Influence of immunosuppressive therapy on the state of immune protection in children

For the treatment of rheumatological diseases, autoimmune lymphoproliferative syndrome and nephrotic syndrome in children, glucocorticosteroid therapy with/without cytostatics is used. Immunosuppression is a serious side effect of these medications. Aim - to investigate immunological parameters in children receiving immunosuppressive therapy in order to determine vaccination tactics. Materials and methods. 50 healthy children (comparison group) and 34 children who received immunosuppressive therapy for rheumatological pathology, autoimmune lymphoproliferative syndrome or nephrotic syndrome (study group) participated in the study. Patients who received high-dose immunosuppressive therapy (n=16) made up the subgroup I, low-dose immunosuppressive therapy (n=18) - the subgroup II. Determination of subpopulations of blood lymphocytes was carried out by the method of flow cytometry, serum immunoglobulins - by the method of radial immunodiffusion. Statistical analysis was performed using the SPSS 23.0 software package. Results. In children who received immunosuppressive therapy, a significant increase in the number of T-lymphocytes (CD3+), a decrease in B-lymphocytes (CD19+) and NK cells (CD3-CD16/56+) was established, while the average levels of serum IgA, IgM, IgG did not differ from the indicators of healthy children, which demonstrates the preservation of humoral immunity. However, in children who received high-dose immunosuppressive therapy, a dose-dependent decrease in the level of serum IgA, IgM, and IgG was found, respectively, by 1.7, 1.3 times, and by 18.9%. Conclusions. It is advisable to vaccinate children before starting immunosuppressive therapy for rheumatological pathology or nephrotic syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.