nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2021-1-98-104nid-12Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESИммунологические факторы риска острого повреждения почек у больных пневмониейImmunological risc factors for acute kidney damage in patients with pneumoniaДаминовБ. Т.DaminovB. T.noemail@neicon.ruМуминовД. К.MuminovD. K.davron.muminov@yahoo.comДаминоваЛ. Т.DaminovaL. T.noemail@neicon.ruТашкентский Педиатрический медицинский институтРоссияTashkent Pediatric Medical InstituteRussian FederationТашкентский Государственный стоматологический институтРоссияTashkent state dental InstituteRussian Federation20212106202423198104Copyright © Даминов Б.Т., Муминов Д.К., Даминова Л.Т., 20242024Даминов Б.Т., Муминов Д.К., Даминова Л.Т.Daminov B.T., Muminov D.K., Daminova L.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/12

Цель исследования: изучить иммунологические показатели у больных пневмонией на фоне ХБП и определить их значимость в развития острого повреждения почек. Материалы и методы: обследовано 120 больных внебольничной пневмонией: 40 больных пневмонией (группа Пн) и 80 больных пневмонией, которая развилась на фоне хронической болезни почек (группа Пн+ХБП). В качестве контрольной группы (КГ) было обследовано 20 здоровых лиц. В ходе исследования выявлено, что количество лейкоцитов в группе Пн+ХБП было выше на 162,24% чем в КГ (p<0,001) и на 27,79% ниже чем в группе Пн (p<0,001). У больных Пн отношение количества нейтрофилов к лимфоцитам достоверно увеличилось, а в группе Пн+ХБП осталось неизменным, несмотря на увеличение абсолютного числа лейкоцитов. У больных пневмонией с фоновой ХБП отмечалось наиболее выраженное увеличение доли Т-лимфоцитов за счет субпопуляции CD8 и CD95 клеток (p<0,001 по сравнению с КГ и группой Пн) и преобладание увеличения IgG (p<0,001). Из 120 больных пневмонией, включенных в исследование, у 97 больных (80,83%) было диагностировано острое повреждение почек (ОПП): у 75 больных - 1-й, у 15 больных - 2-й и у 7 больных - 3-й стадии. В группе больных пневмонией без фоновой патологии почек ОПП было диагностировано у 23 больных группы (57,5%), в группе Пн+ХБП - у 68 больных (85%) (хи-квадрат=10,80, p<0,01). При проведении ретроспективного анализа исследуемых показателей в зависимости от развития ОПП и его степени тяжести были определены иммунологические предикторы развития ОПП. Выводы: внебольничная пневмония на фоне ХБП ассоциируется с истощением клеточного компонента неспецифического иммунитета, активацией приобретенного иммунитета вследствие хронического воспаления и хронической антигенной стимуляции. У больных пневмонией предикторами развития ОПП явились фоновая хроническая болезнь почек, высокие уровни реактивных и антителопродуцирующих лимфоцитов, моноцитов, незрелых гранулоцитов и ЦИК IgG, и уменьшенные уровни нейтрофилов и ЦИК IgМ.

Purpose of the study was to assess the immunological parameters in patients with pneumonia and CKD in the background and to determine their significance in the development of acute kidney injury. Materials and methods: 120 patients with acute pneumonia were examined: 40 patients with pneumonia (group Pn) and 80 patients with pneumonia developed on the background of chronic kidney disease (group Pn+CKD); 20 healthy individuals were examined as a control group (CG). The number of leukocytes was increased in the group of Pn+CKD by 162.24% compared to the CG (p<0.001) although was 27.79% lower than in the group of Pn (p<0.001). In patients with Pn, the ratio of the number of neutrophils to lymphocytes increased significantly, and in the group of Pn+CKD, it remained unchanged, despite an increase in the absolute number of leukocytes. In patients with pneumonia with CKD in the background, the most pronounced increase in the proportion of T-lymphocytes was observed due to a subpopulation of CD8 and CD95 cells (p<0.001 compared with CG and the Pn group) and the prevalence of an increase in IgG (p<0.001). Among 120 patients with pneumonia included in the study, 97 patients (80.83%) were diagnosed with acute kidney injury (AKI): in 75 patients - the 1st stage, in 15 patients the 2nd stage and in 7 patients the 3rd one. In the group of patients with pneumonia without background renal pathology, AKI was diagnosed in 23 patients (57.5%), in the group of Pn+CKD - in 68 patients (85%, chi-square=10.80, p<0.01). Immune predictors of AKI development depending on the development of AKI and its severity were determined by a retrospective analysis of the studied parameters. Conclusion: pneumonia associated with CKD is associated with the depletion of the cellular component of nonspecific immunity, activation of acquired immunity due to chronic inflammation and chronic antigenic stimulation. In patients with pneumonia, background chronic kidney disease, high levels of reactive and antibody-producing lymphocytes, monocytes, immature granulocytes and IgG CICs and decreased levels of neutrophils and IgM CICs were predictors of AKI.

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The authors declare that there are no conflicts of interest present.