Method of complex correction of immunoinflammatory responses of cardiovascular bed

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiovascular surgery and cardiology, and deals with complex correction of immunoinflammatory responses of cardiovascular bed. For this purpose, in case of presence of high level of circulating immune complexes and/or complement in patient, three sessions of plasmapheresis in accordance with conventional methods, and in case of low level of IgG and reduced phagocytic activity of neutrophils and monocytes, as well as in case of confirmed autoimmune process, a course of intravenous infusions of human polyvalent immunoglobulin is carried out in accordance with conventional schemes.

EFFECT: method provides reduction of both hypo- and hyperactive disorders in immune system of patients and resulting increase of efficiency of treatment of cardiovascular system diseases.

3 ex

 

The invention relates to medicine, namely to clinical angiology.

It is now well proven that cardiovascular pathology progresses under the influence of elevated levels of immune inflammation [1,2,3]. In this regard, we are in active search for reducing immune inflammation cardio-vascular bed by the impact of different therapeutic interventions [2,3,4], including monoclonal antibodies and nanotechnology [5, 6]. In this known method is aimed only at the individual components of the immune system and mainly on Pro - and anti-inflammatory individual proteins and molecules [4, 5, 6]. To date, however, not proposed integrated organism-tissue and cell molecular method anti-inflammatory effects simultaneously on Hypo - and hyperactive abnormalities in the immune system[2, 3, 4].

Thus we propose a new technical result, increasing efficiency stabilization of immune and inflammatory reactions in heavy category cardiovascular patients, thereby decreasing the progression of occlusive-stenotic and thrombohemorrhagic lesions cardio-vascular bed by 2-component immunotropic effects of various pharmacodynamic and adaptation to the impacts of funds on bases background�resonant therapy [3, 4]. This is achieved through the use of new interactive exposure to all key parts of the immune system responsible for the inflammatory response. On the basis of previously conducted a discrete analysis of clinical and laboratory data of 220 patients who had used a standard 2-component immunotropic influence methods in progressive cardiovascular disease [2, 3, 4], it was determined the optimal 2-component complex immune effects to stabilize the immune inflammation cardio-vascular bed. It is held as follows.

Consistently analyze the medical history, physical findings and other clinical and laboratory evidence of severe cardiovascular disease, including monografia zitoplazmaticeski method according to regional standards of population immune status. Then the sum of the data confirms the presence of high levels of immune inflammation in a personalized version and in various combinations, using 2 component therapeutic and preventive measures aimed at reducing or eliminating immune inflammation cardio-vascular bed.

1 component - correction of the patient's lifestyle on the individual program, including psychological and physical discharging�and and diet. This component is performed in all patients with a high level of immune inflammation cardio-vascular bed.

2 component - depending on the individual characteristics of the immune status are selected and appointed by the immunomodulators verified with the chemical formula and proven efficacy for reducing immune inflammation. In patients with pathologically high levels of circulating immune complexes (CIC) and/or complement other types of intoxication is performed 3 sessions of plasmapheresis on known and approved methods. At low levels of IgG and phagocytosis of neutrophils and monocytes, as well as with a confirmed autoimmune process in patients of this category is a course of intravenous infusion of human polyvalent immunoglobulin according to conventional schemes.

All activities carried out within 20-30 days. At the end of it is repeated clinical and laboratory examination and, if necessary, shall be appointed immunorehabilitation with the additional use of vitamin preparations, immunomodulators and Spa treatment. The whole complex is on the etiopathogenetic background of traditional treatment methods adopted at the national level, international standards and recommendations.

The advantage of this complex W�consists in the fact, what happens simultaneous Hypo - and hyperregular effects on the Central nervous and endocrine systems, liver and gastrointestinal tract, musculoskeletal system, haematopoietic and reticuloendothelial system, phagocytes, T and b-lymphocytes, plasma opsonins of the blood and antioxidant defense system.

