THE STATE OF THE MUCOSAL IMMUNITY OF THE ROGENITAL TRACT IN PATIENTS WITH VARIOUS VARIANTS OF CLINICAL COURSE OF ACUTE UNCOMPLICATED PYELONEPHRITIS

The purpose of the work was to investigate the state of mucosal immunity of the urinary and genital tract in patients with acute uncomplicated pyelonephritis (AUP), depending on the severity of the disease. Methods. 124 women with AUP and with concomitant chronic inflammatory diseases of the pelvic organs (CIDPO) and 23 clinically healthy women were examined. To assess the clinical picture of AUP was used a division into 3 variants of the clinical course (VCC): mild (n = 105), moderate severity (n = 90) and severe (n = 51). Humoral indicators of mucosal immunity were determined in 64 urine samples and 121 vaginal washings by enzymelinked immunosorbent assay. The levels of immunoglobulins (Ig) A, M, G, secretory IgA (sIgA), lactoferrin (LF) myeloperoxidase (MPO) and lysozyme, C3-component of complement (C3), secretory component, tumor necrosis factor-α (TNF-α) were determined. The concentration of β -defensin-2 was determined in vaginal washings, and the levels of interleukins 10 and 15 – in urine. Results. A significant increase of the concentration of C3, LF, lysozyme, MPO, sIgA, and TNF-α relative to their reference values was found in the urine of patients with different variants of clinical course of AUP. The smallest median values for LF, lysozyme and MPO were recorded in patients with severe VCC AUP. An increase of TNF-α level was more characteristic for patients with moderate severity and severe VCT. The highest increase of IgA, IgM, IgG levels was found in patients with mild VCT. Significantly elevated levels of MPO, IgA, IgG and TNF-α were detected in vaginal washings in women of all groups relative to reference indicators. The highest (p<0.05) increase in the level of non-specific immunity factors (lysozyme and MPO) was observed in vaginal washings in patients with severe VCT, and specific (IgA, IgM and IgG) – in patients with mild VCT. Conclusions. In patients with various clinical course of AUP, a significant increase of the humoral factors of nonspecific and specific immunity and cytokines in urine was established relative to reference indicators; to a lesser extent for non-specific indicators of immunity and to a greater extent for TNF-α in patients with severe VCT. Concomitant CIDPO contributed to the greatest increase in washings of MPO and lysozyme levels in patients with severe VCT, and the level of immunoglobulins of all classes – in patients with mild.