periodontitis in conjunction with chronic viral hepatitis B, phase replication, the second group - 20 patients with parodontitis on the background of CHBV, phase of integration, and the third group consisted of 14 people suffering from parodontal disease in combination with viral cirrhosis B
. State of parodontal tissues was assessed by parodontal probes and indexes. To verify the diagnosis of chronic hepatitis B patients all measured markers of HBV. Assessment of immune status includes determining the total number of T and B- lymphocytes in blood. The level of immunoglobulins classes (A, M, G) – was made by radial immunodiffusion in gel by Mancini. Statistical processing of materials made computer program «Excel».
Results and discussion. It was found that results of that patients of the first group revealed deep parodontal pockets of 5-6 mm, and many dental plaque, the presence of active lesions osteoporosis interdental alveolar membranes, tooth mobility, determined by swelling and the presence of diffuse redness of the gums. Patients complained of great soreness of the gums, bleeding, bad breath. X-ray - the phenomenon of diffuse osteoporosis interdental membranes, reduced alveolar bone levels from 1/3 to ½. The clinical severity of pathological process in parodontal had a direct relationship with the duration of the underlying disease. The maximum expression of the inflammatory response and destructive progress was recorded in patients with hepatitis for a period of at least 2-3 years. Thus, about 82% of patients report that after six months or a year was noted a sharp deterioration of the gums, which was not found before. Positive tests for the presence of markers of chronic hepatitis B replication (HBsAg, NBeAg anti-HBcIgM, HBV DNA) in blood serum coincides with a significant reduction in the combined oral fluid SIgA, immunoglobulin M and immunoglobulin G enhance content.
Patients of the second group had signs of parodontitis were poor expressed: a slight redness gum tissue, they are bleeding, exposure of tooth roots, parodontal pockets of 2-3 mm, and slow the progression of bone resorption jaws. Objectively were recorded baring necks of the teeth, minor congestion. Humoral response was characterized by the fact that only manifested HBs Ag and even then not always. Indicators of immunoglobulins were little changed.
In the third group, patients recorded the mobility and tooth loss, numerous deposits of tartar, less bleeding gums.
Comparing systemic immunological parameters of various groups of patients it was found that patients with parodontal disease combined with chronic hepatitis B present significantly increase levels of immunoglobulins, the highest values reach their level in patients with viral activity and inflammation. In patients with parodontitis associated with chronic hepatitis B in phase replicative found significant violations of immune status. The analysis of immune parameters showed that the studied tests in all patients were significantly altered compared to the norm. The research results showed the presence of patients examined T- lymphopenia, the severity of which corresponded to the 2-nd degree of immunodeficiency state. Significant changes have been reported as part of subpopulation of T- cells. The number of cells that are at predominantly helper activity was lower than in healthy persons in the 1, 7 times in absolute numerous, and 1.5 - in relative terms (p <0.05). This type of immune changes testified about formation in patients with secondary immunodeficiency. Number of B-lymphocytes was moderately increased in absolute and relative terms. Patients along with T-lymphopenia and an imbalance in the system of fixed immunoregulatory cells occurred and improve the content of B-lymphocytes. This type of immune status can be described as active in humoral and supresive in cellular on the link.
Patients had dysimunohlobulinemiya that was determined by increased blood levels of IgG - to 17.7 ± 0.6 g / l, which is on average 1.3 times higher than similar rates in healthy individuals.
Conclusions. 1. Clinical manifestations of patodontitis have a clear dependence on the phase of chronic active hepatitis B disease duration. 2. In assessing the clinical condition of parodontal tissue in patients with chronic hepatitis B should be considered basic biochemical, immunological, virological parameters that reflect the phase of motion and activity of the underlying disease. 3. The clinical picture of parodontitis has a clear connection with laboratory parameters characterizing the functional liver condition.
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