The influence of rehabilitation and prophylactic complex on the state of the immune system in children with recurrent respiratory pathology against the background of gastroesophageal reflux disease
Authors:   Bogomolets National Medical University, Kyiv, Ukraine, Pochynok T.V. , Stamboli L.V. ,   SI «Institute of Pediatrics, Obstetrics and Gynecology named of academician O.M. Lukyanova NAMS of Ukraine», Kyiv, P’iankova O.V. ,   Children's Clinical Hospital No. 1, Kyiv Podilskyi Raion, Ukraine, Zhuravel O.V. ,   Bogomolets National Medical University, Kyiv, Ukraine, Slipachuk L.V. ,   Bogomolets National Medical University, Kyiv, Ukraine, Voronina C.S. ,   Children's Clinical Hospital No. 1, Kyiv Podilskyi Raion, Ukraine, Hur’ieva O.B. ,   Children's Clinical Hospital No. 1, Kyiv Podilskyi Raion, Ukraine
Published: December 2020

The aim is to analyze the results of the use of a rehabilitation and prophylactic complex in children with recurrent respiratory pathology (RRP) against the background of stage 2 gastroesophageal reflux disease (GERD) to prevent the risk of developing respiratory diseases. Materials and methods. 120 children of puberty from 10 to 16 years old were examined, the average age was 13.1±2.5 years (90 children with RRP 6–8 times a year and GERD stage 2, 30 practically healthy children). Children with RRP and stage 2 GERD were randomized into three groups: group 1 (30 people) received basic GERD therapy in accordance with the generally accepted protocol by order of the Ministry of Health of Ukraine dated 20.01.2013 No. 59; group 2 (30 people) received basic therapy and rehabilitation and prophylactic complex, which included natural drug «Immunal» (1 pill 3 times/day for 30 days), essential nutrients «Smart-Omega» (1 capsule 2 times/day for 30 days) and fat-soluble preparation of vitamin D3 (cholecalciferol) 8 drops (4000 IU) 1 time/day for 30 days; Group 3 (30 people) received basic therapy and rehabilitation and prophylactic complex, which included homeopathic preparation Mucosa Compositum (1 ampoule 2.2 ml peros 2 times a week for 5 weeks), Smart-Omega and fat-soluble vitamin preparation D3 at the above mentioned dose. Group 4 (control) consisted of 30 practically healthy children. In all children, the total level of 25(OH)D was determined in blood serum by the method of enzyme immunoassay. To examine the state of the immune system, the indicators of the functional activity of peripheral blood neutrophils were determined according to phagocytosis and NBT-test, concentration in serum and saliva of the main classes of immunoglobulins (G, A, M), lysozyme, and additionally in saliva – the level of secretory A (sIgA). The content of circulating immune complexes (CIC) in blood serum was determined separately. All tests were carried out before treatment and in a month after it. Results. According to the results of the study of children of the main group, in 90% of cases (n=90) with RRP against the background of stage 2 GERD, the concentration of 25(OH)D in blood serum was within the limits of vitamin D deficiency, and in the control group (n=30) in 70% corresponded to its insufficiency. Addition of colecalciferol at a dose of 4000 IU/day before rehabilitation and prophylactic complex to children of group 2 and group 3 significantly increased the level of vitamin D (p<0.01), but the concentration of vitamin D did not reach the norm. After treatment, in children of all three groups, the initially decreased indicators of phagocytosis activity significantly increased; but there was a significant increase in the percentage of phagocytic cells in group 2, where this indicator reached the values of children in group 4 (control group). At the same time, the reserve capacities of neutrophils upon stimulation after treatment were restored in children of group 2 and group 3 (p<0.01). In children with RRP against the background of stage 2 GERD, CIC content significantly increased to treatment and the lysozyme concentration decreased (p<0.01). After treatment the concentration of CIC in children of group 2 decreased significantly, and concentration of lysozyme in blood serum of children of all 3 groups reached the values of the control group. The parameters of local immunity in terms of sIgA, IgA, and lysozyme content decreased significantly (p<0.05) against the background of an increase in the level of IgG in saliva (p<0.01). After treatment, there was a positive dynamics in the content of sIgA, the level of which increased in all 3 groups, but in group 1 it was significantly lower (p<0.05) than in children of the control group. IgA concentration also significantly increased after treatment in children of all 3 groups (p<0.01), but did not reach the level of control data (p<0.05). During treatment, IgG concentration significantly decreased in saliva of children of all 3 groups (p<0.01), but in children of group 1 (basic therapy), this indicator was significantly higher than in the control group (p<0.05). In the dynamics of treatment lysozyme concentration significantly increased only in children of group 2 and group 3 (p<0.05). At the same time, only in group 2 the lysozyme levels reached the values of the control group, while in group 1 and group 3 this indicator was significantly lower than that of the control group. Conclusions. For the correction of identified vitamin D deficiency, adding colecalciferol at a dose of 4000 IU/day to rehabilitation and prophylactic complex increased the likelihood of reaching an optimal level of vitamin D in serum of the examined children, when followed by the use of vitamin D preparations at a prophylactic dose of 1000 IU/day. The use of rehabilitation and prophylactic complexes effectively influenced restoration of physiological state of phagocytic system in general, the normalization of the lysozyme level and the CIC content in blood serum of the examined children. The use of «Immunal» in children of group 2, and «Mucosa Compositum» in children of group 3 in complex prevention of acute respiratory pathology was more indicative in terms of stimulating the production of specific factors, especially sIgA and non-specific factors of local immunity (lysozyme), in contrast to basic therapy. In the course of prospective observation of children with frequent acute respiratory diseases against the background of stage 2 GERD, there was a positive trend in the incidence of diseases and their course. During two years of observation, the number of episodes of respiratory diseases in group 1 decreased by 1.2 times per year, in group 2 by 2 times, in group 3 by 1.6 times, which contributed to improvement in clinical course of the disease and reduction in duration of treatment. The study was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was adopted by the Local Ethics Committee of the institutions indicated in the work. The informed consent of parents and children was obtained for the research. No conflict of interest was declared by the authors. Key words: children, who often get sick, gastroesophageal reflux disease, complex treatment, vitamin D, phagocytosis, NBT-test, class G, A, M immunoglobulins, CIC, sIgA, lysozyme.