Changes in immunological parameters and umbilical blood flow in pregnant women during exacerbation of chronic bronchitis associated with cytomegalovirus infection

Aim. To evaluate changes in immunological parameters and umbilical blood flow in pregnant women with exacerbation of chronic bronchitis associated with cytomegalovirus infection (CMVI).
Materials and methods. The concentration of secretory immunoglobulin A (sIgA), immunoglobulin E (IgE), circulating immune complexes (CIC), interleukin- 6 (IL-6), interleukin-4 (IL-4) and systolic-diastolic ratio (SDR) in the umbilical artery was studied in 80 women with exacerbation of chronic bronchitis in the second trimester of pregnancy, uncomplicated and complicated by the acute phase of CMVI. The first group was represented by 30 women with cytomegalovirus seronegative physiological pregnancy; the second – 25 patients with exacerbation of chronic bronchitis caused by reactivation of CMVI, complicated by the development of chronic compensated placental insufficiency (CCPI); the third – 25 women with chronic simple bronchitis in the acute stage in the setting of the acute phase of CMVI, initiating the formation of chronic subcompensated placental insufficiency (CSPI) at 30-34 weeks of gestation.
Results. In the first group, the concentration of sIgA in blood serum was 4.3±0.26 mg/L, IgE – 3.64±0.23 IU/mL, CIC – 0.091±0.005 AU, IL-6 – 2.41±0.21 pg/mL, IL-4 – 30.1±2.19 pg/mL, cortisol – 527.2±20.95 nmol/L, and SDR in the artery umbilical cord – 3.41±0.06 relative units. In women of the second group, in comparison with the first one, there was an increase in the concentration of sIgA by 1.40 times (p<0.01), IgE – by 1.95 times (p<0.001), CIC – by 1.83 times (p<0.001) , IL-6 – 2.61 times (p<0.001), IL-4 – 1.29 times (p<0.05), cortisol – 1.35 times (p<0.001) in the absence of statistically significant differences the magnitude of vascular resistance in the umbilical artery. In the third group, in comparison with the first one, there was a decrease in sIgA values by 1.26 times (p<0.05) in the setting of an increase in the concentration of IgE by 2.56 times (p<0.001), CIC – by 2.09 times (p<0.001 ), IL-6 – by 3.65 times (p<0.001), IL-4 – by 1.64 times (p<0.001), cortisol – by 1.52 times (p<0.001) and SDR in the umbilical artery – 1.27 times (p<0.001). In women of the third group, in contrast to the second one, a decrease in the concentration of sIgA by 1.77 times (p<0.001), as well as an increase in IgE by 1.31 times (p<0.01), CIC ‒ by 1.14 times (p<0.001), IL-6 ‒ 1.39 times (p<0.001), IL-4 ‒ 1.27 times (p<0.05), cortisol ‒ 1.13 times (p<0.05) and SDR in the umbilical artery ‒ 1.21 times (p<0.001). A direct correlation was established between IL-6 and cord blood flow (r=0.53; p<0.01), as well as an inverse relationship between sIgA and cortisol (r=-0.44; p<0.05).
Conclusion. In the second trimester of gestation, exacerbation of chronic simple bronchitis caused by reactivation of CMVI, which initiates the development of CSPI, in contrast to chronic bronchitis in the acute stage, associated with the acute phase of chronic CMVI, which induces the formation of CCPI, is accompanied by an imbalance of nonspecific local and systemic immune responses, as well as stress-reaction, which leads to the growth of SDR in the umbilical artery.

1. Gorikov I.N., Kolosov V.P., Nakhamchen L.G., Ishutina N.A., Andrievskaya I.A. The state of immune protection during exacerbation of chronic simple bronchitis, caused by the reactivation of chronic cytomegalovirus infection in women in the second trimester of pregnancy. Am. J. Respir. Crit. Care Med. 2018; 197:A7244.

