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features of a condition of local immunity at often ill children

Local immunity of the top respiratory tracts is caused by functional activity of an adenoid tissue, assotsiirovannoj with a mucosa and is presented limfoepitelialnymi by formations of a so-called lymphoid pharyngeal ring (ring Pirogova Valdejera).

The Most expressed clumps of this limfoepitelialnoj tissues are called as tonsils. In a drink there are four basic tonsils are steam rooms palatal, or zevnye, (tonsillae palatinae), individual pharyngeal, or nasopharyngeal, (tonsilla pharyngea), lingual (tonsilla lingualis), and also less large clumps limfoepitelialnoj tissues nearby ustev Eustachian tubes - didymous tubarnye tonsils (tonsillae tubaria). Between tonsils there is the diffusive adenoid tissue localised in a mucosa drinks [62,70,71].

In a context of a theme of the present work it is necessary to present in brief features histological and immunomorfologicheskogo structures of the specified formations reflected in a number fundametalnyh of works. First of all we will notice, that gistogeneticheski and immunomorfologicheski all this tissue has a uniform principle of the organisation According to modern data, the sample structure palatal and a pharyngeal tonsil assumes presence of the follicular V-dependent zone occupying 1\3 all surface of adenoid tissue and an interfollicular T-dependent zone, making the others 2\3 the areas. The V-dependent zone is presented by lymphatic nodules - primary and secondary lymphatic follicles. In the last there is intensive an antigen (AG) - spsnificheskaja a proliferation and differentiation V-limfotsitov and plasmocytes. The T-dependent zone is formed by the diffusive adenoid tissue surrounding numerous veins with a high endothelium, through which lymphocytes, by means of ligand-RECEPTOR adhesive interactions, from haemocirculation arrive in a tonsil tissue, moving in a direction mantijnoj zones of follicles and a cover epithelium. For this reason at this zone always there is quantity V-limfotsitov [7,18,19,13,14,58,66,70,71].

Some authors in structure palatal, and also a pharyngeal tonsil allocate special morfofunktsionalnuju unit - kripolimfon [13,14,19,70,71]. Last represents a lumen of a cryptá of tonsils with its epithelial vystilkoj, infiltrirovannoj lymphocytes, and also the primary and secondary lymphoid nodules bound to a lumen of a cryptá. But there are certain differences of a pharyngeal tonsil from the palatal. In particular, mnogorjadnyj a ciliary epithelium of a pharyngeal tonsil forms superficial immersings - lacunas (a certain analogue of cryptás in palatine tonsils), the dividing organ on a number of upright going platens of an adenoid tissue which expands at a chronic inflammation (adsnoidity) and is called as adenoid vegetations, or adenoides. This tissue, along with a tissue of palatine tonsils, was the basic object of research in group CHBD in the present work. According to separate authors, by the birth moment a small part of a surface of this tonsil vystlana a multilayered flat epithelium [58,66,70,71,89]. On a share of an epithelial integument 2-4 % of the area of a preparation of a tonsil are necessary on the average.

Unlike lymph nodes palatal and pharyngeal tonsils have no closed capsule with eisodic lymphatic vessels and a through current of a lymph. This limfoepitelialnaja a tissue is stimulated with the antigens arriving immediately through a cover epithelium, providing lymphopoietic function and the Ag-specific immune answer.

This fact confirms tesnejshuju functional communication between an epithelium, Ag-prezentirujushchimi cells and lymphocytes Secondary follicles of a tissue are structure where there is an Ag-specific clonal proliferation of lymphocytes [12,13].

Free (zevnaja) a surface of palatine tonsils vystlana a multilayered flat epithelium, and the mucosa in the field of a pharyngeal tonsil, on a surface of cords and in depth krip t is covered by a ciliary epithelium which in separate places is replaced flat or cubic. Replacement of a ciliary epithelium by flat or cubic one authors survey as physiological process, others treat as a metaplasia of a ciliary epithelium as a result of inflammatory process [14,18,19,70,71].

This part limfoepitelialnoj to a tissue is exposed to an intensive antigenic load. And in this respect there is one more feature morfofunktsionalnoj the ring organisations Pirogova - Valdejra. It is a question of a phenomenon limfoepitelialnogo symbiosis.

One of the main physiological characteristics of tonsils is ability of lymphocytes to migrate in an epithelium of cryptás and lacunas, owing to close contact of lymphoid elements to an epithelium. This phenomenon described still in XIX century, wears the name retikuljatsii an epithelium, or, that is more more exact, limfoepitelialnogo symbiosis (LES) [13,62,70,71].