By using the proposed complex in the past 12 years were treated more than 600 patients with predominantly cardiovascular surgical patients with verified increases in the level of immune inflammation in cardiovascular system in progressive pathology of the various divisions of the arterial and venous system. The positive effect of different severity was obtained from 577 patients. Side effects and adverse effects of this complex on the patient's body is not marked in the control of clinical and immunological examination. Unlike steroid hormones, cytotoxic drugs and monoclonal antibodies, we found no negative impacts of the proposed complex on intact cells and molecules of the body of patients.

Clinical example 1. Patient M., 50 years. Diagnosis: Nonspecific aortoarteriit. Oclusion stenotic lesions of all branches of the aortic arch 3 degrees in the A. V. Pokrovsky. Arterial hypertension stage III. Chronic�ski cholecystitis and pancreatitis. Complaints of recurrent ischemic attacks of the brain. An angiographic examination revealed the patency of the right carotid artery (70% stenosis) of all extracranial branches of the aortic arch. Arterial hypertension treated ACE-blockers. Exacerbation of other chronic diseases were not observed. In the immune status of registered hyperreactivity (immunoregulatory index TL/Twith- 2,99; C-reactive protein 12 mg/l; C5A fragment of complement and 27.3 ng/ml; C1inhibito - 464,9; ESR - 37; CEC 163 y. 1; IgG - 8,23 g/l). On the background of etiopathogenetic treatment, including trental and reopoligljukin, patients underwent a 3-week course integrated immune: psychological and physical relief, diet; Glutoxim 1% - 2 ml in 100 ml of saline intravenously daily for 7 days; discrete plasmapheresis No. 3 and 25 ml of human polyvalent immunoglobulin within 10 days daily. After treatment, the patient noted improvement of health, ischemic attack of the brain is not repeated, laboratory benchmarks were within the upper limit of normal. The patient routinely held stenting of the right common carotid artery, then continues immunorehabilitation. Within the next 4 years sick 2 times a year is cool�Dila control tests, including monografia and received 2-3 times per year immunomodulators, neuroprotectors, wobenzyme. In subsequent planned cholecystectomy without complications. At the last examination the patient's condition remains stable, there remains disabled.

Clinical example 2. Patient P., age 69. Diagnosis: Atherosclerosis. Multifocal lesion. CHD III functional class. Stable angina. Stenosis of the aortic arch branches. Chronic cerebral vascular insufficiency 2 degree by V. A. Pokrovsky. Intermittent claudication to 200 meters. Renovascular hypertension. Chronic renal failure (creatinine 140 mmol/l, urea of 12.3 mmol/l). The main complaints of angina and intermittent claudication. After further examination, including CT and angiography the possibility of coronary stenting and endarterectomy from the bifurcation of the right carotid artery. However, according to the immune status observed hyperreactivity exceeding the normal parameters of cellular immunity, complement and the CEC, the decrease in the level of IgG and phagocytosis. Sick for 4 weeks was conducted a full range of immune disorders, including the adaptation of lifestyle, immunomodulators (Glutoxim, Wobenzym, immunofan, trental), 3 sessions of discrete plasmapheresis and 10 doses VNU�revenage polyvalent human immunoglobulin. After immunocorrective complex patient noted improvement of health, reduction of angina attacks and increasing the distance of painless walking. Routinely, the patient underwent stenting of the coronary arteries and a month after that produced endarterectomy from the bifurcation of the right carotid artery. Both the surgery the patient suffered a good. Chronic renal failure remained at the same level and in another month produced stenting of the left renal artery, with the levels of nitrogen products decreased, but did not reach normal. The next 4 years, the patient was held 2-3 times a year a comprehensive examination and periodic courses immunocorrective treatment, including immunomodulators, plasmapheresis and 2 courses over the years, intravenous immunoglobulin therapy. In the past year the patient has additional occlusive-stenotic changes in the iliac arteries and developed Leriche's syndrome. However, on instrumental data the patient has diffuse lesions of the distal arterial bed of the lower extremities, which does not allow to perform reconstructive surgery on the arteries of the lower extremities. However, on the background of conservative treatment of pain at rest in the lower extremities and no distance of painless walking is maintained at 100 meters. Article�Rhone heart and brain of any changes in the patient notes. According to the controlled studies of permeability centerbanner arteries is maintained. Nitrogenous waste products at the same level.

