AUTOIMMUNE AND VEGETATIVE CONDITIONALITY OF THE RECOVERY PERIOD PROLONGATION IN YOUNG PATIENTS WITH THE COMORBIDITY OF GASTROEOSPHAGEAL REFLUX DISEASE AND AUTOIMMUNE TYREOIDITIS
About the author:
Pasiieshvili T. M.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
the disease is more often registered in young people with significant mental strain. This, apparently, is associated with a certain state of the nervous system, chronic stress, lack of sufficient physical activity and the ability to alternate mental and physical exercises. Aim: to investigate the mechanisms of the recovery period prolongation and chronicity of the disease in young patients with GERD and AIT. Object and methods. 113 patients with GERD were examined. The patients were divided into two groups: 83 patients with GERD and AIT; 30 patients with isolated GERD. Groups of patients were represented by students and were identical in age, which ranged from 18 to 25 years. Results and discussion. The content of TNF-α exceeded the reference values in the main group of patients by 4.4 times and in the comparison group by 3 times against the control. The activity of IL-1β in both groups of patients was higher than normal values (6.6 and 3.8 times, respectively). This was regarded as the result of an inflammatory response to the autoimmune process in the thyroid gland and morphological changes in the esophageal mucosa. Moreover, it should be noted that the presence of an erosive form of GERD increased the content of these cytokines, which was probably the result of not only a local reaction, but also a general systemic response. The IL-18 index also increased significantly in both groups of patients. Thus, in patients with GERD and AIT, the content of IL-18 was 1761.5 (1451.7; 2876.9) pg/ml and in persons with GERD – 614.6 (521.9; 721.8) pg/ml. Such a significant discrepancy in this indicator, in our opinion, was the result of the presence of an autoimmune process in the thyroid gland, that is, a violation of the immune response. Cytokine level study in patients with GERB and AIT was repeated after 2 months. Level of IL-18 was 1014.5 (912.7; 1157.3) pg/ml at a rate of 229.4 (198.31; 269.37) pg/ml. It confirms the preservation of the autoimmune component and allowed us to state the constant tension of the immune system. The TNF-α values were 4.7 (4.1; 5.2) pg/ml; and IL-1β – 16.2 (15.1; 16.8) pg/ml. An increase in TNF-α and IL-1β in these patients may be the result of not only the involvement of the immune system with “incomplete” remission of GERD and AIT, but also the result of endothelial dysfunction as a systemic manifestation of pathology. That is, patients with GERD and AIT have conditions for chronization of the process and its progression. Among other factors of such an unfavorable “tandem”, chronic stress, high lability of the nervous, immune and endocrine systems, imbalances in the mode of work and rest, dietary problems, etc. should be identified. Conclusions. Improvement of clinical symptoms in patients with GERD and AIT does not lead to full remission of the disease; asthenic syndrome persists as a manifestation of autonomic dysfunction. Asthenic syndrome is accompanied by the preservation of increased indicators of the pro-inflammatory component of the cytokine cascade, contributes to the progression of pathology.
gastroesophageal reflux disease, autoimmune thyroiditis, asthenic syndrome, cytokines.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 143-147 pages, index UDK [616.441-002+616.29/.33-002.2-008.17]-053.6-078:57.083.3