ppharmПедиатрическая фармакологияPediatric pharmacology1727-57762500-3089Издательство «ПедиатрЪ»10.15690/pf.v22i5.2961ppharm-2696Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLESКлинико-иммунологические параметры воспаления у детей с иммуновоспалительными заболеваниями, ассоциированными с патологией верхних дыхательных путей (на примере псориаза и воспалительных заболеваний кишечника, первые результаты исследования)Features of Upper Respiratory Tract Inflammation Phenotypes in Children with Various Skin, Respiratory, and Gastrointestinal Diseases (Preliminary Research Results)https://orcid.org/0000-0001-7649-5933ГубановаС. Г.GubanovaSvetlana G.

Губанова Светлана Геннадьевна, к.м.н., ведущий научный сотрудник

113999, г. Москва, ул. Фотиевой, д. 10, стр. 1, телефон: +7 (499) 400-47-33

Svetlana G. Gubanova, MD, PhD

10, Fotievoy Str., building 1, Moscow, 113999, телефон: +7 (499) 400-47-33

svetlanagub@gmail.comhttps://orcid.org/0000-0002-3697-4283СурковА. Н.SurkovAndrey N.

Сурков Андрей Николаевич, д.м.н., профессор

Москва

Andrey N. Surkov, MD, PhD, Professor

Moscow

dr_sura@mail.ruhttps://orcid.org/0000-0001-6158-9064ЗеленковаИ. В.ZelenkovaIrina V.

Зеленкова Ирина Валерьевна, к.м.н.

Москва

Irina V. Zelenkova, MD, PhD

Moscow

izelen@mail.ruhttps://orcid.org/0000-0002-2209-7531Намазова-БарановаЛ. С.Namazova-BaranovaLeyla S.

Намазова-Баранова Лейла Сеймуровна, д.м.н., профессор, академик РАН

Москва

Шэньчжэнь

Leyla S. Namazova-Baranova, MD, PhD, Professor, Academician of the RAS

Moscow

Shenzhen

leyla.s.namazova@gmail.comhttps://orcid.org/0000-0003-4962-6998ГанковскийВ. А.GankovskiiViktor A.

Ганковский Виктор Анатольевич, к.м.н.

Москва

Viktor A. Gankovskii, MD, PhD

Moscow

s.slon2012@yandex.ruhttps://orcid.org/0000-0003-4891-9959АлешенкоН. Л.AleshenkoNatalia L.

Алешенко Наталья Леонидовна

Москва

Natalia L. Aleshenko, MD

Moscow

nl.aleshenko@gmail.comhttps://orcid.org/0000-0002-8936-3590КайтуковаЕ. В.KaytukovaElena V.

Кайтукова Елена Владимировна, к.м.н.

Москва

Elena V. Kaytukova, MD, PhD

Moscow

sunrise_ok@mail.ruhttps://orcid.org/0000-0001-7398-0562ВишневаЕ. А.VishnevaElena A.

Вишнева Елена Александровна, д.м.н., профессор

Москва

Elena A. Vishneva, MD, PhD, Professor

Moscow

vishneva.e@yandex.ruhttps://orcid.org/0000-0002-6034-8231МатерикинА. И.MaterikinAleksander I.

Материкин Александр Игоревич, к.м.н.

Москва

Alexandr I. Materikin, MD, PhD

Moscow

al_m86@bk.ruhttps://orcid.org/0000-0002-6760-3119ИванчиковВ. В.IvanchikovVladislav V.

Иванчиков Владислав Владимирович

Москва

Vladislav V. Ivanchikov, MD

Moscow

awdawd22@yandex.ruhttps://orcid.org/0000-0001-5549-857XБессоновЕ. Е.BessonovEvgenij E.

Бессонов Евгений Евгеньевич

Москва

Evgenij E. Bessonov, MD

Moscow

dryss@inbox.ruhttps://orcid.org/0000-0001-6781-9318ИпатоваА. А.IpatovaAnna A.

Ипатова Анна Алексеевна

Москва

Anna A. Ipatova, MD

Moscow

ane4ka-ipatova@mail.ruhttps://orcid.org/0009-0008-0449-2053ФатуллаевС. Т.FatullaevSadig T.

Фатуллаев Садиг Талех Оглы

Москва

Sadig T. Fatullaev, MD

Moscow

dr.sadig@gastrockb.ruhttps://orcid.org/0009-0004-1751-1293ГетмановС. Д.GetmanovStanislav D.