Clinical example 3. Patient L., age 39. The diagnosis of Connective tissue dysplasia. Undifferentiated vasculitis. Occlusion of the arteries of the right tibia III stage according to Fontaine. Complaints of constant severe pain in the foot, cyanosis and erosion in the fingers of the right foot. After a comprehensive clinical and laboratory study showed diffuse arterial disease of the leg and foot on the right. Reconstructive intervention is considered impossible. Were significantly above the norm the level of erythrocyte sedimentation rate, C-reactive protein. Launched intensive conservative treatment, including reopoligljukin, trental and nicotinic acid. Gradually stoped pain in the right lower extremities, cyanosis disappeared and epithelization erosion of the toes.

Subsequently the patient made monografia and showed signs hyperresponsiveness in immune status at the cellular level, and complement the CEC, decreased phagocytosis and IgG level. The patient underwent a complex treatment, including correction of lifestyle, plazmoferez, intravenous immunoglobulin therapy and immunomodulators. The next 10 years, the patient maintained a stable condition mainly due to the right lifestyle and periodic�about receiving immunomodulators. This preserves the restriction in walking over distances of up to 500-800 meters. To 12 year period of observation, the patient appeared angina who were treated quickly enough etiotropic drugs and repeat courses integrated immune. Appeared by this time blood hypercapnia easily stoped ACE-blockers. When coronary angiography and myocardial scintigraphy marked indirect signs of microvascular lesions. Angina at follow-up did not recur. 25 years after the initial manifestations of vasculitis, the patient developed an acute attack acalculous cholecystitis, SKT was revealed 90% stenosis of the celiac trunk and in laparoscopic cholecystectomy detected ischemic necrosis of the gallbladder. Cholecystectomy was completed without features. In the immediate postoperative period on indicators of immune status was a course of immunomodulators and 15 doses of human polyvalent immunoglobulin. The patient was discharged in satisfactory condition at the usual time. Taking into account of collateral compensation stenting of the celiac trunk was decided not to perform. The patient continues an active lifestyle, using mostly adaptations of lifestyle.

Thus, using the method of complex immunocore�tion on the background of traditional etiopatogeniceskije treatment provides a sufficiently high reduction efficiency of immune and inflammatory reactions of the cardio-vascular bed and can prevent critical occlusive-stenotic and thrombohemorrhagic lesions.

The list of references

1. Pokrovsky, L. V., A. Zotikov E., Yudin B. L. Diagnosis and treatment of non-specific aorto-arteritis. M.: Iris, 2002. - 144 p.

2. Nasonov was EATING. The antiphospholipid syndrome. M: Lit-Terra. 2004. - 434 p.

3. Heart disease and blood vessels. The leadership of the European society of cardiology. TRANS. angl. / Under the editorship of E. V. Shlyakhto. - M.: GEOTAR - Media, 2011. - 1480 S.

4. Allergology and immunology. National guide / ed. by Acad. RAS and RAMS P. M. Haitov, prof.And. Ilina. - M.: GEOTAR - Media, 2012. - 634 p.

5. Nishimoto. N. Successful Tretment of a Patient with Takayasu Arteritis Using a Humanized anti-interlcukin-6 Recepter Antibody/ Arhritis Rheum. - 2008. - vol. 58. No. 4. - p. 1197-1200.

6. Torn Yoshilomi., Yukio Nagasaki. Desing and Preparation of a Nanoprobe for imaging inflammation sites. Biointerphases (2012) 7:7 D01 10.1007/s 13758-011-007-5.

Method of complex correction of immune and inflammatory reactions of the cardio-vascular bed, including the use of immunomodulator therapy and correction of the patient's lifestyle, characterized in that in patients with high levels of circulating immune complexes and/or complement perform three sessions of plasmapheresis by conventional methods, at low levels of IgG and decreased phagocytic activity of neutrophils and monocytes, as well as with a confirmed autoimmune process is carried out a course of intravenous infusion of human polyvalent immunoglobulin for General�adopted schemes.



 

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