2. Andrievskaya I.A., Dovzhikova I.V., Ishutina N.A., Gorikov I.N., Dorofienko N.N., Petrova K.K., Prikhodko N.G. Soluble tumor necrosis factor receptor 1 is a potential marker of inflammation in the trophoblast associated with cytomegalovirus infection. Am. J. Respir. Crit. Care Med. 2019; 99:А6173. https://doi.org/10.1164/ajrccmconference.2019.199.1_MeetingAbstracts.A6173

3. Dorofienko N.N., Andrievskaya I.A., Ishutina N.A. [Role of Inflammatory Mediators in Endothelial Dysfunction of Umbilical Cord Vessels in Pregnant Women after Third-Trimester Nonprimary Cytomegaloviral Infection]. Acta Biomedica Scientifica 2021; 6(2):92–97 (in Russian). https://doi.org/10.29413/ABS.2021-6.2.10

4. Milovanov A.P. [Pathology of the mother-placenta-fetus system]. Moscow: Meditsina; 1999 (in Russian). ISBN: 978-5-225-02775-9

5. Strizhakov A.N., Bunin A.T., Medvedev M.V., Grigorian G.A., Musaev Z.M. [Value of utero-placental and fetoplacental Doppler flowmetry in selecting rational tactics in the management of pregnancy and the method of delivery]. Akush. Ginekol. (Mosk.) 1989; (3):24−27 (in Russian).

6. Markina N.V., Stepanova O.A., Shamaeva T.N., Bolotov A.A. [Biomedical Data Statistical Tutorial]. Chelyabinsk: YuUGMU; 2014 (in Russian). Available at: https://www.books-up.ru/ru/book/uchebnoe-posobie-po-statisticheskoj-obrabotke-mediko-biologicheskih-dannyh-11852324

7. Suslov A.V., Semyonova E.F., Mitroshin A.N., Moiseeva I.Ya. [An experimental study of the formation of microecological, morphofunctional and immunological disorders against the background of antibacterial therapy]. Infekc. bolezni (Infectious diseases) 2017; 15(4):55–59 (in Russian). https://doi.org/10.20953/1729-9225-2017-4-55-59

8. Kozlov V.A., Borisov A.G., Smirnova S.V., Savchenko A.A. [Practical Aspects of Diagnosis and Treatment of Immune Disorders: A Guide for Physicians]. Novosibirsk: Nauka; 2009 (in Russian). ISBN: 978-5-02-023237-2

9. Solovieva A.S., Lutcenko M.T. [Circulating immune complexes in pregnant woman under herpes virus infection]. Dal’nevostochnyy meditsinskiy zhurnal 2008; (1):54–56 (in Russian).

10. Hatzidaki E., Gourgiotis D., Manoura A., Korakaki E., Bossios A., Galanakis E., Giannakopoulou C. Interleukin-6 in preterm premature rupture of membranes as an indicator of neonatal outcome. Acta Obstet. Gynecol. Scand. 2005; 84(7):632–638. https://doi.org/10.1111/j.0001-6349.2005.00747.x

11. Lomova N.A., Kan N.E., Tyutyunnik V.L., Kogan E.A., Demura T.A. [The estimation of factors of innate immunity in the placenta during the placental insufficiency]. Gynecology, Obstetrics and Perinatology 2013; 12(5):41–45 (in Russian).

12. Boytsova E.A., Azimurodova G.O., Kosenkova T.V. [Interleukin 4: biological functions and clinical importance in allergies development (review)]. Preventive and Clinical Medicine 2020; (2):70–79 (in Russian).

13. Lutsenko M.T. [Dynamics of cortisol activity in peripheral blood of pregnant women who suffered herpes-virus infection]. Bûlleten' fiziologii i patologii dyhaniâ = Bulletin Physiology and Pathology of Respiration 2010; (38):51–54 (in Russian).

14. Khaustova S.A., Shkurnikov M.U., Tonevitsky A.G. Short highly intense exercise causes changes in salivary concentrations of hydrocortisone and secretory IgA. Bull. Exp. Biol. Med. 2010; 149(5):635‒639. https://doi.org/10.1007/s10517-010-1012-2

15. Gorikov I.N., Andrievskaya I.A., Ishutina N.A., Dovzhikova I.V. [The architectonics of fetal placental veins in second trimester cytomegalovirus infection]. Archive of Pathology = Arkhiv patologii 2019; 81(4):43–47 (in Russian). https://doi.org/10.17116/patol20198104143

16. Sidorova I.S., Galinova I.L. [Endothelial dysfunction in the development of gestosis]. Voprosy ginekologii, akusherstva i perinatologii = Gynecology, Obstetrics and Perinatology 2006; 5(1):75–81 (in Russian).