The role of humoral immunity in predicting the development of acute destructive cholecystitis

The incidence of acute cholecystitis, to date, remains at the same level and amounts to 1.6 cases per 100,000 people. Mortality in this pathology ranges from 4 to 26%. There is no doubt that changes occur in any pathology, both in the local and in the general link of immunity, acute cholecystitis is no exception. The most significant deviations are observed in humoral immunity. Based on this, these criteria can be used to improve the diagnosis of acute destructive cholecystitis. The aim. To evaluate changes in the humoral link of immunity in patients with acute destructive cholecystitis. Materials and methods: A single-stage study of 105 patients with various clinical and morphological variants of acute calculous cholecystitis (acute catarrhal cholecystitis (n=35); acute phlegmonous cholecystitis (n=35); acute gangrenous cholecystitis (n=35)), comparable in age, gender and concomitant pathology and time of surgical intervention, was conducted. When patients were admitted to the hospital with suspected acute cholecystitis, the activity of the following immunogram parameters was determined in the first 2 hours: IgA, IgG, IgM and total immunoglobulin. Statistical processing of the obtained results was carried out using the SPSS Statistics 10.0 program in compliance with the principles of statistical analysis adopted for research in biology and medicine. The results. As a result of the study, an increase in the level of IgA in a subgroup of patients with acute gangrenous cholecystitis (subgroup № 3) to 139.5 IU/ml was found, which is 1,3 times higher than the reference level (p<0,05), 1.1 times less (p<0,05) than the values of the clinical comparison group, and 1.1 times higher (p≤0.05) values obtained in subgroups with catarrhal (subgroup № 1) and phlegmonous (subgroup № 2) acute cholecystitis. It was revealed that the concentration of IgG in subgroup № 3 reaches 196,6 IU/ml, which exceeds the indicators in other groups, relative to the norm values by 1,4 times (p≤0,05), comparison group by 1,4 times (p≤0,05), subgroup № 1 by 1,6 times (p≤0,05), subgroup № 2 1,2 times (p≤0,05). In the subgroup with acute gangrenous cholecystitis, it was found that the concentration of IgM is 190,4 IU/ml, which is higher than in other groups: the clinical comparison group by 1,6 times (p≤0,05), subgroup № 1 by 1,5 times (p≤0,05), subgroup № 2 by 1,2 times (p≤0,05). Conclusions. The study found that in destructive forms of acute cholecystitis, an increase in IgG was recorded by 1,6 times in comparison with the group of patients with non-destructive cholecystitis (p<0,05), as well as IgM by 1,3 times in comparison with the group of patients with non-destructive cholecystitis.

1. Entsova L.L. The value of indicators of nonspecific immunological reactivity of the body in assessing the condition of patients with cholecystitis before and after surgery: diss. ... cand. med. sciences: 03.00.07 / L.L. Yentsov. - M., 1973. - 123 p.

2. Ilchenko A.A. The state of local and general humoral immunity in cholecystolithiasis and biliary "sludge" / A.A. Ilchenko, T.V. Vikhrova, M.M. Zotova // Russ. gastroenterol. journal. – 2001. – No. 1. – P. 10-14.

3. Kalygina T.A. Phagocytic activity of leukocytes and the nitrosine tetrazolium recovery test in patients with chronic colitis and cholecystitis / T.A. Kalygina, N.D. Bolotova // Immunological disorders in diseases of the digestive system: coll. of scientific tr.; edited by A.M. Nogaller. – Ryazan, 1981. – Vol. 74. – P. 59-62.

4. Kozlova N.M. The state of humoral immunity in diseases of the biliary tract / N.M. Kozlova // Bulletin of the All-Russian Scientific Research Center of the Russian Academy of Medical Sciences, 2006. - №5 (51. – P. 93-96.

5. Kotelnikova L.P. Diagnostic significance of serum immunoglobulins and hepatic bile / L.P. Kotelnikova, L.K. Burenkova // The first Moscow International. Congress of Surgeons: Materials of conf. – M., 1995. – P. 325-326.

6. Levkoeva L.G. The study of circulating immune complexes in chronic diseases of the digestive tract / L.G. Levkoeva, G.A. Eliseeva // Immunological disorders in diseases of the digestive organs: Collection of scientific tr.; Edited by A.M. Nogaller. – Ryazan, 1981. – Vol. 74. – P. 22-24.

7. Mudrov V.A. Algorithms for statistical analysis of qualitative features in biomedical research using the spss software package / V.A. Mudrov // Zabaikalsky meditsinicheskiy vestnik - 2020. – No. 1. – P. 151-163. https://doi.org/10.52485/19986173_2020_1_140

8. Palcev M.A. Pathological anatomy / M.A. Fingers, N.M. Anichkov. – M.: Medicine, 2000. – 528 p.

9. Surgical care in the Russian Federation during the pandemic – the main results of 2020 / A.Sh. Revishvili, V.E. Olovyanny, V.P. Sazhin, M.M. Anishchenko // Surgery. N.I. Pirogov journal named after – 2021. - No.12. – P. 5-14. https://doi.org/10.17116/hirurgia20211215

10. Kerr M.A. Function of immunoglobulin A in immunity / M.A. Kerr // Gut. – 2000. – Vol. 47. – P. 751–752.