Гетманов Станислав Дмитриевич

Москва

Stanislav D. Getmanov, MD

Moscow

stas.getmanoff@yandex.ruhttps://orcid.org/0000-0001-6000-5418КомароваЕ. В.KomarovaElena V.

Комарова Елена Владимировна

Москва

Elena V. Komarova, MD, PhD

Moscow

dr.klv-27@rambler.ruhttps://orcid.org/0000-0002-4669-9510ИвардаваМ. И.IvardavaMarika I.

Ивардава Марика Индикоевна

Москва

Marika I. Ivardava, MD, PhD

Moscow

makussa@mail.ruНИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»РоссияPediatrics and Child Health Research Institute in Petrovsky National Research Centre of SurgeryRussian FederationНИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»; Российский национальный исследовательский медицинский университет им. Н.И. Пирогова (Пироговский Университет)РоссияPediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical UniversityRussian FederationНИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»; Российский национальный исследовательский медицинский университет им. Н.И. Пирогова (Пироговский Университет); Университет МГУ-ППИ в ШэньчжэнеРоссияPediatrics and Child Health Research Institute in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University; Shenzhen MSU-BIT UniversityRussian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова (Пироговский Университет)РоссияPirogov Russian National Research Medical UniversityRussian Federation202505122025225553566Copyright © Губанова С.Г., Сурков А.Н., Зеленкова И.В., Намазова-Баранова Л.С., Ганковский В.А., Алешенко Н.Л., Кайтукова Е.В., Вишнева Е.А., Материкин А.И., Иванчиков В.В., Бессонов Е.Е., Ипатова А.А., Фатуллаев С.Т., Гетманов С.Д., Комарова Е.В., Ивардава М.И., 20252025Губанова С.Г., Сурков А.Н., Зеленкова И.В., Намазова-Баранова Л.С., Ганковский В.А., Алешенко Н.Л., Кайтукова Е.В., Вишнева Е.А., Материкин А.И., Иванчиков В.В., Бессонов Е.Е., Ипатова А.А., Фатуллаев С.Т., Гетманов С.Д., Комарова Е.В., Ивардава М.И.Gubanova S.G., Surkov A.N., Zelenkova I.V., Namazova-Baranova L.S., Gankovskii V.A., Aleshenko N.L., Kaytukova E.V., Vishneva E.A., Materikin A.I., Ivanchikov V.V., Bessonov E.E., Ipatova A.A., Fatullaev S.T., Getmanov S.D., Komarova E.V., Ivardava M.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pedpharma.ru/jour/article/view/2696

Обоснование. Ведение пациентов с мультифакторными иммуновоспалительными заболеваниями (воспалительные заболевания кишечника (ВЗК), хронические дерматозы) на современном этапе невозможно без учета клинических и биологических фенотипов болезни. Для разработки оптимального контроля над патологическим процессом необходимо изучение факторов, влияющих на манифестацию, течение и рецидивы заболеваний. Кроме этого, требуется понимание фенотипических клинико-иммунологических параметров воспаления, зависящих от основного патологического процесса, терапии и состояния других вовлеченных в основной патологический процесс органов и систем, в том числе верхних дыхательных путей. Цель исследования — определить основные фенотипические клиникоиммунологические параметры воспаления у пациентов детского возраста с иммуновоспалительными заболеваниями, ассоциированными с патологией верхних дыхательных путей (на примере псориаза и ВЗК). Методы. В исследование включены 60 детей: по 20 пациентов с псориазом и воспалительными заболеваниями кишечника (ВЗК), а также 20 пациентов группы сравнения (условно здоровые дети) в возрасте от 6 лет до 17 лет 11 мес. Все пациенты исследуемых групп консультированы педиатром, оториноларингологом, сурдологом, а также аллергологом-иммунологом (по показаниям). Пациенты с псориазом осмотрены дерматовенерологом, дети с ВЗК — гастроэнтерологом. Инструментальные методы обследования включали: эндоскопию полости носа и носоглотки, отоскопию, тимпанометрию, тональную пороговую аудиометрию. Лабораторные методы исследования: клинический анализ крови, определение уровней АСЛ-О, IL-1α, IL-1β, IL-6, IL-7, IL-8, IL-10, IL-12, IL-15, IL-17, IL-18, IL-19, IL-20, IL-23, TNF-α в сыворотке крови; определение сывороточных белков MDC/CCL22 и TLSP/калликреина в сыворотке крови. Всем пациентам целевых групп выполнялись экспресс-тест кала на Helicobacter pylori и микробиологические исследования (микологическое исследование отделяемого из ротоглотки на грибы рода Candida albicans; бактериологическое исследование отделяемого носоглотки на наличие Staphylococcus aureus; исследование микробиоты кишечника). Результаты. Полученные данные позволяют выделить ведущую сопутствующую патологию верхних дыхательных путей в обеих исследуемых группах — хронический тонзиллит. Анализ состава кишечной микробиоты выявил дисбаланс комменсалов и патобионтов как у детей с ВЗК, так и у пациентов с псориазом. Иммунологически наличие хронического тонзиллита у детей с ВЗК сопровождалось повышением уровней IL-23 и MDC/CCL22, у пациентов с псориазом — IL-18 (p < 0,05). Еще одна выявленная для детей с псориазом ассоциация — с аллергическим ринитом — также характеризовалась значимым повышением IL-18 (p < 0,05). Иммунофенотип пациентов с ВЗК демонстрировал повышение IL-23 (p < 0,05), детей с псориазом — повышение IL-18 (p < 0,05). Заключение. На данном этапе исследования получены первичные клинико-иммунологические маркеры фенотипов воспаления у детей с иммуновоспалительными заболеваниями (на примере псориаза и ВЗК), показана их взаимосвязь с патологией верхних дыхательных путей. В настоящий момент исследование продолжается; результаты работы позволят усовершенствовать принципы ведения детей с иммуновоспалительной патологией.

