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features of a condition of immune system at often ill children.

Pathogenetic basis of formation of group CHBD is the changed reactance of immune system in the form of the congenital or got immunodeficiency (IDS). Numerous literary data specify In it. So in a number of works it is shown, that such indicators of cellular immunity, as level T-limfotsitov and their subpopulations (CD34 - CD4 +, CD8 +), level V-limfotsitov (CD204-) and their functional activity at this group of children have been lowered in comparison with control group [32,69,73,78,]. And depression CD8 + cells was more expressed, rather than CD4 +. At the same time the share of the activated cells carrying marker HLA-Dr, according to flowing cytometry, was raised, along with the cells, carrying markers CD3+CD16 + (T-killers) and CD3-CD16 + (natural killers) [24,43,49].

Changes of parametres of humoral immunity had diverse character and, as a whole, were reduced to the following. In works [24,32,43,49] it is shown, that level IgG in group CHBD was within norm while IgM and circulating immune complexes considerably exceeded norm. At often ill children of 2-6 years concentration IgA was enlarged, and at children of 7-14 years within norm. On this background at children of group CHBD appeared IgG - antibodies in diagnostically significant caption to the most widespread originators of diseases of respiratory tracts - Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus viridans, Streptococcus pyogenes, KJebsiella pneumoniae, Klebsiella ozaenac, Staphylococcus aureus, Moraxella catarrhalis [8,24,36,41].

Microbiological researches of flora of contents of cryptás of palatine tonsils at an adenoid disease have shown obligatory presence of associations of several species of microorganisms. In particular, associations Streptococcus pyogenes and Staphilococcus aureus met in 33,1 % of cases, Streptococcus pyogenes and Staphilococcus epidermalis - in 19,3 % of cases,

Staphilococcus aureus and Streptococcus viridans - in 10,8 % of cases, Streptococcus pyogenes and Neiserii - in 9,3 % of cases, Staphilococcus aureus and Neisserii - in 7,2 % of cases, Streptococcus pyogenes and Hemophilus influenzae - in 5,3 % of cases [84]. In similar, and others, associations микрооіранизмьі each other certain properties, including and antigenic can stimulate or inhibit mutually. Last circumstance directly affects character of the Ag-specific immune answer, and also on a condition of local immunity in a lymphoid pharyngeal ring at CHBD. In this respect by working out of the new vaccines applied including and per os, it is necessary to consider «an antigenic landscape» adenoid tissue of a pharyngeal ring at chronic inflammatory diseases.

It is necessary to notice, that definition in secrets IgA and a lysozyme is the important condition of complex inspection of immune system at CHBD as the majority of researchers note at the given category of patients depression of level of the specified indicators. Some authors, in addition to it, believe, that the answer slgA (secretory IgA) the immunity system as a whole [8,36] is more sensitive to an infection, than. In this part an important role, especially at children of early age, the method of the collecting of the secret which quality essentially affects an end result plays.

Often ill children are heterogeneous io to structure group and at them not always it is possible to tap pathognomonic changes from the basic indicators of immune system. In this respect indicators of local immunity have a main role.

Definition of dynamics of these indicators important at development of tactics of an immunotherapy which effectively enough is already used in pediatrics [8, 21,32,37,40,49,87,88].

As it was mentioned above, a prevailing pathology in group CHBD is the pathology of ENTs-bodies and most practically significant is an adenoid disease and an adenoiditis. A number of works it is devoted studying of the immune status at these diseases. Reception of immunologic "profile" at a pathology limfadsnoidnogo a pharyngeal ring at the concrete patient is the important element for a correct choice of the scheme of treatment, an estimation of the forecast of disease and selection adequate immunotropnyh agents.

At an adenoid disease and adenoidits depression is ascertained sheathe populations T-limfotsitov (CD3 +), subpopulations - T-helperov (CD4 +) and T-cytotoxic lymphocytes (CD8 +), and also V-limfotsitov (CD20 +) and populations of natural killers (CD16 +). And last indicator varied both towards dropping, and towards rising [30, 43,74,75]. As to humoral immuniteza indicators of concentration of immunoglobulins of classes And, M, E and G also vary, mainly towards dropping [43,49,50]. The specified data testify that at group CHBD with chronic inflammatory diseases limfadsnoidnogo a pharyngeal ring there is a secondary immunodeficiency.

This condition associates with the changed microflora where the leading component is Streptococcus piogenes, and also Staphylococcus aureus [84]. Authors notice, that the microflora structure is diagnostically an important point in functioning of palatine tonsils as disturbance or ability loss autoflory to produce biologically active substances conducts to disturbance of a local biocenosis and can promote produtsirovaniju pathogenic microorganisms [26,84]. In these conditions after a tonsilectomy in 1-3 months positive dynamics in the maintenance of the basic populations and subnonuljatsy blood lymphocytes - initially lowered percentage and absolute maintenance EK, T - lymphocytes becomes perceptible, V-limfotsitov and \or initially raised relative maintenance T-limfotsitov comes nearer to normal value [21,25,27]. Positive dynamics of the specified parametres can serve as criterion of an estimation of efficiency tonzill - and adenoektomii.

Activity of neutrophils as component of the congenital immunity, initially lowered at the majority of patients at an adenoid disease and an adenoiditis, defined on level of the spontaneous and induced chemoluminescence, increased after tonzill-adenoektomii, reaching the top value, characteristic for control group [21, 27, 77).

As to an estimation of level of specific antibodies to representatives of an is conditional-pathogenic microflora of the top respiratory tracts in works [21,26,34,42] it is shown, that surgical sanation of the centres of a chronic infection of a lymphadenoid pharyngeal ring leads to depression of initially raised antiserum capacities to two most significant microbic antigens Haemophilus influenzae and Streptococcus pneumoniae.

Thus, changes of indicators of system immunity at CHBD can be interpreted, as a condition of the secondary immunodeficiency induced, besides other factors, a chronic persistent infection of a bacteriemic and virus parentage and demanding application adekzatnyh immunotropnyh agents at treatment of this contingent of sick children.

1.3.

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A source: Amirova Patimat Junuskadievna. The study of the immunomorphological clinical features of adenoid vegetations and palatine tonsils in frequently ill children. Thesis for the degree of candidate of medical sciences. Moscow –2006. 2006

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