Possibilities of the cellular immunity correction using intravenous laser irradiation of the blood and cytokinotherapy with roncoleukin in perioperative period while indirect revascularization done in patients with critical ischemia of the lower extremiti
Objective. To study up the possibilities of the cellular immunity correction using intravenous laser irradiation of the blood and cytokinotherapy with roncoleukin in perioperative period while indirect revascularization done in patients with critical ischemia of the lower extremities.
Materials and methods. Prospective controlled clinic-laboratory investigation was performed in 162 patients, suffering critical ischemia of the lower extremities on background of distal arterial stenosis (occlusion) and to whom indirect revascularization operations were done. Etiology of the lower extremities critical ischemia were the obliterating atherosclerosis - in 108 (66.7%) patients and obliterating thrombangiitis - in 54 (33.3%) patients. In 56 patients a Degree III was diagnosed, and in 106 patients - IV Degree of chronic ischemia. In perioperative period in 34 patients a standard treatment was performed (Group I), in 32 patients - standard treatment and intravenous laser irradiation of the blood (Group II), in 32 patients - standard treatment and cytokinotherapy with roncolekin (Group III), in 33 patients - standard treatment, intravenous laser irradiation of the blood and cytokinotherapy (Group IV), in 31 patients in a revascularized osteotrepanation with intramedullary laser irradiation - standard treatment, intravenous laser irradiation of the blood and cytokinotherapy (Group V). Parameters of cellular immunity (CD3+, CD4+, CD8+lymphocytes; ratio CD4+/CD8+) and of phagocytosis were studied in dynamics. The cellular immunity indices were compared with identical indices in 48 practically healthy persons (a reference group).
Results. While admittance to hospital in patients with critical ischemia of the lower extremities in a distal stenosis (occlusion) the abrupt change of cellular immunity was revealed towards the immune insufficiency. Inclusion of intravenous laser irradiation of the blood and of cytokinotherapy, separately or in combination, into the treatment measures complex of perioperative period in indirect revascularization have leaded towards trustworthy (p < 0.05) elimination of the cellular immunity indices. Correction of cellular immunity trustworthily depended on (p < 0.01-0.001) the treatment factor with moderate (r =0.5- 0.6) correlation. Best results were obtained while joint application of intravenous laser irradiation of the blood and cytokinotherapy in perioperative period in indirect revascularizaation, peculiarly while operation of revascularized osteotrepanation with intramedullary laser irradiation.
Conclusion. Application of intravenous laser irradiation of the blood and cytokinotherapy together with standard treatment in perioperative period while doing indirect revascularization corrects the cellular immunity trustworthily in patients, suffering critical arterial ischemia of the lower extremities, and the dynamics of these indices may be used as an objective criterion of the efficacy estimation for the therapy conducted.
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