Now this zone is surveyed, as a zone of presentation arriving aerogenic by antigens, a zone of the intercellular cooperation providing the Ag-specific immune answer, and also a zone of regulation of these processes [14,18,19]. In this zone the special cells specialised superficial M - of a cell possessing ability to grasp, process and represent AG in the course of an induction of the Ag-specific immune answer [70,71,96,123,124,186] are identified.

M-cages gistogeneticheski are related to dendritic cells (recreation centre), being Ag-representing and playing a key role in the immune answer of an organism at infectious, autoimmune diseases, and also in an induction of antitumoral immunity L27J. Besides, process retikuljatsii an epithelium with the subsequent formation of reticular epitheliocytes and the estimation of their functional activity allows to carry also this class of cells to Ag - representing, and zones limfoepitelialnogo symbiosis - in quality immunoreguljatornogo kompartmenta tonsils [19,58,66].

Rstikuljatsija an epithelium it is most full studied in palatine tonsils where it is constantly observed at level of cryptás, and in pathological conditions - at level free zevnoj surfaces. This process is observed in the period of embryonal development. Penetration of lymphocytes into a multilayered epithelium of cryptás is accompanied razryhleniem an epithelial layer, epitheliocytes disperse and become otroschatymi, forming petlistuju a network in which cells there are groups of lymphocytes.

The described process has the direct relation to formation functionally active immunoreguljatornoj zones. Retikuljatsija an epithelium it is observed not only in cryptás of palatine tonsils, but also in all tonsils of a pharyngeal ring, including, naturally, pharyngeal tonsil and adenoid vegetations [14,70,71].

The general pathomorphologic picture limfoepitelialnoj tissues (adenoid vegetations) at chronic inflammatory diseases at CHBD is studied in detail enough and, according to modern literary data, essentially develops of three principal views of changes is a current inflammatory process, the immune answer of an adenoid tissue and organ reorganisation in connection with transferred earlier inflammatory and immune reactions [13,14,18,19,43,47,89].

Current inflammatory process is shown by a hyperemia and an edema of own plate, an exit in a tissue from vessels of the neutrophils, the raised secretion of a ciliary epithelium, transformation of ciliary cells in goblet, an epithelium exfoliating, a denudation of a basal membrane and formation of erosions.

The immune answer was shown by a reactive hyperplasia

Lymphatic follicles with formation of the light centres (secondary follicles), occurrence in these centres of macrophages, occurrence young plazmotsitarnyh cells, their migration through mantijnuju a zone of a follicle and accumulation of plasmocytes in subepitslialnoj and a parafollicular zone. In more details these phenomena are described in the following part of the present review. As a whole the given processes, from the point of view of immunohistochemical characteristics, are studied insufficiently.

Postinflammatory changes are shown by a metaplasia

mnogorjadnogo a ciliary epithelium in mnogorjadnyj flat, including and keratosic, augmentation of sclerotic changes of a stroma, a thickening of walls iostkapilljarnyh venules, development of a perivascular sclerosis, augmentation of quantity of mast cells [13,18,19,20,62,89].

And, the general paggomorfologija has been studied, both in operational, and in a biopsy material.

It is known, that in antibacterial protection in a lymphoid pharyngeal ring the great value has ' a condition nsspstsificheskoj the resistance presented by activity laktoferrina, lizosomalnyh enzymes, IgG and slgA, and also a saliva lysozyme. At acute inflammatory processes (adenoid disease), including and a virus aetiology, the authentic augmentation of "covering" is defined

Microorganisms a lysozyme and laktoferrinom. Last circumstance considerably strengthened efficiency of local immunity, in particular, for the account opsonizirovannogo a phagocytosis. However, the sorption slgA and IgG on a surface of microorganisms has been authentically lowered, that, in turn, reduced efficiency of local anti-infectious immunity [179]. Thus, there is a dynamic interaction and change of components nespetsifichsskoj resistances at infectious process in a lymphoid pharyngeal ring. Naturally, efficiency of medical and preventive actions at CHBD depends on concrete parametres of the described events.

In a tissue of adenoid vegetations, using vysokospetsifichnyj a method polimeraznoj chain reaction, authors have found presence of genetic material Chlamydia pneumoniae [119,158]. These data confirm a possible etiological role of these, enough widespread intracellular infectious agents, in an induction of inflammatory process in a lymphoid pharyngeal ring.

Thus, and in system of local immunity at CHBD there are authentic changes which can be interpreted as a local immunodeficiency. Certainly, formation of a local immunodeficiency at CHBD also demands its correction with application immunotropnyh agents.

The described picture is accompanied by respective alterations immunomorfologicheskih parametres of adenoid vegetations and the palatine tonsils causing a functional condition of local immunity.

1.4.

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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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