persmedРоссийский журнал персонализированной медициныRussian Journal for Personalized Medicine2782-38062782-3814ФОНД АЛМАЗОВА10.18705/2782-3806-2022-2-1-93-103persmed-33Research ArticleОБЗОРЫREVIEWERSОсобенности ведения больных саркоидозом с аутоиммунным характером воспаленияFeatures of management of sarcoidosis patients with autoimmune inflammationЗинченкоЮ. С.ZinchenkoY. S.

Зинченко Юлия Сергеевна, кандидат медицинских наук, младший научный сотрудник, врач-пульмонолог

Cанкт-Петербург

Zinchenko Yulia S., MD, PhD Junior researcher, pulmonologist, St. Petersburg Scientific Research Institute of Phthisiopulmonology Ministry of Health of the Russian Federation

Saint Petersburg

СтаршиноваА. А.StarshinovaA. A.

Старшинова Анна Андреевна, доктор медицинских наук, профессор кафедры факультетской терапии, начальник Управления научными исследованиями

ул. Аккуратова, д. 2; Cанкт-Петербург, 197341

Starshinova Anna A., DMedSci, MD, PhD, Prof. Head of the Research Department

Akkuratova str. 2, Saint Petersburg, 197341

starshinova_777@mail.ruМалковаА. М.MalkovaA. M.

Малкова Анна Михайловна, младший научный сотрудник лаборатории мозаики аутоиммунитета

Cанкт-Петербург

Malkova Anna M., Junior Researcher, Laboratory of the Mosaic of Autoimmunity

Saint Petersburg

КудрявцевИ. В.KudryavtsevI. V.

Кудрявцев Игорь Владимирович, кандидат биологических наук, ведущий научный сотрудник ФГБНУ «Институт экспериментальной медицины», Школы биомедицины Дальневосточного федерального университета

Cанкт-Петербург,

Владивосток

Kudryavtsev Igor V., PhD. Senior Researcher, Department of Immunology, Institute of Experimental Medicine; School of Biomedicine, Far Eastern Federal University

Saint Petersburg,

Vladivostok

ЯблонскийП. К.YablonskiyP. K.

Яблонский Петр Казимирович, доктор медицинских наук, профессор, проректор по медицинской деятельности ФГБОУ ВО «СПбГУ», директор ФГБУ «СПб НИИФ» Минздрава России

Cанкт-Петербург

Yablonskiy Piotr K, Prof., PhD, MD, Vice-Rector for Medical Activities, St. Petersburg State University. Head, St. Petersburg Scientific Research Institute of Phthisiopulmonology Ministry of Health of the Russian Federation

Saint Petersburg

Федеральное государственное бюджетное учреждение «Санкт-Петербургский научноисследовательский институт фтизиопульмонологии» Министерства здравоохранения Российской ФедерацииРоссияSaint Petersburg Scientific Research Institute of PhthisiopulmonologyRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian FederationФедеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияSaint Petersburg State UniversityRussian FederationФедеральное государственное бюджетное научное учреждение «Институт экспериментальной медицины»; Школа биомедицины Дальневосточного федерального университетаРоссияInstitute of Experimental Medicine; School of Biomedicine of the Far Eastern Federal UniversityRussian FederationФедеральное государственное бюджетное учреждение «Санкт-Петербургский научноисследовательский институт фтизиопульмонологии» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияSaint Petersburg Scientific Research Institute of Phthisiopulmonology; Saint Petersburg State UniversityRussian Federation2022050420222193103Copyright © Зинченко Ю.С., Старшинова А.А., Малкова А.М., Кудрявцев И.В., Яблонский П.К., 20222022Зинченко Ю.С., Старшинова А.А., Малкова А.М., Кудрявцев И.В., Яблонский П.К.Zinchenko Y.S., Starshinova A.A., Malkova A.M., Kudryavtsev I.V., Yablonskiy P.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://persmed.elpub.ru/jour/article/view/33Актуальность

Актуальность: в настоящее время все больше привлекает внимание теория об аутоиммунной природе саркоидоза. Однако не определены четкие критерии аутоиммунного воспаления при данном гранулематозном заболевании, которые позволяют определить тактику ведения пациентов с саркоидозом легких.

Материалы и методы

Материалы и методы: В 2017–2019 годах проведено проспективное сравнительное исследование с включением 187 человек: I группа (n = 114) — пациенты с саркоидозом легких; группа контроля — здоровые лица (n = 73). Триггеры были выявлены по опроснику «Аутоиммунный синдром, индуцированный адъювантами». Аутоантитела в крови определялись с применением иммуноферментного анализа. В-лимфоциты периферической крови были исследованы с применением проточной цитофлуометрии. Статистический анализ проведен с использованием Statistica 10.0 методами параметрической и непараметрической статистики, различия или показатели связи считались значимыми при р ≤ 0,05.

Результаты исследования

Результаты исследования: на основании полученных данных были выявлены триггеры, которые достоверно часто выявлялись у больных с характерной для аутоиммунного процесса симптоматикой (88,5 % против 50,0 %, p = 0,042). Антитела к модифицированному цитруллинированному виментину (а-MCV) определялись в два раза чаще, чем в группе контроля (40,9 % и 25,0 % соответственно). Диагностически значимо было повышение уровня В-клеток CD5+CD27— более 12,45 % и изменение соотношения «наивных» В-клеток к клеткам памяти — более 2:1.

Выводы

Выводы: критериями аутоиммунного воспаления у больных саркоидозом является повышение уровня анти-MCV более 10 Ед/мл и уровня CD5+CD27 — более 12,45 % при изменении соотношения «наивных» В-клеток к клеткам памяти в соотношении 2:1. Данный комплекс имеет высокую диагностическую чувствительность (91,0 %) и специфичность (88,0 %).

 

 

Introduction

Introduction: Currently, the theory of the autoimmune nature of sarcoidosis is increasingly attracting attention. However, there are no clear criteria for autoimmune inflammation in this granulomatous disease, which makes it possible to determine the management tactics of patients with pulmonary sarcoidosis.

Materials and methods

Materials and methods: In 2017–2019 a prospective comparative study was conducted with the inclusion of 187 people: group I (n = 114) — patients with pulmonary sarcoidosis; control group — healthy individuals (n = 73). Triggers were identified according to the questionnaire “Autoimmune syndrome induced by adjuvants”. Autoantibody levels in the blood were determined using enzyme immunoassay. Peripheral blood B-lymphocytes were examined using flow cytofluorometry. Statistical analysis was carried out using Statistica 10.0 by parametric and nonparametric statistical methods, differences or correlation indicators were considered significant at p ≤ 0.05.

Results of the study

Results of the study: triggers were significantly often detected in patients with the symptoms of the autoimmune process (88.5 % vs. 50.0 %, p = 0.042). Antibodies to modified citrullinated vimentin (a-MCV) were detected twice as often as in the control group (40.9 % and 25.0%, respectively). The increase in the level of CD5+CD27 B cells — more than 12.45 % and a change in the ratio of “naive” B cells to memory cells of more than 2:1 were diagnostically significant.

Conclusion

Conclusion: The criteria for autoimmune inflammation in patients with sarcoidosis is an increase in the level of anti-MCV more than 10 units / ml and the level of CD5+CD27— more than 12.45 % with a change in the ratio of “naive” B cells to memory cells in a ratio of 2:1. This complex has a high diagnostic sensitivity (91.0 %) and specificity (88.0 %).

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The authors declare that there are no conflicts of interest present.