THE PECULIARITIES OF LOCAL IMMUNE REACTIONS IN DUODENUM AT POSTRESECTION PORTAL HYPERTENSION

Abstract

Resection of large volumes of the liver leads to various post-resection complications: hemorrhages of varicose veins of the esophagus, stomach, rectum, ascites, splenomegaly, secondary hypersplenism, parenchymal jaundice, porosystemic encephalopathy, liver failure, portal hypertension. Postrezectional portal hypertension leads to structural rearrangement of the organs of the basilar portal hepatic vein, as well as the remodeling of their structures. Venous drainage from the duodenum is carried out through the portal hepatic vein, where hemodynamic disorders are complicated by various morphological changes in the vessels and structures of the specified organ. It should be noted that the features of local immune defense of the duodenum at postresection portal hypertension are not sufficiently studied.

The aim – to investigate the features of local immune reactions in the duodenum at postresection portal hypertension.

Material and Methods. The research was conducted on 45 male rats, which were divided into 3 groups. The group 1 consisted of 15 intact animals, 2 – 15 rats after resection of the left lateral part – 31.5 % of liver parenchyma, 3 – 15  animals after resection of the right and left side parts of the liver (58.1 %). Euthanasia of animals was carried out by bloodletting in conditions of thiopental anesthesia 1 month after the beginning of the experiment. The cut pieces of the duodenum were fixed in a 10 % neutral formalin solution, and after appropriate ethyl alcohol of increasing concentration was poured in paraffin blocks. Histologic sections 5–7 μm thick after deparaffinization were stained with hematoxylin-eosin, for van Gizon, Mallory, Weigert, and toluidine blue. In the detection of plasmocytes with IgA, IgM, IgG, IgE histologic sections of the duodenum was treated with monospecific antiserгm against these classes of immunoglobulins conjugated with fluorescein isothiocyanate using the direct Kuns method with appropriate controls that were studied using a luminescent microscope "Lumam P-8". In a luminescent light, plasma cells that gave a specific luminescence were read on 1 mm² of the mucosa of the investigated organ. The content of secretory Ig A (SIgA) was determined by the method of separate immunodiffusion in agar with a specific serum against SIgA. Quantitative indicators were processed statistically.

Results. One month after resection of 31.5 % of the liver, local immune reactions in the mucosa of the duodenum changed slightly. Violation of local immune homeostasis was more pronounced in resection of 58.1 % of the liver volume. Thus, the number of plasmatic cells from IgA in the mucosa of the subject decreased by 26.6 %, the level of secretory immunoglobulin A decreased by 27.9 %. while the plasma-producing producers IgM, IgG, IgE increased accordingly by 97.0 %, 4.2 and 6.0 times. The degree of changes in local homeostasis correlated with the depth and prevalence of hemodynamic disorders, dystrophic, fibrotic, infiltrative and sclerotic processes in the investigated organ, that is, it plays an important role in the morphogenesis of the duodenum in postresection portal hypertension.

Conclusions. Resection of 58.1 % of liver parenchyma leads to postresection portal hypertension and pronounced changes in local immune homeostasis in the duodenal mucosa, characterized by a decrease in the levels of SIgA and the number of IgA-producing plasmocytes, significant violations of the correlation between the immunocytes that synthesize IgA, IgM, IgG, IgE, the emergence of immune complexes in the stroma and vessels. The degree of changes in local immunity correlates with the depth and prevalence of hemodynamic disorders, dystrophic, fibrotic, infiltrative and sclerotic processes in the investigated organ.