Reactive response of peripheral blood polymorphonuclear neutrophils of patients to acute pancreatitis depending on genesis

S.І. Ivashchuk

Abstract


The reactive response of peripheral blood polymorphonuclear neutrophils of patients to acute pancreatitis by different etiological factors remains not fully understood.
Objective. To investigate the system relationship of the parameters of the reactive response of peripheral blood polymorphonuclear neutrophils and indicators of systemic inflammatory response and protection, taking into account the etiological factor in patients with acute pancreatitis.
Materials and Methods. The study involved 189 patients, among them were 45 (23.8%) women, 144 (76.2%) men, aged 23 to 77 years. All the patients had edematous form of acute pancreatitis. The control group consisted of 37 healthy individuals. The reactive response of neutrophilic granulocytes of patients with acute pancreatitis was assessed by the index of reactive response of neutrophilic polymorphonuclear leukocytes, neutrophil-lymphocyte ratio, the shift index of neutrophils and leukocytes, lymphocyte-granulocyte index, the correlation index of neutrophils and monocytes, leukocyte and lymphocytic index, the general indicator of the correlation of the absolute quantity of leukocytes and erythrocytes sedimentation rate.
Results and Discussion. The formation and course of acute pancreatitis is accompanied by the increase in 7,56 times of the reactive response of neutrophilic granulocytes, with the evident activation of innate factors and anti-infective defense mechanisms and their advantages over adaptive specific immunity. The formation, development and progress of alcoholic acute pancreatitis is accompanied by the evident (in 5,05 times) activation of the reactivity of peripheral blood neutrophilic granulocytes. In patients with alcoholic acute pancreatitis the value of neutrophil-lymphocyte ratio significantly increases (in 3,10 times), indicating a significant advantage in the initial stage of alcoholic acute pancreatitis nonspecific protection by activation of neutrophilic granulocytes, by contrast, «professional» immunocompetent lymphocytes in this period show no activity and their concentration in peripheral blood is not changing. The significant increase (in 3,28 times) of the correlation index of neutrophils and monocytes indicates the evident activation of the microphage system of anti-infective defense compared to the activity of macrophage defense system.
In patients with alcoholic acute pancreatitis the reactive response of neutrophils reduced in 95,29% compared with that to biliary one. Cellular anti-infective defense in patients with biliary acute pancreatitis is caused mainly by monocytes/macrophages, whereas for alcoholic pancreatitis the microphage system is prevalent. The vacuolization of peripheral blood neutrophils cytoplasm was observed in 9 (12,5%) patients with biliary acute pancreatitis and was not detected in alcoholic pancreatitis. The neutrophils toxigenic granularity was observed in 36 (30,77%) patients with alcoholic acute pancreatitis and in 54 (75%) patients with the biliary one.
Conclusions. 1. The elevated intoxication (medium severity) minimizes the functional stimulated activity of factors and mechanisms of non-specific anti-infective defense of the organism of patients with acute pancreatitis: the suppressive effect of intoxication on the overall level of non-specific resistance of the patients organism generally decreases in 90,58%.
2. In patients with alcoholic acute pancreatitis the nonspecific resistance index decrease in 2,53 times is due to the intoxication of organism mainly by the infectious and to a lesser extent, by the autoimmune process and alcohol.
3. The patients intoxication with biliary acute pancreatitis is accompanied by the limiting of the functional activity of non-specific factors and mechanisms of innate and acquired immune specific immune defense of patients, the reduction of the index of nonspecific resistance of the organism in 47,72%.
4. The peripheral blood neutrophilic granulocytes reactive response and their toxigenic grain is more pronounced in the patients with biliary acute pancreatitis than in the patients with the alcoholic one. The cytoplasm vacuolization of neutrophilic granulocytes takes place exclusively in patients with biliary acute pancreatitis confirming the stronger organism intoxication of this genesis.


Keywords


pancreatitis; alcoholic; biliary; neutrophilic granulocytes

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DOI: https://doi.org/10.22141/1997-2938.3-4.26-27.2014.83209

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