Justifications for differentiated approach in correction of some changes of the immunologic disorders in patients with rapidly progressing generalized parodontitis with different drug susceptibility of the parodontal bacteria

Анотація

Rapidly progressing generalized perio­dontitis (RPGP) still remains an extremely important medical problem, despite certain achievements in solving most of the issues of etiology, pathogenesis and treatment. The study included 102 patients with rapidly progressing periodontitis of I-II and II-III degrees of severity, with ineffective and inconsistent results of previous treatment who were examined and treated in the clinic of the Department of Surgical Dentistry, Periodontics and Implantology of the SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine». On the basis of the diagnostic and therapeutic measures carried out, it was established that, in patients with rapidly progressing generalized periodontitis, the formation of various drug sensitivity in periodontopathogenic microorganisms to protocol antibacterial therapy is closely associated with immunological protocol diseases. The presence of drug-resistant bacteria in the periodontal tissues is combined with a more pronounced immunodeficiency in the mechanisms of systemic and local protection than when the lesions are colonized by drug-sensitive periodontal microorganisms. The revealed features of immunity disorders in patients with RPGP with drug-resistant infection to conventional antibiotic therapy are manifested by a decrease in CD₃+ lymphocytes, cells with cytostatic activity (CD₄+, CD₁₆+) expressing receptors for the activation of lymphocytes CD₂₅+, HLA-DR and apoptosis CD₉₅+), against the background of a slight increase in CD₂₀+, CD₁₁₆+, CD₅₄+, significant inhibition of the synthesis of SIgA, IgM, α-INF, γ-INF; a pronounced increase in the production of pro-inflammatory cytokines IL-1β and TNF-α. The need for a differentiated approach in the correction of immunological disorders in patients with RPGP depending on the detected sensitivity and resistance of periodontal pathogenic bacteria to the protocol generally accepted antibacterial therapy has been clearly proved; this provides a faster relief of the infectious and inflammatory process (on average on 3.6±0.2 day) in more than 90% of cases, normalization of the parameters of immunological reactivity in 93.3% of the observed and stable clinical remission of the disease.