Background. The management of patients with multifactorial autoimmune diseases (inflammatory bowel diseases (IBD) and chronic dermatoses) is currently impossible without taking into account the clinical and biological phenotypes of the disease. To develop optimal disease control, it is necessary to study the factors that influence the manifestation, course, and relapse of the diseases. In addition, it is required to understand the phenotypic clinical and immunological parameters of inflammation, which depend on the underlying pathological process, the therapy, and the condition of other organs and systems involved in the underlying pathological process, including the upper respiratory tract. The aim of the study was to determine the main phenotypic clinical and immunological parameters of inflammation in pediatric patients with immune-inflammatory diseases associated with upper respiratory tract pathology (using psoriasis and IBD as an example). Methods. The study included 60 children: 20 patients with psoriasis and 20 children IBD, as well as 20 patients in the control group (conditionally healthy children) aged 6 years to 17 years 11 months. All patients in the study groups were consulted by a pediatrician, an otolaryngologist, an audiologist, and an allergist (if indicated). Patients with psoriasis were examined by a dermatologist, and children with IBD were examined by a gastroenterologist. Instrumental examination methods included nasal and nasopharyngeal endoscopy, otoscopy, tympanometry, and tonal threshold audiometry. Laboratory methods of research: clinical blood test, determination of antistreptolysin O, IL-1α, IL-1β, IL-6, IL-7, IL-8, IL-10, IL-12, IL-15, IL-17, IL-18, IL-19, IL-20, IL-23, and TNF-α levels in blood serum; determination of serum proteins (MDC/CCL22) and TLSP/kallikrein in blood serum. All patients in the target groups underwent rapid fecal testing for Helicobacter pylori and microbiological studies (mycological examination of oropharyngeal discharge for Candida albicans fungi; bacteriological examination of nasopharyngeal discharge for Staphylococcus aureus; and examination of intestinal microbiocenosis). Results. The obtained data allow us to identify the leading comorbid pathology of the upper respiratory tract in both study groups was chronic tonsillitis. Analysis of the intestinal microbiota composition revealed an imbalance of commensals and pathobionts in both children with IBD and patients with psoriasis. Immunologically, the presence of chronic tonsillitis in children with IBD was accompanied by increased levels of IL-23 and MDC/CCL22, while in patients with psoriasis it was accompanied by increased levels of IL-18 (p < 0.05). Another association identified for children with psoriasis — with allergic rhinitis — was also characterized by a significant increase in IL-18 (p < 0.05). The immunophenotype of IBD patients demonstrated an increase in IL-23 (p < 0.05), while in children with psoriasis, an increase in IL-18 (p < 0.05). Conclusion. At this stage of the study, the primary clinical and immunological markers of inflammation phenotypes in children with autoimmune diseases (using the example of psoriasis and IBD) and their relationship with the presence of comorbid pathology of the upper respiratory tract have been obtained. The study is currently ongoing; the results of this work will help improve the principles of managing children with immune-inflammatory pathology.

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